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| Volume 10, Number 1 Spring/Summer 1987 | |
| CONTENTS | |
| On the Meaning of Love ...........................................5 Viktor E. Frankl | |
| Logotherapy: Hcalth through Meaning ...............................9 Eli~abcth Lukas | |
| Schizophrenia and the Existential Vacuum ........................... 17 James Lantz and John Belcher | |
| Franklian Family Therapy ........................................22 James Lantz | |
| A Question of Meaning: Rabbinical Counseling and Logotherapeutic Models ........................................29 Yaakov Thompson | |
| The Symbolic Growth Experience and the Creation of Meaning ...........................................35 Willard B. Frick | |
| The Three Sacred Treasures and the Rehumanization of Medicine ....................................42 Hiroshi Takashima | |
| Hinduism and Logotherapy .......................................44 Sitansu S. Chakravarti | |
| The Meaningful Personality .......................................46 Michael Shaughnessy and Robert Evans | |
| Despair An "Absoluti,.ation" of Values ...........................50 Marian Wolicki | |
| Psychogenic Neuroticism and Noogenic Self-Strengthening .............................................52 Moshe Addad | |
| Pedagogy and Logotherapy .......................................60 Charles Okechukwu lwundu | |
| Frankl in the Context of Personality Theorists | |
| Robert F. Massey | |
| This article outlines the major concepts of prominent personality theorists and summarizes Frankl's comments on each approach. A second article, to be published in the next issue of the International Forum.for Logotherapy, synthesizes the perspectives of personality theorists and evaluates Frankl's specific contribution to a holistic model of human development. | |
| The Pioneers: Freud, Adler, Jung | |
| Freud37 emphasized unconscious motivation. He postulated three personality structures (id, ego, and superego) which emerge during early childhood. Character is formed according to how an individual handles the libidinal energy that charges instinctual impulses (sexuality and aggression) during the psychosexual stages of development (oral, anal, phallic, and genital). Male and female development show essential distinctions. Symptoms and defense mechanisms arise when attempts to control the instincts generate excessive anxiety. 35 Cultural achievements result from sublimations and reaction formations, and civilization causes discontent by repressing instinctual gratification.34 Religion represents both an obsession that tames civilization-threatening instincts and an illusion to protect humans against a sense of helplessness.36 | |
| Frankl on Freud. Frankl published his first paper in 1924 at the invitation of Freud. He honors Freud ("psychoanalysis is irreplaceable,"Jo, r-12 but asserts that psychoanalysis needs reinterpretation and reevaluation. Freud both unmasked the neurotic by ferreting out hidden, unconscious motivations and promoted self-understanding (FrankJ3°31 ). FrankJ33 critiques Freudian theory for being mechanistic, for espousing pan-determinism, for viewing homeostasis as normative, for overemphasizing the pleasure principle, for being reductionistic, and for considering a person as curable by techniques alone. | |
| Frankl lauds Freud for highlighting objectivity in psychotherapy, yet concludes that he went too far and succumbed to the objectification and reification of human processes. This objectification portrays a human as a thing ruled by mechanisms. In the psychoanalytic theory of psychic energy and in the psychological atomism of dividing the psyche into id, ego, and superego, a human being becomes depersonalized, and the individual aspects are personified. This renders a person "the automaton of a psychic apparatus. "33• P· 22 | |
| Frankl believes that persons are not determined or "lived by ... instincts. "29• P· 7 Meanings and values are not inevitably sublimations or reaction formations. Humans strive, reach out, and act creatively rather than mainly discharge tension in order to regain homeostasis. Humans become authentic when the self is deciding rather than when the id is driving. Frankl characterizes Freud as stressing the "will to pleasure. "30, P-vrn ( Frankl admits that he coined this term; actually Freud37 spoke of the "unpleasure principle" as individuals seek equilibrium.) | |
| Frankl eschews Freud's reductionism in which psychological phenomena are reduced to drives and instincts and, in turn, are determined by them. Frankl deals with humans as intentional, choosing beings, unique subjects. According to Frankl, Freud "id-ified and de-selv-ified human existence, ... degraded the self to a mere epiphenomenon ... [ and] denigrated the unconscious, in that he saw in it only the instinctual and overlooked the spiritual. "31. P-27 "Id-ifying" the unconscious idolizes the irrational and the instinctual. For Frankl, the self is more than the ego. The ego represses and sublimates drives and instincts, but is existentially irreducible and cannot be traced back to them. The self has a transcendent quality; a person is responsible for oneself but not only to oneself. The intentionality of the self and the ought of responsibility imply responses going beyond the individual. Love and aggression do not reside in the psyche nor even in the person but are directed toward other non-interchangeable selves. Freud's statement to Princess Bonaparte -"The moment a man questions the meaning and value of life he is sick" -reduces a noological concern to a psychological issue.30, P-87 This misinterprets the spiritual distress of an existential vacuum as a pathological mental disease.Frank! regards Freud as "a child of his time "29, P-118 with its spirit of nihilism, fatalism, and reductionism. | |
| Freud and Frankl's descriptions of conscience showcase the contrast between logotherapy and psychoanalysis.7° For Freud, the superego introjects parental prohibitions. Its origin differs for females and males. The superego inevitably involves conflict, guilt, anxiety, and harshness. The superego depends partly on the id. In setting up the ego ideal as part of the superego, the ego both masters the Oedipus complex and remains subject to it, for the ego ideal is the heir of the Oedipus complex. Frankl distinguishes between superego and conscience. Conscience is irreducible, presupposes the capacity for self-transcendence, is nongender specific, and empowers a person to discover meaning in unique situations. Through its use, an individual becomes free and exercises responsibility. Conscience may be creative when a person feels obligated to contradict superego or social/ tribal norms that violate higher values. | |
| Adler2A5 attributed uniqueness and creativity to each individual. Persons create life styles based on interpretations of their natural endowments, situational opportunities, and self-chosen goals. A life style unifies all dimensions of a person, who is oriented toward a fictional, final goal. Early recollections encapsulate current motivations based on life style and goal. This goal may be one of relying on inferiority or of seeking superiority as a compensation for felt weaknesses, or it may be one of pursuing excellence and of increasing selfesteem. Accomplishments relating to the three tasks of life or social ties friendship, work, and sexual love -augment self-esteem. Adler judged the adequacy of the goal by the twin criteria of whether an individual uses it to enhance personal self-esteem and to advance community through empathetic "social interest." "Social interest" is derived from Gemeinschaftsgefuhl and may be better translated as "deep sense of community."55 A neurotic approach centers around taking advantage of or camouflaging insecurity through "safeguarding strategies" (depreciation, accusation, distancing). Whatever does not fit with a neurotic "schema of apperception" is relegated to the "not understood" as a neurotic misperceives and manipulates by employing a "private intelligence." In contrast, a person with well-developed social interest reasons according to the "common sense" of "shared understanding." Such a person also displays more courage and optimism, assumes more responsibility, and acts more industriously. Adler pointed to the power of social structures in perpetuating cross-sexual and intergroup cooperation or antagonisms. He advocated the active encouragement of social interest in social relations and acknowledged the influence of both personal and formal philosophy. He made favorable comparisons between religion and individual psychology -both speak of perfection and a loving community. A person may discover meaning through religion, which has energized an increase of love and social interest. | |
| Adler wrote on "the meaning of life." "Human beings live in the realm of meanings ... We experience reality always through the meaning we give it. "1, P· 1 In "the meaning given to life ... we have the key to the whole personality. " 1· P· 22 Early memories solidify and preserve this meaning. "We are self-determined by the meaning we give to our experiences ... Meanings are not determined by situations, but we determine ourselves by the meanings we give to situations. "1• P· 14 Many people do not ask, "What is the meaning oflife?" Yet, "in ... actions .. . every [person] inevitably puts the question and answers it. "1• P· 4 Behavior demonstrates that people have chosen a certain interpretation of life. Nobody possesses the absolute meaning of life, yet some answers are better in the sense of being "true for [h u ]mankind, true for the purposes and aims of human beings. There is no other truth than this; and if another truth existed, it could never concern us; we could never know it; it would be meaningless."1· r 4 Through responses to the social tasks of life, each individual reveals a personal sense of the meaning oflife. All true meanings of life have common meanings whereas all failures "arc lacking in fellow-feeling and social interest. "1• r 8 "The meaning of life is interest in others and cooperation."'· r-9 Giving meaning to life by contributing to social cooperation enhances the individuality of the person who exercises the abilities needed to accomplish this. "Only the individual who understands that life means contribution will he able to meet ... difficulties with courage and with a good chance of success. "1, P· 21 | |
| Adler used therapeutic techniques which logothcrapy has labeled and expanded upon. To a bright girl who upset her family each morning with complaints about school, Adler advised fussing even more and putting a sign above her bed proclaiming, "Every morning I must torment my family as much as possible. "2· P-398 This kind of intensification of a symptom provided a precursor, highlighting the absurdity of symptoms, that Frankl formally incorporated into the tcchni4ue of paradoxical intention. J,ikcwise, the unreferenced, humorous story, that FrankJ1°-r. 108 uses to illustrate paradoxical intention, about the tardy boy who claimed he was late because of slipping on the ice and arrived at school only by walking backwards was earlier attributed to Adler by Bottome,20 who published the first edition of her biography in 1938. Adler's recommendation to depressives brooding over their own troubles that they "consider from time to time how you can give another person pleasure. "3• p. 25 focuses attention away from self-absorption in an aggravating problem, as does dereflection. | |
| Frankl on Adler. Frankl was associated with Adler for a period until 1927.87 In a 1925 article in the Adlerianjournal, Frankl spoke of the need to criticize the philosophical buttresses for an intellectual's neurotic symptoms. He discussed | |
| · P· 251 | |
| values and called society "our first duty toward life. "27 The "psychotherapist's job [involvesJ reinstilling the love for life and the will to be part of society."n r 252 He concluded, "The way to personal happiness goes through social interest (or community feeling), affirmation of life (or simply courage), virtus27· P-252 "Social interest, of course, is the key concept in Adler's psychotherapy, while virtue has since become a part of Erikson's developmental psychology" (H. Ansbacher, personal communication, March 3, 1987). Frankl's later comments on Adler center mostly around the emphasis on power. Borrowing Nietzsche's phrase the "will to power," FrankP0 characterizes Adlerian psychology as emphasizing "the status drive." He recognizes the power principle as guiding the adolescent. FrankP disagrees with Adler on the nature of goals. Frankl sees Adler's notion ofgoals as "intrapsychic" and as the means of dealing with feelings of inferiority and insecurity whereas Frankl views goals as transcending the self and the psyche. He suggests that contemporary people experience futility more than inferiority. From Frankl's perspective, "The Adlerian ... regards ... [the] entire therapeutic procedure ... as nothing but an attempt at encouraging the patient. The purpose of this encouragement is to help the patient overcome ... inferiority feelings. 3 1. P· 19 | |
| Jung5 L52•54 proposed "to analyze the depths of the psyche." He observed both a personal and a collective unconscious. The collective unconscious "contains all the patterns of life and behavior inherited ... from ancestors ... [ which constitute] a potential system of adapted psychic functioning. "so. P-185 These patterns, with their images and feelings, Jung called archetypes. Human brains universally resemble each other, and therefore, not surprisingly, function similarly in producing analogous forms and motifs. The collective unconscious presumes a social, historical, trans personal dimension to personality because it presupposes that an individual is related to collective humanity. Ideal development results in individuation -becoming one's innermost and incomparable uniqueness. Individuation prompts broader and more intense relationships. | |
| When an individual is not adequately accomplishing individuation in consciousness, but is too socially adapted, regressed, stifled, or stuck, the archetypes from the collective unconscious are energized as compensations to assist a person in moving on to the next appropriate stage of psychological development. Some main archetypes are the anima, animus, shadow, persona, and self. People respond to archetypes and psychic processes in several "typical" ways: as "introverts" or "extroverts"who tend to emphasize one of the four psychological functions (thinking, feeling/ evaluating, sensing, or intuition) and to have one of them as an auxiliary function. In speaking of both the psychological types and archetypes, Jung was interested in their union. He pointed to "the transcendent function" as synthesizing diverse elements in personality. | |
| Because he considered children to have no problems with themselves, though they may challenge their elders, Jung focused on the stages of life beginning with youth (just after puberty). Middle age is a crucial time of transition, when both men and women typically examine their values and the meaning in life. A spiritual crisis may occur since the more physical bases of esteem are no longer prominent, and a need for more transcendent values emerges. In acknowledging that modern people have spiritual problems, Jung50,53 recognized transcendence, religious significance, the need for discovering a religious outlook on life, and the desire for reconciliation with, sometimes seemingly opposing, spiritual powers. | |
| Jung viewed Freud and Adler as having enunciated significant truths, but as being incompatible and as requiring a superordinant synthesis. Their differences | |
| "the Eros theory" and "the will to power" --emanate from the varying attitude-types of their originators. Adler stressed the subject who seeks security and supremacy while Freud focused on the object which advances or impedes a subject's desire for pleasure. Jung rejected these two theories as reductionistic and asserted that "human behavior is conditioned as much by the subject as by the object. "52, P-43 He looked for both the yesterday and the tomorrow oflife and viewed neurosis as not simply a result of past cause~ but as an (unsuccessful) | |
| , P-46 | |
| attempt at "a new synthesis of life ... with a core of value and meaning. "52 Jung evaluated psychoanalysis and individual psychology as unveiling the "shadow side" of people. He was concerned with "positive values" and stipulated that "for the creation of a real value ... both energy and valuable form are needed. "52• P-47 'There is no energy unless there is a tension of opposites ... Life is born only of the spark of opposites. "52, PP-53-54 The goal of development individuation -is to unite the opposites, to achieve a conjunctio oppositorum. | |
| Frankl on Jung. Frankl asserts that archetypes are mythical beings which individuals arc motivated to get rid of as irritants. He characterizes this position as a variant on maintaining or restoring inner equilibrium rather than on encountering other beings or striving to fulfill meaning. Frankl critiques the archetypes in the collective unconscious as "mere self-expressions "29• P-64 of the human race. Unless values and meanings stem from a sphere beyond and above humans they lose their demand quality. Frank13 1 chides Jung for interpreting religiousness impersonally as archetypes in the collective unconscious. Frankl credits Jung with discovering religious elements in the unconscious, but believes he erred in locating the unconscious God in the region of drives and instincts rather than in the personal and existential sphere. For Frankl, individuals are not driven to religiousness but choose and take responsibility for these decisions. In genuine religiousness, the I of a person decides rather than being determined by unconscious powers operating autonomously. Frankl denies that archetypes are innate or inherited, though personal religiousness may pursue preestablished paths formed by cultural traditions. | |
| N eo-Freudians/ N eo-Adlerians | |
| Sullivan. 90 His six stages of human development, extending from infancy to late adolescence/young adulthood, revolve around the psychosocial needs for interpersonal security, friendly collaboration and intimacy, and lustful satisfaction. A mature person successfully integrates these needs. Modes of communication contribute to consensual validation or distortion in referring to reality. Defining a self involves reciprocal influence (e.g., the nurturing behavior of a "good mother" facilitates the emergence of a "good me" self-concept). All humans are essentially similar. Symptoms are not fixed entities but means of coping with reality. Sullivan viewed religion as a social institution through which culture prohibits and thwarts impulses for which it has not yet evolved adaptations by relegating them to the realm of the mysterious.67 | |
| Horney, 47 in treating neuroses, discovered more cultural than instinctual influences. Neuroses grow out of disturbed human relationships. Striving toward self-realization (being truthful to oneself, being active and productive, and relating to others in a spirit of mutuality) contributes to a "morality of evolution" whose criterion is whether human growth is promoted or obstructed. A growing person develops a real self -the "central inner force, common to all | |
| , P-17 | |
| human beings and yet unique in each, which is the deep force of growth. "47 An individual with neurosis becomes alienated from the real self. Neuroses have their origins in anxieties which become linked with repressed hostilities against unfavorable socializing influences. A neurotic develops self-idealizations instead of a real self, imposes neurotic claims (exemptions from responsibility) on others, searches for glory rather than actual accomplishments, suffers from a tyranny of shoulds (compulsions), and distorts the normal needs for affection, power, prestige, and possessions, A growing person balances the three interpersonal movements -toward, against, and away from others -whereas a neurotic overemphasizes one or two of them. 46 Homey45A8 constructed a feminine psychology which points up the strengths and vulnerabilities of both females and males in contrast to the chauvinism of psychoanalysis. | |
| Erikson. 23,24-25,26 His eight stages of psychosocial development extend from the cradle to the grave. For each stage Erikson has proposed essential processes: | |
| 1) Each stage begins with a crisis or turning point (secure survival for the infant) and 2) ends with a positive or a negative resolution (trust vs. mistrust in infancy), with a constructive outcome being a combination of the two that favors the positive. 3) An ego strength emerges with a positive resolution (the secure infant develops hope). 4) A ritualization symbolizes the central processes of a particular stage (habits of mutual recognition, which envigorate any trusting relationship, begin in infancy). 5) A lasting foundation contributes to ego identity (an infant learns "I am what hope I have and give"). 6) Through institutional guardians society offers protection for a particular aspect of human development (religion embodies hope). | |
| While recognizing physiological influences on personality, Erikson stressed the interrelationship of an ego and society. A number of his insights on human development emerged from his studies of play. Cultural and political contexts prompt variations in personality formation. "Pseudo-speciation"(the righteous position of considering one's group superior to another) inhibits discovering a wider identity and constructing cooperative community. Conscience and ethics show developmental progression. | |
| Fromm, 3s,39,4o,43 highlighted both the specifically human aspects of personality and the inherent interrelationship of character and social processes. Consciousness of uniqueness, freedom, and responsibility distinguish humans from animals. Freedom involves not only "freedom from" by transcending biological and social conditions but also "freedom to" become individuated, be productive, and love actively. Humans remain sane by fulfilling both physiological and specifically human needs (relatedness, transcendence, rootedness, identity, frame of orientation and devotion). Consciousness and the capacity for responsibility generate dichotomies that humans must face, for all needs arc not provided for by nature. Happiness and fulfillment come only through the active use of intelligence, choice, and will in dealing with the human situation. Some of these dichotomies arc "existential" and endemic to the human situation (wanting to live and fulfill all our talents, yet knowing we will die before we can) and some arc "historical" and changeable through social restructuring (technology can be life-saving or destructive). Many people find consciously assuming responsibility for freedom too overwhelming and seek to escape through conformity, authoritarian submission, or destructiveness. | |
| Fromm describes personality as social character -the adaptiveness of self within economic, political, and historical contexts. He defined character from two viewpoints: 1) how humans "assimilate" reality (the receptive, hoarding, exploitative, marketing, and productive orientations) and 2) the "modes of relatedness" (biophilous, necrophilous, narcissistic, and incestuous fixation). Love varies according to a person's character structure and orientation; producive love involves care, responsibility, respect, and knowledge. 41 Humans must be seen in their totalities. Divorcing philosophy and ethics from psychoanalysis, construed as natural science, is a mistake. The sources of norms for ethical conduct can be discovered in human nature. Social structures may dictate ethics, guidelines for conscience, and religion in authoritarian and irrational ways, or they may support a humanistic approach in which individuals assume responsibility for these processes. | |
| Frankl on the neu-Freudians/ neo-Adlerians. Frankl has commented little on the nco-Freudians/ neo-Adlcrians, who trained in psychoanalysis and revised its theory in a more social/ cultural dircetion.2-1 1 Frankl insists that Horney and Fromm's stress on self-realization as an ultimate motive is not sufficient grounds for a motivational theory since it "dcvaluates the world and its objects ... [as] | |
| "29 45 | |
| mere means to an end. -p. Frankl refers to Erikson's identity concept as compensating for deficiencies in Freud's ego psychology. Frankl adds that the struggle for identity is not a direct goal but that a person discovers an identity to the extent that the individual is committed beyond the self, to a cause greater than oneself. In a chapter on "human motivation,"29-p. 6 Frankl takes Fromm42 to task for seemingly equating being driven with striving for a goal. This criticism of one of Fromm's sentences eclipses Fromm's main point in the chapter that the ideas of both Freud and Marx have been oversimplified and distorted. Frank l's reflections on conformism and fanaticism as collective neuroses parallel Fromm's notions that conformity is an escape from personal freedom and that authoritarian structures impose dominance or submission in contrast to democratic frameworks which encourage creative and responsible freedom. | |
| Behaviorists, Social Learning Theorists | |
| Dollard and Miller22 attempted to test psychoanalytic concepts empirically. They postulated that stimuli act as "drives." "Cues" guide how individuals make "responses" to drives. "Reinforcements" most significantly induce learning. Learning may occur unconsciously when cues are similar in different situations. Higher mental processes and verbal capacities affect normal human learning. Language and imagery are "cue-producing responses," which function as symbols that represent part of a stimulus pattern leading to another response. These symbolic, cue-producing responses facilitate learning. They are especially important in making anticipatory goal responses which weigh the consequences of a particular plan of action. Anxiety, anger, frustration, and aggression can occur in critical childhood situations such as feeding, learning about cleanliness, early sex training, and sibling rivalry. Conflict arises when two drives compete. Problems may arise when these early conflicts are not labelled verbally (because oflinguistic immaturity), particularly when the childraising situation is unfavorable. Emotional conflicts can be intensified when old cues and stimuli are generalized to new ones. Symptoms occur because they are reinforced and have some drive-reduction power. | |
| Skinner, 86 as a "radical behaviorist," explains all human behavior through "operant conditioning." Responses are repeated when reinforced either positively (bringing a desirable consequence) or negatively ( removing an unpleasant stimulus). Reinforcements are patterned through "schedules" (interval, ratio, fixed, variable). In this "empty-organism" theory, only the observation of measurable responses and reinforcements are considered scientific. "Personality" represents a chaining of behaviors in which current behavior is linked with primary reinforcers through a series of conditioned secondary reinforcers. | |
| Bandura. 13 In his social learning theory, personality responses "imitate" "modeled" and "reinforced" behaviors. Reinforcement comes directly or vicariously through anticipation of being treated the same as a model. A "continuous reciprocal interaction [occurs] between cognitive, behavioral, and environmental determinants. "12• P-vu Cognitive capacities make possible both socially sanctioned behaviors and self-regulation. Difficult behaviors more likely appear when the individual has a "perception of self-efficacy." | |
| Rotter.82 His social learning theory emphasizes that behavior depends both on expectancy of obtaining reinforcement in a particular situation and on preference for certain reinforcements. Behavior is directional or aimed at some goal. In fulfilling some need, an individual experiences greater "freedom of movement" when the expectancy of receiving a wanted reinforcement is higher. | |
| A "minimum goal level" represents the least reinforcement that will be satisfactory to a person. With internal "locus of control," individuals perceive themselves as in charge of the consequences and expect effort to pay off, while with external locus of control, luck, fate, or chance are seen as governing the results. | |
| Wolpe. 92 His systematic desensitization is significant because his conditioning model spells out interconnections among neurological functioning, cognition/ fantasy, emotions, interpersonal sequences, and observable behaviors. | |
| Frankl on Behaviorists and Social Learning Theorists. Frankl has written a little on specific behavioral theorists and more extensively on behaviorism in general. Frankl31-D calls Skinner a pioneer, but disagrees with the pandeterminism of Skinner's conditioning processes which imply the inevitable manipulation of humans. Frankl attributes the "real cause" of human behavior not to conditioning processes but to reason. Frankl29 refers to Wolpe's91 study on the effectiveness of non-psychoanalytic therapy as showing that technique is less important in therapy than the quality of the interpersonal relationship between therapist and client. | |
| Frankl11 lauds behaviorism for demythologizing neuroses in showing that psychoanalytic explanations for their etiology are beliefs rather than established facts. Learning and behavior therapists support his supposition that phobias are avoidances of situations which arouse anxiety. Logotherapy anticipated a number of behaviorist positions such as phobias being avoidances and paradoxical intention working similarly to "flooding"92 and "implosion."88 Behavior modification and paradoxical intention can be combined. Both behaviorists and logotherapists evoke humor as curative. Learning and conditioning processes may occur in psychogenic neuroses. Frankl28 suggested that neurosis is a conditioned reflex which is secondarily reinforced by anticipatory anxiety. Behavioral research is helpful, but treatment must follow persons beyond the plane of neuroses into the human dimension where self-transcendence and self-detachment operate. Frankl concludes that logotherapy is rehumanizing both behaviorism and psychoanalysis. He11 criticizes the behavioral model for inventing drives and instincts as the explanations for human behavior because it shuts out more specifically human motivations such as the will to meaning. The behavioral and medical models have their limits because conscience cannot really be dealt with reductionistically and "the feeling of meaninglessness ... is an existential despair and a spiritual distress rather than an emotional disease or a mental illness. "1 L P-138 Frankl also chides behaviorists for making value judgments and deciding what is good or bad for a patient, which he regards as "reductionist indoctrination." In contrast, he characterizes a logotherapist as practicing phenomenological analysis of values with ordinary persons who through "pre-reflective ontological self-understanding ... [are] responsible for | |
| PP-124 125 | |
| fulfilling the meaning potential inherent in a given life situation. "31· | |
| Humanistic Personality Theories | |
| Allport8 took an open-systems approach to persons as unique, unified, conscious, intentional, and capable of freedom and becoming. Current motiva | |
| 75 | |
| tion is potentially "functionally autonomous" of past determinants. A "proprium" (self) develops through seven stages from bodily awareness in infancy through the pursuit ofself-defined projects in propriate striving. Values, defined as "meanings related to the self'8• P-164 are important. Constructing a unifying philosophy of life, which incorporates a goal and a purpose for living, is one of the six characteristics of human maturity. Types of conscience and religious orientation can be distinguished. Conscience operates as "a process that controls transitory impulse and opportunistic adjustment in the interests of long-range aim and consistency with the self-image. "6, P-68 A "must conscience," based on the dread of punishment, differs from an "ought conscience," bolstered by internalized sanctions, self-respect, and a broad scheme ofvalues. Religion, as a system of meaning and interpretation, can be used "extrinsically" to advance self-esteem and social standing or "intrinsically" to live by faith and to harmonize oneself with spiritual reality.9 Personality functions in a social context. "We never encounter personality apart from some situation. "8, P-176 He advised watching for "the numerous points of intersection and the mutual interdependence of the ... [individual and social] structures, "8, P-194 for "nothing in personality is purely 'social' and nothing purely 'individual. "'8, P-193 Allport7 analyzed personality and social influences in intergroup prejudice and tolerance. | |
| Frankl on Allport. Allport helped to introduce logotherapy to the United | |
| 30 33 | |
| States. Frankl29-, frequently refers to Allport's preface to Man's Search for Meaning. Frankl3° agrees with Allport for objecting to homeostasis as the sole motivator of human behavior. He applauds Allport for not limiting psychology to the "machine" and "rat" models, for "no computer is capable of laughing at itself, nor is a rat capable of asking itself whether its existence has a meaning. "33• P-122 Both see persons as intentional, as having a sense of humor, and as displaying religious tendencies. 30 Both recognize that all forms of psychotherapy are not for everyone; Allport did so in observing that some motives can be taken at face value and are not necessarily unconscious as psychoanalysis emphasizes. FrankJ29 cites Allport as providing a theoretical basis for "dereflection" in speaking about selfless goals as helping to overcome neurosis. Both theorists are more interested in consciousness of self rather than in drives and instincts.11 | |
| Rogers81 concentrated on a research approach to subjective processes. He highlighted the self-actualization motive, originally studied by Goldstein.44 Self-actualizing persons gain the most from personal learning that furthers their creative potentials and enables them to be more fully aware and communicative. Rogers distinguished between frames of reference and methods of evaluation which rely on conforming to external standards as opposed to ones that encourage responsibility for being more responsive to internal experiencing. The self of a fully functioning person is more likely to emerge free from incongruities and defenses when receiving facilitative conditions -unconditional positive regard, emphathetic understanding, and honest congruence. These prove helpful in effective therapy, in families, in educational settings, in training groups, and in institutions. Productive interpersonal relationships require congruence ofexperience, awareness, and behavior within a person and congruence between persons in order to maximize empathy, reciprocated trust, and mutual satisfaction. 80 | |
| Frankl on Rogers. Frankl credits Rogers with having "deidiologized psychotherapy"3L P-108 Frankl concurs with Rogers8 1 that "the warm, subjective, human encounter of two persons"29• P-93 matters most in psychotherapy. Because of his emphasis on self-transcendence, Frankl disagrees with postulating self-actualization as the prime human motive but sees it as a side effect of fulfilling meaning in one's life through productive activity and loving. | |
| Maslow62-65 is most famous for his hierarchy of prepotent motivation and his studies on self-actualization. He propounded the desirability of researching human development beyond the realms of the pathological and of conformity to the average. He distinguished between D (deficiency) and B (being) needs, values, and psychologies. A deficiency approach focuses on homeostasis and security. A being orientation explores the highest aspirations of humans. Experiencing the highest of the prepotent needs -self-actualization -does not constitute a restful mecca but generates new longings -metanceds. Metaneeds include the search for Truth, Beauty, Justice, and Meaningfulness. Once the lower needs are sufficiently gratified, especially in the first two years of life, an individual may have a greater frustration tolerance and pursue higher needs even at the expense of some personal sacrifice. Metamotivated persons incorporate the interests of others and the importance of B values into enlarged selves that become fused with external causes. A person "has a higher and transcendent nature, and this is part of [one's] essence, i.e., [one's] biological nature as a member of a species which has evolved. "65, P· xvi Metapathologies ensue from the deprivation of intrinsic metaneeds. | |
| Self-actualizing persons are more likely to be aware of peak and nadir experiences. Similarities exist between peak and mystical cxperiences.63 Mystical and legalistic approaches to religion differ. They parallel promoting growth by security-seeking in human development. Many people live out a "Jonah complex" in not responding to the challenges of growing to their fullest potentials.66 A "normative social psychology" could encourage the advancement of "good preconditions" conducive to self-actualization.65 ,66 Maslow used Ruth Benedict's term "synergy" to indicate an aspect of ideal development which "transcends the dichotomy between selfishness and unselfishncss"66• P-19 and joins self and others together in cooperative ventures. Synergy intertwines persons who may conflict because they differ in gender and social groupings. In the ideal conditions of "Eupsychia, "64 the supports necessary to advancing up the hierarchy of motivation are available within one's social context. Then persons are more likely to achieve and enjoy the "full humanness" of mental health rather than the "human dimunition" of pathology. | |
| Frankl on Maslow. Frankl2930 cites Maslow as stating that homeostasis is a relatively negative notion and does not explain basic human motivations which are more positively oriented. He30 credits Maslow with implying the intentionality of human experience and applauds him for pointing out that behavior has several determinants and not only unconscious motivations. Frankl's contrasting the "abyss experience" of an existential vacuum with "peak experiences" parallels Maslow's65 comparing them with "nadir experiences." Frankl3° sees a risk in fusing facts and values when the "is" and the "ought" merge in peak experiences or in self-actualizing people because he believes such fusion might misinterpret "the polar field of tension established between object and subject. "30, r. 51 Frankl29· P· 54 refers to Maslow65, P· 159 as saying that self-actualizing people are "strongly focused on problems outside themselves ... [such as] a task that they feel is their responsibility." Frankl asserts that the concept of "self | |
| "29 | |
| actualization ... is not a sufficient ground for a motivational theory. , P· 8 While desirable, self-actualization and peak experiences are side-effects and consequences and cannot be sought directly as goals.29,30,33 They ensue and cannot be pursued. Self-actualization occurs spontaneously as a person pursues meanings rather than when directly intended or sought. Maslow emphasized that self-actualization is an outcome or byproduct: | |
| Seeking for personal salvation is anyway the wrong road to personal salvation. The only real path ... [is] salvation via hard work and total commitment to doing well the job that fate or personal destiny calls you to do ... Self-actualization via commitment to an important job and to worthwhile work could also be said, then, to be the path to human happiness ... ~ happiness is an epiphenomenon, a by-product, something not to be sought directly but an indirect reward for virtue ... The only happy people I know are the ones who are working well at something they consider important ... Self-actualizing subjects ... were metamotivated by meta-needs (B values) ... expressed in their devotion to, dedication to, and identification with some great and important job.64, P· 6 | |
| Frankl disagrees that needs necessarily form a hierarchy, for he contends that higher needs such as striving for meaning may occur precisely when lower needs are most threatened ( as well as when lower needs are taken care of and life does not seem satisfying). For Frankl, "the need for meaning is independent of other needs. "33·p. 34 Frankl quotes Maslow's observation of his writings that "the will to meaning is ... man's primary concern. "33, P· 29 | |
| Social/ Cognitive Theorists | |
| I.ewin59,6D,61proposes a "field theory" of personality. Human development occurs within a context as a person perceives and interprets the environment which exerts forces and influences. An individual acts from a "psychological position" in the context of one's "life space," which encompasses one's participation in social groups and physical surroundings, the quality ofthis environment, and personal goals. Levels of aspiration toward goals, as well as one's capacity and possibilities for activity and movement toward them or away from barriers to them, shape development. | |
| Berne. 14•15 His transactional analysis centers around the interactions or transactions that occur between people. It addresses both the capacities of persons that make transactions possible and the larger social contexts within which transactions take place. 69, P· 72 People act on basic needs or "hungers" for sensory stimulation, recognition, contact, sexual encounter, and ways to spend time. | |
| Time is structured through rituals, activities, intimacy, and social-psychological "game playing" in order to gain "strokes" of recognition. Transactions occur between people's "ego states" -individually experienced and socially observable changes in the use of personal energy. Ego states represent feelings, attitudes, and behavior patterns. They form three ego-state structures, depending on whether they occurred in one's past (Child ego states), are present responses to reality (Adult ego states), or were appropriated from external sources (Parent ego states). The interactions that are exchanged between the ego states of the transacting parties can be 1) mutual and straightforward or "complementary," | |
| 2) intended to serve different purposes by the interacting partners and thus "crossed," or 3) "duplex" with both an apparent "social" and an "ulterior" or "psychological" and controlling meaning. "Games" are duplex transactions. The distribution of strokes, the gaining of recognition, and the patterns both of ego-state energy usage and of transacting are guided by "scripting." Scripting, transpiring largely in a family context, shapes a child through basic life messages (injunctions, permissions, and modeling) imparted by parental figures and the fundamental decisions that a youngster makes about the final (script) goals, which the growing person intends to accomplish, in response to these messages. The goal of constructive human development is autonomy coupled with a capacity for intimacy. Impediments to growth result in symptoms or "racket behaviors" which substitute thoughts, feelings, and actions that foster mediocre conformity or pathology for a more independent, authentic fulfillment. | |
| Laing56-57 ,58 explores the interconnections between the experiences of self and family systems. The ontologically secure self -who encounters the hazards of life with a firm sense of identity -contrasts with the schizoid or ontologically insecure self -who feels dissonance within and in relation to others. Identity develops through continually acting upon and being influenced by others. In words or nonverbally, others may confirm or collude against an individual's personal sense of identity. Persons in family systems are interlinked not only through interaction but also through interexperience ( emotional responsivity to family events) and interperception. Depending on the congruence or disagreement between how I view myself and others and others' views of me and how I view them, feelings ofunderstanding and misunderstanding arise. When disconfirmation and misperception occur, alienation results. | |
| Internalization ofthe family context significantly influences the evolution of a self. A family can disconfirm authentic identity and induce alienation 1) through invalidating personal feelings by imposing inappropriate expectations and debilitating social roles; 2) through "scenarios" that perpetuate roles over generations irrespective of individual differences; 3) through "operations" that subtly block awareness ofnon-sanctioned options as if the individual were given a "social lobotomy"; 4) through "rules" which govern what thoughts, expressions, and behaviors are allowable and punishable and through "metarules"that impose silence on and non-awareness of the process of forbidding, and | |
| 5) through "mapping" in which a family of origin by projection and introjection induces and instructs the young in how to handle distinctions, identities, rules, operations, attributions, scenarios, and roles before they can sift the evidence or discover a real I on their own. | |
| Angyal10•11 is significant especially for his emphasis on organization. A holistic perspective emphasizes that life occurs between organisms as open systems and the environment. Persons and the milieu interpenetrate and relate dynamically in the total context of the "biosphere." Humans display the twin tendencies toward autonomy or mastery and heteronomy or love. Heteronomy denotes yearnings to be joined with the reality of non-self physically, socially, ,and spiritually. From the cradle to the grave, we desire to come into existence by having meaning and significance for another. Being valuable to another augments self-respect whereas the threat of isolation evokes anxiety and anger. Striving to live in harmony with meaningful superordinant realities such as social systems, nature, God, or a universal ethical order fulfills the heteronomous dynamic. Angyal also stresses organization by observing that all people have both traumatic and nurturing experiences which are not inevitably determining but can form the nuclei for constructing personalities oriented toward either neurosis or health. Personality represents a time Gestalt with dimensions (by having depth or being superficial, by progressing toward goals and through stages, and by being broad or narrow). | |
| Frankl on Social/ Cognitive Theorists. Frankl does not make any references to Lewin, Berne, Laing, or Angyal. Nor does he mention family or social systems theory or therapy, though his work presupposes human cognitive abilities. | |
| Existential Personality Theorists | |
| Binswanger 16•17 in his "existential analysis," examines the unity of human existence prior to any split into subject and object. Person and environment are inextricably connected in each Dasein -being-in-the-world. Within the constraints of reality, each person is responsible for constructing a "world-design." Dasein can transcend self through love and the realm of eternity. The worlds of Dasein include the Umwelt (the realm of biology, perception, and action), the Mitwelt (the arena of meaningful relationships), and the Eigenwelt (the dimension of subjective valuing of self and outer reality). Though humans are "thrown" without choice into existence (Geworfenheit), are swayed by historical circumstances and corporeality, and may abandon the free potentiality to be themselves (and succumb to "mundanization"), they remain responsible for choosing a self authentically, for "taking a stand" to advance self-realization, and for constructing an order of preference, that presupposes a higher perspective, in order to endow time, space, and materiality with an existential direction. A person is always both instinct and spirit. "Spirituality extends its reach down to the deepest valleys of'vitality, '"17•P-3 As a self that can intend objects, a person is capable of religiosity, morality, aesthetics, and a "religious I-Thou relation. "17• | |
| p. 2 | |
| Buss. 18,19 As "world-openness," the goal of Dasein is to become as perceptive and responsive as possible to the presence ofevery phenomenon that the light of a purposeful, autonomous, free, and healthy existence can illuminate. Dasein discloses the meaning and context of phenomena. It is attuned to the world | |
| through particular moods, and remains indebted to existence with the options of | |
| falling prey and being guilty or of freely working and enjoying. Dasein is | |
| responsible for using space, time, bodiliness, and dying meaningfully. Bodily | |
| expressions and symptoms are not only analyzable scientifically but "body forth | |
| a way of being." Dasein "shares with" and can "be with" others. Symptoms | |
| manifest disturbances in relationships. The past, bodily being, and significant | |
| others interact with choice to co-determine individuals as they are motivated to | |
| relate to the future. Daseinanalysis is not anchored by the psychoanalytic | |
| inquiry of"why," but poses the question of"why not?" (give up the restrictions of | |
| neurosis and experience a richer existence?). As a conscious guidance into | |
| wholeness, therapy might better be called synthesis than analysis. | |
| May73.77 contrasts human growth with personal emptiness, violence, and meaninglessness. Human existence entails complexity ~ people are free yet needing to be responsible, both rational and irrational (daimonic), neither completely passive nor totally active, have the capacities for both evil (violence) and good (love), are capable of independence yet fearful of alienation, and are potentially anxious yet able to exercise courage. Consciousness of self distinguishes humans. Through conscience persons tap their deeper levels of insight and ethical sensitivity. Creatively becoming a constructive self requires responsible freedom and courage. Persons struggle for self-esteem and significance through power. Humans exercise power in many forms aggression and violence emerge only when the more fundamental powers (to be, selfaffirmation, self-assertion) have proven ineffective.76 Through will, individuals organize themselves to pursue certain goals.75 Through intentionality, experience becomes meaningful, and we can understand the outside world. | |
| Frankl on Existential theories. FrankJ3° notes that in the 1930's he used the term txistenzanalyse as an alternative for "logotherapy," which he originated in the 1920's. But, when daseinanalysis (popularized by Binswanger in the 1940's) was also translated as "existential analysis," he stuck with the label "logotherapy." Frankl29 distinguishes daseinanalysis from logotherapy -the first emphasizes the illumination of being and the second the illumination of the possibilities of meanings. Frankl brands the assumption that daseinanalytic terminology bridges the gap between subjectivity and objectivity as "selfdeceptive" since both cognition and love are "grounded, indispensably, on a field of polar tension between the objective and the subjective. "29, r. 135 He characterizes daseinanalysis as specializing in psychosis, and logotherapy in neurosis. Daseinanalysis portrays humans as "monistic ... a neutral noeticpsychic-somatic existence ... imprisoned within (the) existential mode ... [ whereas its complement --logotherapy ~ recognizes the transcendent and spiritual capacities of persons who display] the manifold character of bodymind-spirit within the unity of human existence. "29, P· 135 | |
| Frankl agrees with Binswanger that "instincts and spirit [are] incommesurable concepts."31, P 26 Frankl3° credits Binswanger with reinstating the human being in full humanness in psychotherapy and regards "the I-Thou relation ... as the heart of the matter. "30, P· 26 Ontoanalysis ( as portrayed by Binswanger and the phenomenologist E. Straus) reclaims the subjectivity and choice-making that FrankJ29 sees as mistakenly objectified by the exclusively psychodynamic emphasis of psychoanalysis. Frankl asserts that logotherapy goes further: | |
| 1) beyond encounter to search for meaning and 2) reobjectifies the objective (meanings and values) that Frankl regards ontoanalysis as subjectifying. He views Binswanger's daseinanalysis as "ontologizing ... Adler's tenet of tendentious apperception"29• P-134 in that he compares the "specific mode of being-inthe-world" of the "a priori structure of Daseingestalten" to the tendentiousapperception aspect of a style of life. FrankJ3° cites May as observing that the existential approach considers will and decision-making central to human functioning as confirming that the will to meaning should not be misinterpreted as a drive to meaning. | |
| May opines that "logotherapy hovers close to authoritarianism ... [because] clear solutions ... bel[y] the complexity of actual life" and because his perception of Frankl as sometimes supplying goals "take[ s] over the patient's responsibility. "78, P-42 In viewing logotherapy as "education to responsibility," FrankP 1 ·P121 denies the charge of authoritarianism. Bulka compares May and Frankl on their similarities ( appreciating values, freedom, responsibility, and potential for actualization) and contrasts them on their difference ("self-expression versus self-transcendence and the ethics of inwardness versus the objective value world")21· P-50. Bulka counters May on the observation of authoritarianism by presenting an excerpt from an interview, between Frankl and a patient, "which might be misconstrued as authoritarian, "21 ,P· 52 but which, in Bulka's eyes, shows | |
| "21 ·P-53 | |
| that "the value was presented, but not imposed. May's more "internal" focus on the psychological dimension of human existence and Frankl's more "external" viewpoint that includes certainty about the noological dimension have contributed to this dispute. May responds that Frankl's use ofthe categorical instruction of"don't" and his expressed conviction, "we will cure you," that requests "unquestioning faith in the therapist" are "skating on the edge of authoritarianism. "78, P-55 FrankJ32replies that he does not mind exercising the authority of a medical doctor in giving recommendations and prognoses. | |
| Phenomenologists | |
| Phenomenologists have more developed a method for exploring the experiencing of humans, and have employed the method in examining aspects of human experiencing, than they have constructed comprehensive personality theories.87 Some noteworthy phenomenological studies on aspects of personality development and functioning include: Jaspers49 on psychopathology, Schutz85 on social action, Minkowski79 on lived time, Straus89 on lived movement and spatiality, Scheler84 on values, and Schachtel83 on sensation and emotions. | |
| Frankl on Phenomenologists. Frankl asserts that "logotherapy is the result of an application of Max Scheler's concepts to psychotherapy. "Jo, P-10 He33 concurs with Scheler that being human involves being open to the world. Frankl lauds Scheler's phenomenology for "preserving the humanness of human phenomena"29· P-73 and finds support in Scheler for regarding pleasure not as a goal but | |
| as a side effect. Frankl views Jasper's position that a person becomes who one is by making a cause one's own as confirmatory of his conclusion that selfactualization is "the unintentional effect of life's intentionality. "30, P· 38 He concurs with Jasper's that "being human is not being driven but 'deciding what one is going to be."'31, P· 26 Frankl33 disagrees with Jaspers that the world is a book written in code for us to decipher and proposes that it is one we must dictate as we respond responsibly to life. The companion piece to this article(" A Critique of Logothcrapy as a Personology") will summarize the comparisons and contrasts between the constructs of logotherapy and other personality theories and appraise Frankl's contributions to understanding human existence. | |
| ROBERT F. MASSEY, Ph.D. is visitng professor ofcounseling and marriage andfamily counseling at Queens College, New York and a licensed psychologist and a marriage andfarnily therapist in New Jersey. Afuller treatment ofeach of the theories outlined in the above article can be found in Massey. 68 | |
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| Logotherapy for Chronic Pain | |
| Manoochehr Khatami | |
| Chronic pain is a perplexing problem costing billions annually in the United States alone_<, It affects family relations,job performance, emotional wellbeing, and even doctor-patient relationship. 22 Several studies have reported the shortterm effects of various treatments for chronic pain. Few reports have assessed the long-term effects. | |
| Differential diagnosis is important in planning treatment for patients with chronic pain. They may have a depressive syndrome, 17 narcotic addiction, 16 or the pain symptoms may be related to financial reward and to family interaction.18 Recently, a variety of therapeutic methods have been applied to chronicpain problems, including behavioral techniques, 13 family therapy,21 stress inoculation procedures, 19 and electromyographic (EMG) biofeedback, which reduces anxiety, 1' and may thereby reduce pain perception.1.2° Other treatments have included various physical interventions (such as acupuncture and percutaneous neural stimulation), and finally, pharmacologic treatments. | |
| These treatments arc based on different conceptualizations of the problem. However, this plethora of therapeutic methods should not be construed as evidence of efficacy. Initial reports of new treatments often sound promising, but more carefully controlled subsequent studies reveal their limitations. | |
| A previous pilot study15 at our center showed that the multimodal treatment program for chronic pain resulted in significant reductions in levels of pain, depression, and analgesic intake. Follow-up one year after the end oftreatment revealed that all five patients continued to maintain the gains acquired during active treatment. | |
| These initial findings led us to further test this treatment program in a new sample of 23 patients, whose follow-up status at one year is reported here. | |
| Subjects and Measures | |
| All patients received thorough medical, neurological, and radiologic evaluations before entering the study, after it was determined that no surgical or medical intervention was indicated. Patients with psychosis or presumed organic causes for pain were excluded. | |
| Tables 1 and 2 show the demographic and history of illness and treatment data for the patients. | |
| Of the 23 patients, 14 completed the full course of therapy. The remaining nine were designated as partial completers. There was no major age difference between these two groups (mean=43.8). Evaluation consisted oftherapist ratings | |
| Table 1. Demographic Data | |
| Variable Full completers Partial completers Total (n =14) (n =9) (n = 23) | |
| Sex Male 4 3 7 | |
| Female 10 6 16 | |
| Race White 14 9 23 | |
| Other 0 0 0 | |
| Age (mean) 43.5 (14.5)" 44.2 (13.6) 43.8 ( 13.8) | |
| Employed Yes 5 6 II | |
| Noh 9 3 12 | |
| Marital s 0 I | |
| M 12 7 19 | |
| D/W/Scp. 2 3 | |
| " Numbers represent group means; numhers in parentheses are standard deviations. h Not employed included homemakers. | |
| Table 2. History of Illness | |
| Previous physicians. hospitalizations, and operations include only those related to treatments for chronic pain. | |
| Full completers Partial completers Total | |
| (n =14) (n = 9) (n =23) | |
| Length of illness | |
| < I year 4 2 6 | |
| > I year IO 7 17 | |
| Number of previous physicians 4.9 (3.8)" 3.1(1.7) 4.2 (2.8) | |
| Number of hospitalizations 1.3 (1.9) 3.1 (4.7) 2.0 (3.3) | |
| Number of surgical operations 5.3 (3.3) 3.8 (1.6) 4.6 (2.7) | |
| % Previous tricyclic therapy 28.6% 33.3% 30.4% | |
| Suicidal ideation 21.4% 37.5% 27.3% | |
| Weeks in therapy 26.9 ( 15.5) 8.8 (9.1) 19.8 (15.9) | |
| Number of therapy sessions 22.9 (14.5) 6.4 (5.9) 16.9 (14.4) | |
| a Numbers represent group means; numbers in parentheses are standard deviations. | |
| and patient self-reports. The latter included the Symptom Check List-90 (SCL 90);8 the Beck Depression Inventory (BDI);2 and weekly self-ratings of pain, anxiety, depression; work and family satisfaction with a modification of the Visual Analogue Scale (VAS). 1 Each patient kept a detailed record of time, frequency, and severity of symptoms and a daily record of medications (pills/ day). | |
| Follow-ups were done by mailing to each patient the test batteries that were given at the initial evaluation. The time from termination to follow-up for full completers averaged 46.3 weeks; for partial completers 33.9 weeks. This difference was not statistically significant. | |
| Therapy consisted of weekly one-hour sessions. The average full completer received 22.9 sessions (SD=l4.5), partial completers an average of 6.4 sessions (SD=5.9). Therapy consisted of three phases: (1) symptom control (dereflection), (2) stimulus control (modification of attitude), and (3) social system modification. | |
| Symptom Control (Dereflection) | |
| Chronic pain patients develop a sense of helplessness, hopelessness and meaninglessness about their pain. This sense of psychological impotence and consequent lower self-image has been called the "giving-up-given-up" complex. 10 Patients apply these overgeneralized attitudes not only to themselves, but to the rest of the world. Thus, their daily lives are dominated by the experience of pain and the usually futile pursuit of relief, while interest in other aspects of living are drastically reduced or nonexistent. | |
| Symptom control is designed to reduce these helpless and hopeless attitudes by teaching patients to master or control their major symptom, pain, and to reduce anxiety and chronic tension, thereby allowing them to distance themselves from the pain. The dereflection process aims at: | |
| • | |
| Inner growth through forgetting the self | |
| • | |
| Turning from something that subjectively is seen as a problem to something that objectively is meaningful | |
| • | |
| Discovering something new which reduces the significance of the old | |
| • | |
| Overcoming egocentricity by opening oneself to the world ( dereflection, 12 EMG biofeedback,7-5 and relaxation training14-24). | |
| One half of each therapy session, for roughly the first ten-week treatment, was devoted to symptom control. In addition, patients were instructed to practice relaxation techniques at home three times a day. Each patient was required to complete a daily and weekly log about the severity and frequency of pain and their daily activities. | |
| Stimulus Control (Modification of Attitude) | |
| "Internal stressors" which may lead to chronic tension, consist of personal belicfs,3•4 that dictate how internal and external stimuli are interpreted and given meaning. The personal interpretation of environmental events is evident in the patient's stream of consciousness, cognitions, or self-talk. These cognitions or attitudes may result in high anxiety, muscle tension, and other physiological responses. | |
| If personal beliefs do interact with environmental events to produce cognitions and consequent somatic and psychological responses, then modification of these cognitions and beliefs should change as patients evaluate and respond to events perceived as stressful.9•19 For example, a patient with an extreme achievement orientation is disposed to construe even minor daily events as if each were important and highly related to the question of achievement. | |
| The stimulus-control phase of treatment employs techniques to teach patients to identify irrational and distorted cognitions or thinking associated events; identify personal beliefs or silent assumptions upon which these cognitions are based (e.g., "I must do everything perfectly"); and change both the distorted thinking and personal beliefs and modify their attitudes. | |
| The modification of attitudes aims at | |
| • | |
| Inner growth through changing the self | |
| • | |
| Turning from something that is subjectively experienced negatively to something subjectively experienced positively | |
| • | |
| Gaining a perspective of something old, so it is seen in a new light | |
| • | |
| Accepting fate by the new attitude | |
| • | |
| Search for meaning within the existing situation | |
| • | |
| Education for courage and dignity | |
| • | |
| Change unavoidable suffering into human triumph.'' Thus patients learn to develop a more realistic evaluation of events or stressors and more appropriate responses to them. Reality testing and correction of these maladaptive cognitions and beliefs were undertaken using verbal techniques and homework assignments. The patient recorded cognitions associated with increased pain and/ or dysphoria or other stimuli for pain-related | |
| behavior. Nearly half of the total treatment time was devoted to stimulus control applied after symptom-control training. | |
| Social System Intervention | |
| Social or interpersonal payoffs ("secondary gain") for pain include attention and concern from others and avoidance of occupational, familial, and/ or sexual responsibilities.22 -21 In essence, pain becomes the currency for interpersonal or family transactions. The structure of families of psychosomatic patients is "characterized by enmeshment, overprotectiveness, rigidity and lack of conflict resolution. "21 The enmeshed family is less able to adapt to stressful circumstances since each member's functioning is overly influenced by another's, and autonomous exploration and mastery of problems are discouraged.21 | |
| Social-system modification consists of structural family thcrapy21 or direct instructions to family members to modify the positive and negative reinforcers for pain behavior. In family therapy the therapist functions as a boundarymaker, separating subsystems. | |
| This phase oftreatment was designed to decrease the interpersonal payoff for pain. For example, spouses might be directed to give positive reinforcement (attention, admiration, concern) for activities that were goal-directed (e.g., exercises, work, walking, recreational activity), or to withdraw positive reinforcement for pain-related behaviors (e.g., complaining, pill taking, withdrawing from activities). Similarly, nonpain behavior and continuous functioning were reinforced by the therapist. The net result was that the "sick role" had fewer and fewer interpersonal rewards for patients, as they developed a wider variety of interpersonal behaviors. | |
| Results | |
| Of the 14 patients who completed treatment, 12 were avilable for follow-up evaluation. Of the 9 partial completers, 8 were available for follow-up. | |
| Table 3 shows the results for full completers. No patient showed worsening on any parameter during treatment or at follow-up. In comparison with pretreatment status, significant decreases in pain (p<.01); pills/day (p<.05); BDI (p<.00 l ); SCL 90 -anxiety (p<.05); somatization (p<.0 I); and hostility (p<.05) were found at follow-up. Partial completers (Table 4) demonstrated significant improvements in only pain (p<.05) and SCL 90 -hostility (p<.05) at follow-up. | |
| A second analysis was conducted. Those who evidenced a 50% or greater reduction from initial measure at follow-up were called responders. The Fishers Exact Test revealed significantly better response to the full treatment program as compared to the partial treatment exposure for pain (p<.05) and for depression by BDI (p<.01). | |
| Table 3. Full Completers: Evaluation vs. Follow-llp Comparisons | |
| Evaluation Follow-up t a | |
| Pain (n = 9) 53.9 (17.3) b 19.8 (27.0) 3.10** | |
| Pills/ day (n = 9) 15.1 (10.3) 7.2 (2.6) 2.34* | |
| BDI (n = 11) 12.7 (4.3) 3.6 (3.1) 6.44*** | |
| SCL-90(n= 12) | |
| Depression 1.3 (1.0) 0.9 (0.5) 1.28 | |
| Anxiety 0.9 (0.8) 0.6 (0.3) 1.78* | |
| Somatization 1.3 (0.5) 0.8 (0.3) 3.08** | |
| Hostility 0.7 (0.5) 0.4 (0.4) 2.44* | |
| lnterp. sensit. 0.9 (0.6) 0.6 (0.5) 1.57 | |
| " t values are for one-tailed paired I tests. b Numbers represent group means; numbers in parentheses are standard deviations. * P<0.05. | |
| ** P<0.01. *** P < 0.00I. Table 4. Partial Completers: Evaluation vs. Follow-Up Comparisons | |
| Evaluation Follow-up I a | |
| Pain (n = 6) 52.5 (]9.4)b 42.2 (11.0) 2.50* | |
| Pills/day (n = 9) 10.3 (10.0) I1.8 (13.2 0.77 | |
| BDI (n = 7) 12.0 (14.0) 12.9 (12.9) 0.49 | |
| SCL-90 (n = 8) | |
| Depression 1.3 (1.3) I.I (1.3) 1.14 | |
| Anxiety 1.1 (1.2) 0.9 (1.0) 1.40 | |
| Somatization 1.3 (0.9) 1.1 (0.5) 0.95 | |
| Hostility 1.2 ( 1.2) 0.6 (0.9) 2.73* | |
| Interp. sensit. 0.9 (1.2) 0.5 (0.6) 1.57 | |
| a I values are for one-tailed paired I tests. h Numbers given are group means; numbers in parentheses are standard deviations. | |
| * P< 0.05. | |
| Discussion | |
| We conceptualized chronic pain as having intra-and interpersonal determi | |
| nants. This conceptualization led to the application of specific techniques to provide symptom control, stimulus control, and social system changes in the treatment of outpatients with chronic pain. | |
| Significant decreases in pain, depression, anxiety, somatization, hostility, and analgesic ingestion were obtained without symptom substitution at one year follow-up for full completers, while partial completers showed significant reductions in only pain and depression at follow-up. In addition, the partial completers obtained less reduction of both pain and depression than full completers. These between-group differences cannot be attributed to time between termination and follow-up which was equivalent in both groups. | |
| The absence of placebo control or wait-list comparison groups makes inferences from this study tentative. However, the many previously unsuccessful attempts to modify pain by analgesic, psychotropic medications, and/ or surgery in this patient sample suggest that responses to the multimodal treatment program that were sustained for one year are not likely to be explained solely by a "placebo effect." In addition, the greater benefit that resulted from the full treatment program as compared to the partial program argues for a specific treatment effect. | |
| We cannot readily compare these pilot results with the literature since few reports of psychotherapy for outpatients with chronic pain exist and none ofone year follow-ups. Most reports from the literature describe treatment in the inpatient setting. Nevertheless, the operant conditioning paradigm for the treatment of pain behavior has proved to be beneficial, 13 although reports on long-term follow-up of patients receiving behavior modification is lacking. Relaxation training with or without EMG biofeedback also has been used to treat tension headaches with some success.7 | |
| Our results suggest that further controlled comparison studies are needed to determine the effectiveness of this treatment program for outpatients with chronic pain and to isolate the active ingredients in this treatment package. | |
| MANOOCHEHR KHATAMI, M.D. is medical director, Center for BioBehavior Medicine, St. Paul Medical Center, Dallas, Texas. | |
| REFERENCES: | |
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| 2. | |
| Beck, A. T., C.H. Ward, M. Mendelson, et al. An Inventory for Measuring Depression, Arch. Gen. Psychiat. 4 (1961) 561-571. | |
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| Beck, A. T. Cognition Affect and Psychopathology. Arch. Gen. Psychiat., 24 (1971) 495-500. | |
| 4. ____ Cognitive Therapy and the Emotional Disorders. New York, International Universities Press, 1976. | |
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| Blanchard, E. G. Clinical Applications of Biofeedback Training. Arch. Gen. Psychiat. 30 (1974) 573-589. | |
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| Bonica, .J. Fundamental Consideration of Chronic Pain Therapy. Postgrad. Med. 539 (1973) 81-85. | |
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| Budzynski, T., .J. Stoyva, and C. Adler. Feedback Induced Muscle Relaxation: Application to Tension Headache. J. Behav. Iher. & Exp. Psychiat. I (1970) 205-211. | |
| 8. | |
| Derogatis, L. R., B. S. Lipman, and L. Covi. SCL-90: An Outpatient Psychiatric Rating, preliminary report, Psychopharmacol. Bull. 9 (1973) 13-28. | |
| 9. Ellis, A. Reason and Emotion in Psychotherapy. New York, Lyle Stuart, 1962. | |
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| Engel, G. L. A Life Setting Conducive to !llness, the Giving-up, Given-up Complex. Ann. Intern. Med., 69 (1968) 293-300. | |
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| Frankl, V. E. The Will to Meaning. New York, The World Publishing Co., 1969. | |
| 12. | |
| ____ Man's Search/or Meaning. New York, Washington Square Press, 1985. | |
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| Fordyce, W. E., R. S. Fowler, Jr., J. F. Lehmann, et al. Operant Conditioning in the Treatment of Chronic Pain. Arch. Phys. Med. Rehabil. 54 (1973) 399-408. | |
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| Jackobson, E. You Must Relax. New York, McGraw-Hill, 1962. | |
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| Khatami, M. and A. J. Rush. A Pilot Study of the Treatment of Outpatients with Chronic Pain: Symptom Control, Stimulus Control and Social System Intervention. Pain 5 (1978) 163-172. | |
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| Woody, G. and C. O'Brien. Chronic Pain and Narcotic Addiction: a Multitherapcutic Approach A Pilot Study. Comp. Psychiatry 20 (1979) 55-60. | |
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| Lcssc, S. Marked Depression. New York, Jason Aronson, 1974. | |
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| Maruta, T. and D. W. Swanson. Psychiatric Consultation in the Chronic Pain Patient. Mayo Clin. Proc. 52 (1977) 793-796. | |
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| Meichenbaum, D. Cognitive-Behavioral Modification. New York, Plenum Press, 1977. | |
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| Melzack, R. The Puzzle of Pain. New York, Basic Books, 1973. | |
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| Minuchin, S. Families and Family Therapy. Boston, Harvard University Press, 1974. | |
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| Stcrnbach, R. A. Pain Patients Traits and Treatment. New York, Academic Press, 1974. | |
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| _____ Strategies and Tactics in the Treatment of Patients with Pain in Pain and Suffering: Selected Aspects. Springfield, Ill., 1970. | |
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| Yorkston, N. A. A Simple Method of Relaxation. Lancet ii (1969) 1319-1324. | |
| Lawyers, Liquor, and Lototherapy | |
| Robin Goodenough | |
| This article explores the reason why alcohol has undermined lawyers and the legal profession at a time when they find themselves floundering in an existential crisis. Professionals estimate the number of alcoholics in the general population at about IO percent. The number of alcoholic lawyers is estimated in excess of 15 percent." The number would be even larger if one were to include those lawyers in trouble with the law due to "alcohol related problems" (e.g. alcohol and stress). An increasing number of lawyers are not "hard core" alcoholics, but their abuse of alcohol combined with other factors, though not requiring detoxification, makes it imperative that they get immediate help. | |
| Professions with a high degree of pressure are most prone to alcohol and drug abuse and an assortment of disabling mental problems. The legal profession is one of the strongest influences in shaping and governing our society. Sadly it has also been among the professions "under the influence" for some time, hidden until lately and severely impairing the profession and thwarting the aim of justice. | |
| There is little question that the legal profession, zealous in practice and adversarial in nature, is one of the most highly stressful pursuits today. A landmark study in the American Bar Foundation JournaJ2 compared law students with medical students. It tested them before entering graduate school, during school, and on into the practice of their respective professions. Before entering law school, students were found to be similar to the normal population at large on the psychological level. During law school and after graduation, the students were "significantly elevated" in their stress and other psychic symptom levels. 2 This increased throughout the practice of law. Some blame these adverse psychic pressures on the " ... attitudes, behaviors, values and traits" oflaw school training. It is felt that law training makes candidates ... personally or socially undesirable and may be inimical to the process of law." Although the study recognizes that lawyers are"... extremely influential in the life of America's polity, underpinning the political, legislative and judicial systems," the study refers to the lawyers' emotional well-being as being "impaired." | |
| The study confirms that law-school preparation tends to be dehumanizing in nature and utilitarian in its pursuits. Formal legal education does not impart "... a single one ofthe interpersonal skills" so essential in dealing with their own "emotional tensions" or their clients. The study concedes that some law educators feel these "elevated distress levels" sharpen resources for the adversarial, confrontational system of law they must practice. Unfortunately this points to serious handicaps and shortcomings in those entering legal practice and to an inevitable clash with legal and social concepts of candor, equity and justice. | |
| Lawyers are mandated by the Code of Professional Responsibility1 to | |
| "zealously" represent all clients (none are to be turned away except for just | |
| cause, and most clients cannot be dropped without the permission ofthe court). | |
| Many lawyers get carried away by zeal and try to "win at all costs." Law for | |
| many becomes a "driven" profession where "time is money" and the size of fees | |
| and awards the symbols of success. The Professional Code puts little emphasis | |
| on ethics. Lawyers for the most part are taught to study carefully and dwell just | |
| above the "lowest common denominator" ofconduct as laid out in the Discipli | |
| nary Rules. These are the "don't do" guidelines. | |
| The Unheard Conscience | |
| To race up the ladder of"success"in the law, most lawyers rush headlong into the quest for power, material gain and the pleasures that follow. They adopt the "herd" code. Little attention is paid to the (inner) voice of conscience -it goes unheard! In logotherapeutic terms, the most important goal in life, the "will to meaning," is overlooked in the drive for "will to power" and "will to pleasure." Overlooking the need to build meaning and purpose, too many lawyers strive for the transient joys of life. They encounter a conflict of values and conscience which result in what Frankl calls the "existential vacuum." Having attained and drained themselves in getting power, position, wealth, and all the trappings of superficial success, lawyers begin to realize that this sort of satisfaction has no "staying power." In fact it too often conflicts with the true values they hold within and without (at home, family and church). As Frankl would suspect, they begin to ask themselves if there is not something more meaningful than a series of victories and defeats, and amassing material possessions. Anxiety, tension, emptiness, and frustration set in. At the peak ofsuccess, they find themselves in an existential pit. They wonder if there is any meaning at all to life, let alone what that meaning and purpose might be for them. They seem to be riding high, but many feel bored, bewildered, and beaten (even the best litigators meet defeat). Cynicism replaces what little humanitarianism remains in the trade. Like their colleagues caught in the existential quagmire, lawyers look to a quick and easy legal fix. And many of these talented but lost professionals futilely try to fill their existential vacuum with alcohol. But the "fix" is fleeting and fails them. The damage of alcohol abuse to the drafters and upholders of justice is far more extensive than previously realized. There is a sudden realization that new leadership is urgently needed in the law, and dramatic, unique endeavors are required to reverse the damage caused by alcoholism, a significant contribution in this area. | |
| Frankl points out this emotional, existential malaise which occurs when one has a conflict of conscience and ignores the unconscious voices that cry out for action in meaningful, purposeful and fulfilling lives.9 Lawyers, like most of society, are used to operating skillfully in two dimensions, the physical and the psychological. Logotherapy would open up the power of the third dimension, the noetic, the human and spiritual dimension, giving lives additional power and untapped meaning. 8 In this third dimension, "pursuit of meaning"7 would help lawyers move from the "letter" of life and law to the "spirit" of life and law. Presently too many lawyers worship precedent, looking to the past and backing into the future. Humanitarianism, for the most part in conflict with the mechanism of the law, has the power to uplift the law to cope with the problems of society. Just as the word logos means both "meaning" and "word," so the law must broaden its goal to highlight the spirit ("meaning") of the law and strengthen the letter ("work") of the law. | |
| Damage through Alcohol | |
| A brief look at our nation's capitol will give some idea of the damage which alcohol (let alone other drugs) has done to those pledged to uphold the law. In Washington alone there are over 2,500 "hard core" alcoholic lawyers managing peoples' lives, fortunes, and futures. 16 Many more lawyers have problems combining alcohol with a myriad of professional and personal problems (and other drugs). The combination of problems with alcohol handicaps the lawyer's primary function to help others cope. Clients entrust their most important personal problems and possessions to lawyers. Yet over half of the lawyer disciplinary cases involve lawyer misuse of alcohol and/ or drugs. Although untold numbers of drinking and drunken lawyers continue to practice, only recently have lawyers been coming out of hiding and in increasing numbers voluntarily asking for assistance. More than one lawyer a day comes to the lawyers' counseling center for help. Lawyers across the nation are charged by law with the supervision and discipline of their profession. To date discipline and control standards have been so lax that the public is clamoring for a role in the supervision oflawyers. New efforts are being made to cope with the damage alcohol has done and is doing to lawyers. Logotherapy can play an important role by providing new insight and power to heal. | |
| Most forms of therapy across the country are limited to two dimensions, one basing the problem solely on the physical and biological nature of alcoholics. However, even the biological programs rely heavily on adjunctive psychotherapy, specifically on the group therapy of Alcoholics Anonymous. The second basis for therapy is psychological and employs a number of the new psychotherapies, e.g. Cognition Behavior Therapy (Penn), Interpersonal Therapy (Yale), etc. Alcoholics are given counseling and a copy of Under the Influence. 13 The book states that"... accumulated evidence ... positively indicates that physiology, not psychology, determines whether a drinker will become addicted to alcohol or not." The book criticizes the National Institute of Mental Health (NIMH) for viewing alcoholism as primarily a "symptom of psychological inadequacy." The book decries the idea that "irresponsible drinking causes alcoholism," as stated by the NIMH. The book challenges the prestigious NIMH to choose between a disease and a position including the "psychological inadequacy" view. This is the simplistic "either-or" fallacy which is rejected in basic logic. Most therapies follow the NIMH route using the two dimensions. In spite of the position of the book labeling alcoholism a "disease," those with alcoholic problems are sent to AA for 100% non-drug, non-disease therapy (which with all its faults, is acknowledged the most successful). Therapy continues to be a blend of these two dimensions, biological and psychological. Frankl's third dimension employs the sheer power of humanity to heed the inner call to a higher path, to have exclusive rights to select one's attitude, to employ one's freedom to choose and to rise above life's problem~ these strengths must be fully tapped. | |
| Logotherapy's Input | |
| Logotherapy can give a powerful, unique healing input. In this writer's view, alcoholism and alcohol problems are often a combination of physical, environmental, and possibly hereditary factors~ the biological plane. In addition, as the NIH M states, psychology plays a primary role in control. Logotherapy reaches into that third source of power and healing -the human dimension, the power to find real meaning. In this case "freedom ofchoice" is all important. To detoxify and stay dry for a year or two is not enough. The true alcoholic must stay dry for life. With logotherapy one finds the wherewithal to choose not to take that deadly first drink. As stated by Frankl and developed by Elisabeth Lukas, 12 one needs to distinguish the biological dependency treated in a detoxification program, and the search for meanings and values, after detoxification. The alcoholic is not responsible for his biological dependency, but is for his actions afterwards. That choice is not to take another drink. In the third dimension, there is provision for human error and self-forgiveness. Climbing "back on the wagon" is part of the continuing logotherapeutic program. | |
| Therapy for alcoholics is still in a frontier condition. The 50 states have about 50 approaches. Most judges do make AA attendance a condition of rehabilitation and of resumption of legal practice, along with requiring periods of suspensin and disbarment varying erratically from six months to about five years.3 As the true alcoholic is never "cured," the probation period must be for life. This would give the alcoholic additional motivation not to destroy his life and career. | |
| Logotherapy would look to procedures for prevention to avoid following a proforma lawyer lifestyle leading to the nothingness of the existential vacuum. Logotherapy would warn against shortcuts or direct pursuits of instant happiness and prepackaged pleasure that lead to addiction. Only Frankl's formula of causes and experiences above and beyond the self can give healing and soothing to the pain of noogenic neurosis, preventing relapse and a return to alcohol or drugs. Armed with biological psychological and humanistic understanding given by logotherapy, one in the throes of life's crises and/ or chemicals would have the best and strongest chance of climbing out of the abyss into a meaningful existence. Frankl states that unlike the other members of the animal kingdom, humans have the power to choose their attitude, no matter what their condition, to transcend predicaments, and to "turn tragedies into triumphs"10 ("lemons into lemonade"). In alcohol therapy, many find genuine, lasting meaning in life by joining the cause, giving their time and talent to help others out of addiction and dispair, back into real living. | |
| Needed Reforms | |
| Foremost among the things lawyers can do to face the challenging problems which the law faces is to work for reform of the present legal system. The preparation for the adversarial life and the extent lawyers go to win, often "at all costs," not only takes a terrible toll in the life of the lawyer but does grave injustice to justice. There are international methods ofdispute settlement which have stood the test of time. These are used before or in lieu of formal litigation, and would help roll back our reputation of "The Litigation Society" and "sue crazy" lawyers. They take different names and forms but their methods entail knowledge and skills from that third dimension of Frankl's -the humanitarian level. Processes such as mediation, negotiation, conciliation, arbitration encompass justice in its finest and most efficient form. A back seat is given to the hostility, aggression, and confrontation found in the adversary system. As the civil courts are jammed and the criminal justice system almost gridlocked, more effective, friendly, efficient, and economical means can be readily implemented to accelerate reform in the dispute-solving process. Areas where this is working with great promise and with excellent results include family mediation (expertly handled by both lawyers and social scientists) which is friendlier, more private, less costly, quicker, more therapeutic, and more successful than formal divorce in many cases. Wife and child support payments are twice as dependable as in divorce settlements. Fortunately this is a rapidly growing trend in family law. | |
| Arbitration is another area of reform where formality, friction, cost and hostility are diffused. Internationally it is older than the "World Court" and is the most popular choice to settle disputes, with ground rules and most decisions made before problems arise. More and more local jurisdictions are using arbitration, but progress is blocked by vested legal interests in the USA. | |
| On the personal level, many approaches using logotherapeutic techniques would give an additional dimension to the psychotherapy currently used to cope with the big three problems facing bar associations -alcohol, drugs, and mental health problems. Some of these specific logotherapeutic methods are put forth in two books by James Crumbaugh.4-5 | |
| Criminal law presents devastating conflicts to lawyers. The pressures are subtle and relentless. Over 90 percent of criminal clients are probably guilty. Even more depressing, most violence is committed by recidivists. Lawyers must do their utmost to convince judge/jury of their clients' innocence and argue passionately for the defendants' release to the society they have harmed and will probably harm again. Often the criminal, the plea bargaining, and the trial itself will have a disintegrating and deleterious effect on the lawyer who is expected to go "all the way" to win. If he wins, the client often feels he should have done better. Ifthe lawyer loses, he usually gets the blame. To reconcile this contentious, adversarial, manipulative legal process with his personal values of truth, goodness, honesty and justice requires a major effort on the part of the lawyer in his struggle to maintain his integrity and self-respect, let alone the esteem of those important in his personal life. | |
| A Poor Image | |
| Increasingly the lawyer of today is being typed by the public as being untrustworthy, devious, a "shyster," greedy, etc. Polls usually rate lawyers near the bottom ofthe professional scale. It was not always so, according to the president of the Bar Association in Washington, Paul Friedman. 14 He laments the passing of the idealistic lawyer offormer times, held in high esteem by the public. It was an "... ethical, skilled ... noble profession ... resolved disputes fairly and equitably ... attended to clients' interests, and (showed) great sensitivity to ethical obligations." The clients and the public have a negative view today. | |
| Friedman 14 reports on a National Law Journal poll taken in the summer of 1986. When asked "Which professions deserve the most respect," only 5 percent chose lawyers. Clergy scored the highest, followed by doctors and teachers. Only I in IO said they would recommend that a son or daughter become a lawyer. Thirty-two percent thought lawyers were too interested in money (in contrast to the rich, human rewards logotherapy promises in the arena of causes and personal experiences); 22 percent believe lawyers manipulate the legal system wi.thout any regard for right or wrong; 20 percent felt lawyers file too many lawsuits. Little wonder lawyers lack respect, self-esteem and self-worth, dwelling in the gloom and doom of their existential vacuum. Lawyers are a ripe field for logotherapeutic interlude. Reverence for the law profession is at a low ebb, and this exacerbates the lawyer's existential crisis. To feel dishonest and untrustworthy is a heavy lc'ld for a profession to carry, justified or not. A recent popular TV figure warned his client to watch out for lawyers. "They have morals but no ethics!" | |
| An article in the Washingtonian, 15 the area's leading magazine, entitled "Too Many Lawyers" did little to enhance the above image. The theme was "Our legal system -the prime support of our freedoms -is burdened by too many laws, too many lawsuits, too may lawyers, and too much greed." Logotherapists would find things ready for reform both with the nature and extent of the criticisms. They would analyze the same, seeking ways to improve the profession (and the individual) where needed. Even improvement of the public image would help elevate professional performance and lift lawyers out of the existential doldrums. Lawyers actually do a great amount ofpro bono work. But often it is too little and too late. To echo Frankl's lofty favorite of Goethe "If we take man as he is, we make him worse; if we take him as he ought to be, we help him become it.''8 This would herald the positive optimistic and constructive approach used by logotherapy. No matter how low the alcohol-abusing lawyer may have sunk, the therapist must deal with him as he ought to be! | |
| By the very nature of their profession, lawyers are in a unique position to apply the principles oflogotherapy both to enrich and reform their lives and to uplift the legal profession. Frankl points to the role of"causes" in carrying out the "will to meaning." Unlike former times when people went in great numbers to the rabbi, priest or minister with their most personal problems, today many of these people go to lawyers to seek guidance for personal, traditional problems. People are often afraid of going to professional mental health sources lest they | |
| be labeled. But they know that they have greater legal confidentiality and | |
| protection ofprivacy with a lawyer than in the confessional. To render humanit | |
| arian service to those with these needs the lawyer must take a genuine, giving | |
| interest in the person in order to help find solutions. | |
| The educational service lawyers could render is also limitless. They could | |
| present information on every level of education beginning with elementary | |
| school (alcoholism starts with 10 year-olds). Preventive law and practical appli | |
| cations could be stressed. Lawyers could teach alternative forms of handling | |
| disputes, using litigation as a means of last resort. Many persons running afoul | |
| of the law today don't know what the law is, can't keep up with the endless | |
| changes, and thus have little respect for the law. Frankl's urgent plea for | |
| responsibility and responsibleness as the sine qua non of freedom should be | |
| drilled into the minds and hearts of those being educated and those being | |
| rehabilitated. It is the cornerstone of preventative law as well as the foundation | |
| for rehabilitation. | |
| A recent example of the abuse of finding physical and mental excuses for everything, leading to the breakdown of justice, has just occurred in what is touted as a history-making case of compassion in Washington (i.e. compassion for all but the victims). It is a case which flies in the face oflogothcrapy, for it was based solely on finding an escape from responsibility for an alcoholic lawyer who had committed a series of record-breaking crimes on the innocent and unsuspecting public. Lawyers and mental health experts get part of their negative reputation by the endless search for excuses which lift the blame from transgressors, stripping them of the right to be guilty, the right to make amends, and the right to take the royal road to responsibility, reform and rehabilitation. The case is in re Kersey 11 decided in 1987 and is a landmark decision.It absolves an alcoholic lawyer who has lied, cheated, mixed client's funds with his own, misled clients and court, worked against a client's interests, kept his money, and admittedly handled clients' cases "disastrously." Even though this alcoholic attorney faced the judge with one of the "worst, long list of violations" ever before the Board of Professional Responsibility, the judge ignored the Board's consistent recommendation that he be disbarred (later suspended) and (immediately) let him return to the practice oflaw. Alcohol was the "insidious disease" and entirely to blame ... not the poor drunken lawyer. Somehow the despoiled public got left out. The judge felt that alcoholics never really believe they are alcoholics, and punishing the criminal offender would not deter other bonafide alcoholics (contrary to common sense and to the Disciplinary Board which labeled the defendant "one of the worst ever)." Lawyer Kersey immediately returned to "practice." There are three clear losers. The first is Justice -little wonder her eyes are covered. The second is the defendant, Attorney Kersey. He has been robbed of his right and dignity and ability to acknowledge his guilty acts and make restitution for the carnage he committed, a necessary prelude for successful reform. The public and unsuspecting clients now using his services are also the losers and are in jeopardy. There is a fourth loser; it is the legal profession. The court's intentions may have been good, but its wisdom was lacking. This lawyer-judge is seen as protecting a fellow lawyer, holding him | |
| blameless for a long list of provable crimes. | |
| Lawyers will continue to make alcohol their drug of choice. It is a legal, though devastating, drug. Lawyers are too shrewd to fool with illegal drugs. Alcohol is also socially acceptable and widely available day and night. It is inexpensive, though its true cost to the public is staggering. Alcohol's use is easily masked. It is almost impossible to pinpoint the passage from an alcohol abuser to a true alcoholic. The point at which one is a legal alcoholic can be spread over the years. If the alcoholic can prove some lasting psychotic damage, lawyers can use this as a defense to crimes requiring "intent." Deaver, one ofthe closest friends and confidants of the Reagan family, plans to escape perjury charges by blaming his crime on alcohol. 17 Alcohol is a main perpetrator of depression, suicide, and violence. In combination with mental problems and other medications, alcohol can be deadly. It is the chief route to escape from responsibility. | |
| But there are some promising new approaches. Special groups by Alcoholics Anonymous, set up to help "attorneys only," provide the therapy lawyers normally resist, to publicly admit alcoholism and share their problem. More and more alcoholic lawyers and lawyers with alcohol problems ( combined with drug and mental problems) are coming out of the woodwork for help. As long as therapists confine themselves to only two levels, the biological and psychological, the road will be longer and slower to reform and rehabilitation. But if they examine and employ the touch and technique of Frankl's third dimension, they will find ways to restore responsibility and greatly enrich the possibility, speed, and effectiveness of therapy. | |
| ROBIN GOODENOUGH, Ph.D., J.D. isprofessoroflawandpsychiatryat the University of Baltimore School of Law, Baltimore, Maryland. | |
| REFERENCES: | |
| I. American Bar Association, Model Code of Professional Responsibility. Chicago, 1986. | |
| 2. American Bar Foundation Research Journal. Spring 1986. | |
| 3. American Law Reports, "Alcoholic Attorney/Discipline; Rehabilitation/Reinstatement." American Law | |
| Reviews, 4th. | |
| 4. | |
| Crumbaugh, James. C. Everything to Gain. Chicago, Nelson-Hall, 1973. | |
| 5. | |
| ---~ William M. Wood, and W. Chadwick Wood. Logotherapy: New Help.for Problem Drinkers, Chicago: Nelson-Hall, 1980. | |
| 6. | |
| Directors, D.C. and M.D. Lawyer Counseling Bar Association. Interview, June 1987. | |
| 7. | |
| Fabry, Joseph. The Pursuit of Meaning. New York, Harper & Row, 1980. | |
| 8. | |
| Frankl, Viktor E. P.,ychotherapy and Existentialism. New York, New American Library, 1971. | |
| 9. | |
| ____ The Unconscious God. New York, Simon and Schuster, 1975. | |
| 10. | |
| ____ Man:, Search for Meaning. New York, Washington Square Press, 1984. | |
| 11. | |
| In re Kersey, District of Columbia. Court of Appeals, 1/28/87. | |
| 12. | |
| Lukas, Elisabeth. Meaning in Suffering. Berkeley, Institute of Logotherapy Press, 1986. | |
| 13. | |
| Milam, James, and Katherine Ketcham. Under the Influence: A Guide to the Myths and Realities of Alcoholism. New York, Bantam Books, 1985. | |
| 14. | |
| The Washingtonian Lawyer, Washington, D.C., March/ April, 1987. | |
| 15. | |
| The Washingtonian Magazine, February 19, 1984. p. 114. | |
| 16. | |
| Washington Post, March 24, 1987. p. B6. | |
| 17. ____ "Deaver's Use of Alcohol May Figure in Defense," April 28, 1987. | |
| Application of Rotter's Learning Theory to Teaching Logotherapy | |
| Vera Lieban-Kalmar | |
| The great debate of the 1980s about the effectiveness and the parameters of education in the United States is summarized in the Carnegie Foundation Report for the Advancement of Teaching: quality education has an obligation to reach students with data and facts, but must primarily involve them in refining their value systems for the good of society.2 | |
| This debate raised the concern of educators as to how they can measure concrete data of learned subject matter that includes values. How can gain scores be applied to value-oriented subjects? | |
| A course ofexistential psychology may offer an answer. This article presents a pilot study focused on these issues: does student behavior change toward a refined value system as a result of participation in an experiential educational program, such as a survey course in logotherapy? What behavior patterns are responsible for producing the change toward a refined value system? | |
| Theory | |
| For educators, Frankl's concern with existential attitudes and their corresponding value systems is of major importance. Their task, to set an example by modeling a "refined conscience"6 in order to bring about an attitudinal change in students, requires conversion of concepts into workable situations applicable to the students' life. Rotter's Social Learning Theory11 is an analytic explanation, whereby attitudes and value systems are perceived as behavioral processes. According to Rotter, behaviors expressing attitudes and value systems are learned through social interaction; i.e., interaction with the environment in space and time. Rotter agrees with Frankl that meaningful experiences influence each other, creating an interdependence.9 This interdependence is based on the selection and interpretation of reality as it is encountered in new goal-oriented experiences. Rotter observed that social behavior is dependent on three factors: | |
| I. the situation as perceived by the individual | |
| 2. | |
| the expectancy of success resulting from one's conduct | |
| 3. | |
| the reinforcement value resulting from the effects of one's action. | |
| Any event can be defined as reinforcement when it can be shown to change the potential for occurrence of a given behavior. The "Value of Reinforcement" as expanded by Dorsett,4 produces behavior change in a person, if the learning situation is perceived as: | |
| 1. | |
| meaningful 3. repeated | |
| 2. | |
| personally unique 4. the result of one's own action. | |
| JOO | |
| The value of reinforcement warrants goal-directed behavior. The feedback a person derives from the value of reinforcement, and the importance of the situational choice are variables of human learning in a social situation. 12 The relationship of the situation, the expectancy of success, and the reinforcement value are components for behavioral change as approached in this study. | |
| Rotter observed two opposing world view positions in a given situation. One view holds that events are consequences of one's own action and thereby under personal control. This is in agreement with Frankl's concept of a meaningful existence and assuming responsibility for it.7 Rotter refers to this position as the internal locus ofcontrol belief. II The other view, external locus of control, holds that events arc unrelated to one's own behavior and occur by luck, random choice, fate, and therefore are beyond personal control. | |
| Internal locus of control, as related to Frankl's view of a person striving toward meaning in life, was analyzed by Yarnelll 3 and Eisner9 who compared Crumbaugh's Purpose in Life Test3 and Rotter's Internal-External Locus of | |
| Control Scale. 12 These and other authors I ,9, 10 used the same instruments for | |
| their psychometric studies of the external personality types. | |
| This article reports how Rotter's theory with its determinants was adapted to a survey course in logotherapy. The subject matter of this course was taught as a pilot study. The course was designed to illustrate lecture material with audiovisual handouts, and exercises designed to be important to the individual's personal experience. It was hypothesized, that what was being taught in this course would be perceived by the students as meaningful, personally unique, repeated, and as a consequence of one's own actions, and therefore result in a behavioral change toward a higher score on Crumbaugh's Purpose in Life test. 3 | |
| Study and Procedure | |
| Three classes of graduate psychology students (N=35) were taught during the '85, '86, and '87 winter quarters at John F. Kennedy University, a private accredited institution in Orinda, California. The students were not a random sample of general psychology students, but chose this survey course in logotherapy as an elective. To control for extraneous variables, the following criteria were held constant: | |
| I. time of year, day, hour and location of instruction | |
| 2. | |
| the instructional materials and exercises | |
| 3. | |
| testing~ administered on first and last day of class. (To preserve anonymity, social security numbers were used instead of names.) | |
| The class lasted for three months -11 sessions of 90 minutes each, with a I 0-minute break at midpoint. Class preparation was geared at a ratio I:2 ( one hour class time to two hours preparation). The class required, in addition to a reading list, three written assignments: a position paper, a case history, and completion of a 60-item criterion referenced test (to serve as a study guide for the required reading). The course concluded with a JO-item closed book test requiring definitions and sentence completions from questions derived from the 60-item CRT test. | |
| IOI | |
| The subject matter was taught applying the criteria of Rotter's Social Learning Theory; 11 lecture and class participation alternated at a ratio l: I. In order to present course content as meaningful, personally unique, repeated, and a result of one's own actions, class participation was encouraged (but never demanded) in three formats: | |
| I. written/ oral self-reports 2 exchange of activities in dyads or triads | |
| 3. individual presentation of projects. For group work specific regulations were agreed upon and followed: | |
| I. time was to be shared equally | |
| 2. | |
| everyone had a right to respond to questions | |
| 3. | |
| or to pass without penalty | |
| 4. | |
| only positive personal remarks were encouraged in group work. | |
| Example of the lesson plan from Session 4 illustrates this approach: Group reviews "Areas of Meaning," taught previously, followed by a lecture and audiovisuals on "The Socratic Dialogue." This dialogue is then practiced in dyads applying the concepts taught in "Areas of Meaning." Within the dyad each takes turns as client and therapist. Length of the exercise is closely monitored by a prearranged time schedule. In other, more involved exercises, the class is divided into triads, third member serving as observer and providing feedback. In a triad the exercise is rotated among partners, thus repeated three times, each time with other individuals within the triad. At the conclusion of the exercise comments, observations, and insights are summarized with the whole class participating. | |
| Results and Evaluation | |
| The study applied Crumbaugh 's PIL test measuring the degree of student awareness in leading a purposeful existence. It was assumed that an attitudinal scale sensitive to detect existential vacuum would show no significant change in scores on the post test, as students choosing this elective were more motivated in this course than in any "required" course; consequently, they would feel purposeful throughout the course. The PIL test exceeded the one month retesting immunity by two additional months, therefore any change in the scores could not be due to a lack of testing sensitivity. Computed test scores by individual groups are shown in Table I. | |
| Table I. T Test Means and Standard Deviation of Pre-and Post-Test of PIL | |
| Pre M S.D. Post M S.D. df t p | |
| Gr. I 111.00 10.66 123.47 6.38 13 6.99 .001* | |
| Gr. II 105.23 20.24 114.46 17.26 12 4.10 .002* | |
| Gr. III 109.75 7.34 118.25 8.59 7 5.02 .001* | |
| *significance | |
| 102 | |
| Table 2. Combined Group of Pre-and Post-Test PIL Scores Group N Mean D.S. d p | |
| Pre PIL 35 108.54 14.44 | |
| 19.68 8.27 .001* | |
| Post PIL 35 118.80 12.42 | |
| The mean difference in the scores between Pre-and Post-PIL test of 10.26 presented 19.68% of the common variance, exceeding by that amount the effect size stated in the hypothesis. The t value of 8.27 indicated a 2-tailed probability at p. 00 I significance. | |
| Analysis of variance investigated the Mean differences of PIL scores among the three groups regarding gender and age which yielded no significance (p. 5843). Likewise there was no significant variation within the three groups regarding gender and age. | |
| From the results of the differences on the Pre-and Post-PIL test it can be concluded that a change to an increased attitude toward a higher purpose in life took place during the I I-week intervention time for the three consecutive classes independent of sex or age, supporting the hypothesis that in teaching a subject students perceive as meaningful, personally unique, repeated, and resulting through one's own action, students will show a behavioral change on Crumbaugh's Purpose in Life test. | |
| But was this increased PIL score (signif. 001) actually due to the I I-week intervention? This discussion ensued after reporting the test results to the students on the last day of class. Personal accounts stated a possible explanation in the change scores: though students were personally motivated in enrolling in an elective course in logotherapy, and were also aware of their purpose in studying this course, they expressed agreement that involvement in the subject through exercises helped them to focus, clarify, and refine further their purpose in life. These personal accounts were additionally validated with anonymous evaluations of course content, teaching methods, and ratings of instructors~ a routine practice of the University on the last day of class, which uses these statements to maintain quality education of programs. These ratings, equally high for three consecutive years, drew the attention of the administration in charge of the department. | |
| Conclusions | |
| This study showed a consistent pattern which needs further investigation against other patterns of intervention. Does the gain score on the PIL test occur equally in other classes which teach logotherapy in an equal amount of time within the format of a traditional academic lecture setting? Does the gain score in the PIL test occur equally in classes which are taught the same program but with different instructors? Does the gain score on PIL test occur equally in other psychology classes taught at the same time? Finally, these test scores should be investigated over a period of time after intervention stopped, to find if the gain scores on the PIL test had a lasting effect. | |
| The results of this pilot study warrant further investigation of Frankl's position: to teach effectively is to model an example toward refinement of one's conscience -a position which should be further tested applying as guideposts Rotter's Social Learning Theory toward lasting behavioral change. 11 | |
| VERA LIEBAN-KALMAR, Ed.D. is director of training at the Institute of Logotherapy in Berkeley, and teaches logotherapy at the Kennedy University, Orinda, California. | |
| REFERENCES: | |
| I. Addad, Mosha. "Psychogenic Neuroticism and Noogenic Self-Strengthening." The International Forum for Logo therapy, 10( I), 1987. | |
| 2. | |
| Carnegie Foundation. "Sustaining the Vision." Chronicle of Higher Education, June 5, 1985. | |
| 3. | |
| Crumbaugh, James. "Cross Validation of Purpose in Life Test Rased on Frankl's Concepts." Journal of Individual ArchologF, 24, 1968. | |
| 4. | |
| Dorsett, Rohert. "Experiential Learning as Locus of Control Change Technique." Ed.D. Dissertation, University of San Francisco, 1979. | |
| 5. | |
| Eisner, Harry. "Purpose in Life as a Function of Locus of Control and Attitudinal Values: Test of Two of Viktor Frankl's Concepts." Ph.D. Dissertation, Marquette University, 1978. | |
| 6. | |
| Fabry, Joseph. 171e Pursuit of Meaning. New York, Harper & Row, 1980. | |
| 7. | |
| Frankl, Viktor. The Will to Meaning. New York, New American Library, 1981. | |
| 8. | |
| ____ The Unheard Cry for Meaning. New York, Simon and Schuster, 1986. | |
| 9. | |
| Hochreich, Dorothy. "Defensive Externality and Attribution of Responsibililty," Journal of Personality, 42, 1974. | |
| 10. | |
| Lieban-Kalmar, Vera. "Effects of Experience-Centered Decision-Making on Locus of Control, Viktor Frankl's Purpose in Life Concept and Academic Behaviour of High School Students." Ed.D. Dissertation, University of San Francisco, 1982. | |
| 11. | |
| Rotter, Julian. Social Learning and Clinical Psychology. New York, Prentiss Hall, 1954. | |
| 12. | |
| ____ "Centralized Expectancies for Internal Versus External Control of Reinforcement." Psychological Monographs 80, 4, 1986. | |
| 13. | |
| Hamel!, Thomas. "Purpose in Life Test: Further Correlates." Journal of Individual Psychology, 12, 1971. | |
| Logotherapeutic Intervention for Families in Early Chemical Dependency Recovery Patricia E. Haines | |
| Chemical dependency pathology debilitates individuals and devastates families. The most painful aspect of addiction for a family is the human debasement ofdependent persons and family members occurring from spiritual depletion, or as F rankl2 calls it, the "existential vacuum." The first step is crisis management followed by rehabilitation for the afflicted and education/ treatment of the family. These initial steps are necessary but not sufficient for recovery. It must be followed by counseling to bring about change in individual behavior and lifestyle. | |
| The Phenomenon of Co-Dependency | |
| Today clinicians look at chemical dependency as a co-dependency -the user and the significant others. Dan and Marianne, both in their late 30s, have been married for 16 years, with two adolescent children. During the first four years of marriage the couple drank moderately. Then Dan's drinking pattern changed. He continued drinking after the party was over, and Marianne became increasingly aggravated by his behavior. They fought. He accused her of nagging; she accused him of destroying the family with his drinking. Marianne tried to control his drinking by emptying his bottles and extracting promises not to drink, neither proving successful. The children learned to play one parent against the other, blame others for their actions, and procrastinate. | |
| After 10 years of abusive drinking Dan completed a 28-day treatment program, which included the family. As a result Dan was on the road to recovery and Marianne and the children began to work on co-dependency issues that centered around their need to control the home environment in order to prevent his return to drinking. Dan took on that responsibility for himself. | |
| The couple was confused and obviously in emotional pain. "He's not drinking and I attend Al-Anon, but our marriage seems to have more stress," Marianne said. "We're irritable with each other. I resent his AA involvement at times. It seems he gives them more attention than us. We argue more about insignificant things. Sometimes I love him intently and other times I have feelings of hate like 1used to." | |
| Dan said, "Sometimes the atmosphere at home is no better than it was. She still nags. The kids arc unruly. I find myself thinking, "What's the use? I might as well get drunk." | |
| According to Wegsheider, the healing process offamily restoration can begin early in recovery. | |
| Recovery of the spiritual potential begins with the first rays of hope that life can be different ~ at the point of intervention for the dependent, at the very prospect of intervening for the family. Hope is an emotion deeply rooted in the spirit. As hope returns, life can begin to take on meaning again, and the battered psyche can find the strength it needs to start rebuilding all its potentials. The wise counselor nurtures hope tenderly and helps the client use it to fuel work together. | |
| In early recovery the family suffers still, but the pain is different from the | |
| despair when addiction was active. Suffering in recovery is directly related to | |
| growth. Counselors need to help clients understand that "it gets worse before it | |
| gets better." Basically, two people, who lost touch with each other for years, are | |
| beginning to court, a difficult task in an already established marriage with | |
| children. Each member must grow, and grow up, before a solid marriage is | |
| reborn. The problem is they want the happy family now before the work is done. | |
| First things first. Individual recovery must be the first step. To accomplish this, the counselor asks both parties to put off any decision about the marriage until individual healing has firmly taken root. This is not to say that no work is done to maintain togetherness, only that the focus is not yet on marital and family counseling. The "I" must change before the "we" can change. | |
| Frankl said: "It is a prerogative of being human, and a constituent of human existence, to be capable of shaping and reshaping oneself. "3· P· 73 Emphasis in counseling recovering people is on establishing, or re-establishing, a personal value system. This vital step is discussed by Frankl in terms of responsibility: "Man is responsible for what to do, whom to love, and how to suffer. Once he hits realized a value, once he has fulfilled a meaning, he has fulfilled it once and forever. "3· p. 74 | |
| While adult co-dependents work on resolving individual issues and developing a recovery plan, the children are helped to do the same. Individual sessions are held to let them know they are important in their own right. They are encouraged to identify and to change their destructive behaviors. Of course, counseling is designed to relate on their levels of understanding. | |
| The early months are a time to address and conquer individual confusions. During this stabilizing process powerful feelings surface within the dependent and co-dependents. One young woman experienced such conflict. Debbie, 28, completed treatment for multiple chemical dependency. Her husband stood by her during her years of destructive chemical use and during her six-week treatment. Both were on an emotional "high" when she was discharged. They felt all their troubles were behind them because "the cause"was gone. Soon they settled into a daily routine. She attended her recovery meetings. He agreed to attend AI-Anon, though he felt out-of-place because women outnumbered men. | |
| In individual counseling Debbie revealed that she was "bored" with her mate as a spouse and as a sexual partner. She battled feelings ofguilt and shame. Her very conflict within was a threat to continuing sobriety. Painstakingly she sought to find meaning in her contributions to those around her and in new life experiences. She helped others who suffered from chemical addiction. She made coffee for meetings, cleaned up afterward, and stayed for a while to talk to other troubled women. She went shopping for her parents and transported a neighbor to the doctor's office. In short, she became aware of constructive activities that increased her feelings of self-worth, and at the same time benefitted others. Eventually she was able to see her husband in a new, even exciting way. | |
| Obviously, struggle and suffering are part of the healing process. Yet the struggle need not be negative. As Lukas4 points out, logotherapists concentrate on helping clients set realistic goals and enhance their value structures rather than to delve into pathology. They participate with clients in the endeavor to strengthen their spirits and that in turn leads to mental health. | |
| Discovery and Rediscovery | |
| This period ofestrangement, or seeming limbo, is an opportunity for clients to reach for their respective "missions." It can be used productively as "think"time. Frankl4 relates the incident of his brief theraputic encounter with a young survivor of the Holocaust, who spent 2½ years in a mental hospital. The man displayed schizophrenic-type behaviors following liberation. In their sessions Frankl likened the man's situation to the biblical story of Jonah and the whale: Jonah refused to go into Ninevah as God commanded. Jonah did not truly recognize his mission until he had spent time imprisoned "in the bowels" of the whale. After his liberation, Jonah carried out his mission. Using this analogy Frankl helped the man see that through his incarceration, he had been given time to identify his mission. | |
| Therapy should permit clients to fully explore themselves and their surroundings in order to identify missions important to them. They are emerging from years of imprisonment in addiction. With liberation comes a myriad of opportunities. | |
| Counseling in Early Recovery | |
| Initially groundwork is laid with dependents and co-dependents to form a base of recovery. The counselor guides individuals within the context of the family, to integrate the following truths personally: | |
| 1. | |
| I believe I have personal meaning andpurpose in my life. I am important in my own right. No matter what mistakes I have made in the past, no matter how much the quality of my life has deteriorated, and regardless how I have permitted myself to become less than I can be, I have a special contribution to make to someone or something. My uniqueness has always been there. Alcohol and drugs temporarily interfered with my growth. | |
| 2. | |
| I must make wellness a priority in order to fulfill a higher purpose. Being dry and clean, or simply changing behaviors within families, accomplishes little except for the short-term goal of easing tensions and improving life temporarily. Establishing and maintaining total wellness ~ spiritual, mental, physical, emotional~ is an ongoing process of building a meaningful lifestyle through getting to know oneself and developing one's potential. | |
| 3. | |
| To achieve greater fulfillment I must look honest~y into myself; identify shortcomings, and be willing to do something constructive to remedy them. I must be willing to admit that as a human being I am imperfect. Even so, I will do everything in my power to reach my optimum spiritual and functional capacity. Looking at my shortcomings honestly, I will take active steps to change those self-defeating behaviors. | |
| 4. | |
| I am willing to believe that I am not the complete source of my own strength, but that there is a Superior Power that will enrich the quality of wellness and provide a source ofstrength. The book, Alcoholics Anonymous, says: The first requirement is that we be convinced that any life run on self can hardly be a success. On that basis we are almost always in collision with something or somebody, even though our motives are good. Most people try to live by sclf.-propulsion. 1 _p. 60 | |
| For those who have difficulty with the "Superior Power" concept of the recovery programs, it is acceptable to use the collective strength of the group as the Power greater than oneself. Usually with time and an open mind, dependents and co-dependents find a God they can understand. According to Alcoholics Anonymous: | |
| We finally saw that faith in some kind of God was a part of our make-up, just as much as a feeling we have for a friend. Sometimes we had to search fearlessly, but He was there. He was as much a fact as we were. We found the Great Reality deep down within us. In the last analysis it is only there that He may be found_ 1, p. 55 | |
| 5. | |
| I can change me, no one else can. I can't make anyone else do what l want. In chemical dependent families everyone usually has tried to change everyone elsc,resulting in unbearable frustration when efforts are not successful. In early recovery the counselor helps each family member to break this pattern. They learn to modify expectations of others and to accept them where they are in their respective recovery programs. | |
| 6. | |
| I have control over my attitudes. "You have to accept my ill-temper and selfish ways because that's the way I am." Not so. In recovery, dependents and co-dependents learn that attitudes are under their control and can be changed if they choose to do so. | |
| 7. | |
| There are alternatives and choices, always a plan B. Most recovering people, faced with a dilemma, feel as though they must find an immediate solution: therefore, they choose the first one that comes to mind. The counselor teaches clients to slow down the think process, then decide. | |
| 8. | |
| I take personal responsibility/or my decisions. I learn I am responsible for my actions whatever the outcome. I no longer blame others when situations do not turn out as I had planned. | |
| 9. | |
| I can learn how to make daily tensions work for me. It is a myth that recovering individuals should be spared tension because dealing with tensions may "drive" dependents to drink or use other drugs, which in turn will cause | |
| co-dependents to revert to destructive, punitive behaviors. Clients are assisted to meet tensions "head on" and to manage them without a return to old coping behaviors. | |
| l0. Life isn't fair -I don't expect it to be. Sometimes clients delude themselves into believing that in recovery life will suddenly treat them fairly because of their accomplishment. They need to realize that in wellness suffering still occurs, and life, or fate, will not always be kind or fair. But, together in recovery they can weather any storm. | |
| l l. No one owes me a thing. Once at an AA meeting a woman bragged that she had been sober five years. With that, a man replied, "My mother has been sober 68 years." Recovering families will eventually become aware that their behaviors during days of drug and alcohol abuse were abnormal. Counseling and involvement in self-help groups are necessary to restore participants to normal functioning. In other words, I don't expect to be viewed as a "special" person who deserves a medal because I'm well. Rather, I expect to be treated with respect and regard because my efforts have made it possible for me to function as normally as possible. | |
| 12. In spite of trials and hardships, I can build a rewarding and contented lifestyle. Frankl said, "Suffering ceases to be suffering in some way at the moment it finds a meaning, such as the meaning of a sacrifice, "2•P-179 The key to this truth is the ability of clients to put suffering in perspective and to build a responsible, effective, personal recovery program designed to maintain a state of total wellness. | |
| Logotherapy can be of immense value during this critical early phase offamily rehabilitation. There are many recovery programs through therapy such as Alcoholics Anonymous, Al-Anon, Alateen, Tough Love -that bring families, and individual members closer to the state of total wellness, providing the strides that have personal meaning. Personal meaning is the adhesive component of recovery which tells clients, "This is all worthwhile. I want this life and 111 do anything to maintain it." | |
| PATRICI A E, HA INES is a licensed professional clinical counselor in Ohio, completing her doctorate in counseling and human development at Kent State University. | |
| REFERENCES: | |
| I. Alcoholic Anonymous (Third edition). New York, AA Service, 1976. | |
| 2. | |
| Frankl, V.E. Man's Search for Meaning. Pocket Books, 1963. | |
| 3. | |
| ____ The Will to Meaning. New York, New American Library, 1969. | |
| 4. | |
| Lukas, Meaning in Suffering. Berkeley, Institute of Logotherapy Press, 1986. | |
| 5. | |
| Wegscheider, S. Another Chance. Palo Alto, Science and Behavior, Inc. 1981. | |
| Family Treatment and the Noetic Curative Factor | |
| James Lantz and Richard First | |
| This article describes the results of a curative factor in a family treatment study conducted between January 5 and March 31, 1987. The purpose was to prove or disprove the null hypothesis that meaning or the noetic curative factor is important in family treatment as conducted by family therapy practitioners from four different theoretical perspectives. | |
| The four major approaches to family treatment most frequently mentioned in introductory texts about family therapy2•5 are the psychoanalytic, the interactional, the structural, and the existential. In the psychoanalytic approach L2 the therapist helps family members express hidden feelings (catharsis) and develop insight about their feelings. In the interactional approach2,5 the therapist helps family members improve the patterns of communication that are part of their daily living. In the structural approach2•4 the therapist helps the family members develop a more effective and less chaotic family structure in which parents can provide leadership and direction to the family organization. Jn the existential, or noetic, approach2•3 the therapist helps family members discover meaning in their daily existence. These general goals for family treatment, presented by theorists from each approach were interpreted to identify four primary curative factors in family treatment, one curative factor for each approach: | |
| Insight-catharsis: Family therapy helped me and the other family | |
| members express hidden feelings and gain insight about our feelings. | |
| lnteractional: Family therapy helped me and the other family | |
| members improve our communication. | |
| Structural: Family therapy helped me and the other family members | |
| experience a more stable family atmosphere. | |
| Noetic: Family therapy helped me and the other family members | |
| improve our ability to discover meaning in our lives. | |
| Four family therapy practitioners, each with more than ten years of experience, were asked to participate in the study. Practitioners were chosen because of their experience and because each could accurately be considered as a representative ofa specific theoretical approach (i.e., psychoanalytic, structural, interactional, and existential). Each was asked to have five families in treatment for more than four months to choose the most important curative factor of the four identified when treatment was terminated. Every family member 15 years old or older was given four index cards. Each card contained one of the four identified curative factors and the client was asked to pick the one considered to be most helpful. Table I describes the results of this process. | |
| Table l. Study Results | |
| Existential | |
| TOTAL | |
| Curative | |
| Psychoanalytic | |
| lntcractional | |
| Structural | |
| Factor | |
| Practitionc1 | |
| Practitioner | |
| Practitioner | |
| Practitioner | |
| (5 families) | |
| (20 families) | |
| (5 familic:-i) | |
| (5 familie'-) | |
| (5 families) | |
| ( 19 members) | |
| (81 members) | |
| (19 member~ | |
| (21 members) | |
| (22 members) | |
| 3 first choices | |
| 18 first choices | |
| lm.ighl-Catharsis 9 fir:-it choice~ | |
| J fir-a chollT~ | |
| J fin,t chmce:-i | |
| l"a<.:to1 (Psychoanalytic) | |
| 4 first choice:-, 5 first choices 21 first choice<i | |
| lntnact1onal Factor J lir~l choiccs 9 first choicc~ | |
| ( lntcractional) | |
| 9 first choice:-, I fir'.t choic1.: 15 first choice:-, | |
| Stt uctural-Organi1.at ion 2 fir:-,t choice, 3 fir~t choice:-i | |
| Factor (Structural) | |
| 6 fir:-,t choices IO flfst choices 27 first choices | |
| >/octic or Meaning 5 first cho1n:~ 6 first choices | |
| Factor ( 1-.xistcntial) | |
| Insert Table l about here | |
| The noetic ( existential) curative factor was chosen a<; the most helpful curative factor by 27 family member participants. The next most frequently chosen curative factor was the communication factor, chosen first by 21 family members. Note that the client population of each practitioner tended to choose first the curative factor most closely associated with that practitioner's specific orientation. Yet for the three nonexistential practitioners, the noetic curative factor came in second. This means it was the first choice as curative factor behind the curative factor encouraged by the practitioner. The study clearly shows that the noetic or existential curative factor is an important treatment process in all four orientations chosen for this study. | |
| JAMES LANTZ, Ph.D. and RICHARD FIRST, D.S. W. are assistant professors, The Ohio State University, College of Social Work. | |
| REFERENCES | |
| I. Ackerman, Nate. Treating the Troubled Family. New York, Basic Books, 1966. | |
| 2. Foley, Vincent. An Introduction to Family Therapy. New York, Grune and Stratton, 1974. | |
| 3. Lantz, James. "Family Logotherapy," The Journal of Contemporary Family Therapy, 1986, 8(2), 124-135. | |
| 4. | |
| Minuchin, Salvador. Families and Family Therapy. Cambridge, Harvard University Press, 1974. | |
| 5. | |
| Nelson, Judith. Family Treacment. Englewood Cliffs, Prentice-Hall, 1983. | |
| 6. | |
| Satir, Virginia. Coryoint Family Therapy. Palo Alto, Science and Behavior Books, 1964. | |
| Making Logotherapy a Reality in Treating Alcoholics | |
| Rosemary Henrion | |
| Over the past fifteen years James Crumbaugh 1,2,3 has developed five steps with corresponding exercises in the practical application of logotherapy. These steps are realistic and workable for discovering new meaning and purpose in life. | |
| As a psychiatric mental health clinical nurse specialist I provide direct care in acutely emotionally disturbed veterans and their families in individual, group, and family therapies at the Veterans Administration Hospital at Gulfport, Mississippi, a neuropsychiatric division ofthe Biloxi VA Medical Center. Some 450 beds of the Center are allocated for patients with emotional disorders. The logotherapy program is regularly attended by IO to 12 patients from the Alcohol Treatment Unit and psychiatric units. Classes consist of 45 minutes of instruction and 40 minutes of logo-psychotherapy. The group meets three times weekly. The alcoholic-treatment patients remain in logotherapy for 21 days out of a total treatment of 28 days, but some request to continue in logotherapy as outpatients. Patients with psychiatric diagnoses remain in logotherapy as long as they are in the hospital or feel they are gaining therapeutic benefits. | |
| Patients admitted to the logotherapy program fill out the Purpose-in-Life Test,3 intended to measure their "existential vacuum." The test is again administered after completion of the program, to ascertain effectiveness. This test has been used internationally in more than I00 theses and dissertations. | |
| One of Crumbaugh's contributions to the practical application of logotherapy lies in the area of creative values. A number of exercises are especially designed for patients to use introspection and reflection in major problem areas and in future-oriented goals. | |
| Referral to Logotherapy | |
| Every patient admitted to the Gulfport Division is interviewed by the treatment team within 72 hours. The team is composed of a psychiatrist, clinical psychologist, psychiatric social worker, professional and sub-professional nurses, dietician, and music, recreational and occupational therapists. I am included in the treatment team; my presence at patient staffings provides team members with the opportunity to acquire an in-depth awareness of the therapeutic benefits of logotherapy. The treatment team makes decisions with patients actively participating in the treatment plan. When patients are referred to the logotherapy program, I remain in frequent communication with the team, both verbally and by recording the observations of patients' behavior. After veterans complete the program, I send a written evaluation to the psychiatrist about behavior in class and the degree to which I think they may apply logotherapeutic principles after discharge from the hospital. | |
| I usually begin with Maslow's hierarchy of motivational needs. The first level pertains to survival (food, shelter, warmth); the remaining four levels are psychological: security, self-esteem, love and affection, and self-actualization. This information is there to develop awareness of problem areas. The patients often express feelings of restlessness, boredom, and isolation from society. These feelings lead to drink and illegal street drugs. As patients deteriorate physically and emotionally, their negativism worsens until a crisis is reached and they have to be hospitalized. In this state of emotional upheaval and physical illness, patients respond best to the alcohol treatment program and logotherapy. If appropriate action is not quickly taken, rationalization becomes the coping mechanism, and patients lose the will to recover. By complementing alcohol treatment through group psychotherapy and lectures, the treatment team feels that patients without purpose and meaning will benefit through the logotherapy program. | |
| The five steps Crumbaugh developed are: (1) selecting a view of life, | |
| (2) developing self-confidence, ( 3) stimulating creative thinking, ( 4) establishing encounters, and (5) "dereflection" (accentuating the positive).2 | |
| Two Life Views | |
| In the first step the patients need to clarify within themselves whether their belief system is mechanistic or theological. Individuals with a mechanistic belief system see themselves as mere machines, mechanical devices. They are nothing more than any other animal except more sophisticated, the result of chance, with no intrinsic purpose despite the regularities of natural laws. Mechanistic persons do not believe in a hereafter; for them the personality ceases at death. Since there is no intrinsic meaning or purpose in life, they have to pull themselves up by their own bootstraps and create their own meanings, especially during stressful periods. | |
| The teleological belief system has been defined as the doctrine offinal causes, or adaptation to definite purpose.4 It holds that humans may be described in some ways as machines but are much more. Although psychological processes, conscious experience, and feelings are functions of the brain and nervous system, they cannot be reduced to bodily processes alone. Max Scheler states that humans alone among the animals have the ability to contemplate the possible, to control their future, and are not limited to past or present. 1• P-124 According to this view a Higher Power created a unique human being and a design with meaning and purpose. But human beings, having free will to direct their future, are therefore responsible for making choices. The future will bring difficulties. Significant losses will occur. | |
| The attitude ( attitudinal value) with which individuals face conflict will depend greatly upon which of the two viewpoints are adopted in their approach to life. Ifthey have not given much thought to the critical approach, they will, in difficult periods, probably turn to alcohol to escape the pain, or become dependent on tranquilizers or illegal street drugs for temporary relief from the stress of their problems. The ultimate copout is suicide. | |
| Most patients who hear of this choice in approaches to life and its implications, respond positively to the task ofchoosing. Frequently, this is the first time they have reflected upon their needs and the effective coping mechanisms to meet a crisis. One person said, "I have never thought about a belief system. I never developed goals or plans for anything; I just drifted from one day to the next." A second one said, "I have had no reason to reflect upon what I believe or what I need to do with my life. I know I wanted to be successful like other people but every time I get to that point, I start drinking, and failure is the result. I don't know why I do these things to myself ..."A 34-year old man said, "I am really angry that I have wasted so much of my life. I see that logotherapy is going to be therapeutic for me." | |
| I assist patients as individuals or in groups in deciding whether the mechanistic or teleological view fits them best. Most patients believe in the teleological view; readily identify their needs, begin the search for new meanings and purposes from this point of view. For others who "straddle the fence" one didactic session or logo-psychotherapy session sometimes is the turning point. One patient said, "I felt I was mechanistic until yesterday, when I received this note from my mother." The note was attached to a prayer and said, "I will continue to pray for you. Love, Mother." This communication helped him realize that he believed teleologically, and he said, "I prayed to a God and I really didn't know if there was one." He looked shocked that this event occurred to him, but this seemed to be just what he needed to finalize his decision. | |
| Self-Confidence | |
| The second step is to develop self-confidence. Once patients are aware of their life view, they reflect on their behavioral patterns, past and present. They have little or no self-confidence because of repeated failures and because they couldn't cope with daily problems. They often experience emotional devastation in such areas as occupation, marriage, or parenthood. To increase their self-confidence, Crumbaugh developed the Power of Freedom exercise2• p. 69-71 in which selfassuring statements are repeated twice daily in the morning, and just before bedtime at night. To achieve optimal therapeutic benefits, this exercise must be done regularly. It is based on the fundamental assumption of logotherapy that human beings have an area offree will, that all life is not completely determined by conditioning plus heredity. Therefore, they can make free choices in all situations and direct themselves toward chosen goals. | |
| Another exercise formulated by Crumbaugh is the Projection of Creative Meaning exercise.2, P-71 -73 It assists patients to make their best choices by a balance of intuition checked by reason, and select the wisest action under present circumstances. | |
| Creative Thinking and Encounter | |
| After the patients develop some self-confidence, they begin the third step, to think creatively. "Now that I am in this situation, what am I going to do with my future?"This question is discussed in logo-psychotherapy groups, and problemsolving begins to take place. The vocational psychologist provides aptitude and general psychological testing, and recommends possible areas of employment. Patients may be helped to prepare for a profession by formal education in university or technical programs. As the course progresses, the search for new purpose and meaning continues, and most patients become more hopeful. | |
| The fourth step is encounters in meaningful relationships. Many participants in the class have read the assigned chapter2, PP-88ff and know the definition of encounter, but have never experienced this kind of relationship; this is a new adventure for them. So I explain the rationale for their being unsuccessful in establishing an encounter. | |
| When individuals experience emotional disorders, satisfying relationships with others break down. They must examine their lives to determine what specifically caused the breakdown. The most significant factor preventing two people from developing a deeper, more meaningful relationship, is lack oftrust. Patients in the group have opportunities to share thoughts and feelings openly about their relationships with others. They also discuss future relationships that they would like to be meaningful and purposeful. | |
| In the continued struggle to find meaning in relationships, it is helpful to consider the three sources of encounter: the sub-human, human, and suprahuman. | |
| At the sub-human level individuals relate to animals rather than to other human beings. For some people this is the easiest way. Somewhere in the past, they may have experienced a severe traumatic relationship with a "significant other" human being.Now they feel threatened by any other similar relationship; the feeling of rejection or abandonment is too painful. Subsequently, animals may be accepted as though they possess human characteristics; they are "personified." An encounter on this level is non-threatening. | |
| The next, the human level, involves a genuine relationship with another human being, which is deepest and most significant when feelings arc shared, when partners understand and accept each other for what they are rather than for what they have to offer materialistically. | |
| The third level of encounter pertains to a Higher Power, in Frankl's terms, the suprahuman dimension. Individuals may believe that the world is the result of design or ofchaos, but they must reach a decision before they can make meaning out of their lives in relation to life as a whole. This decision will condition how they will face life's problems. | |
| Individuals who have never witnessed a deep, meaningful relationship at the human level, may tap various sources for an authentic encounter. The first may be close relatives and friends. Civic groups, church activities, adult education classes, and volunteer groups are excellent means to meet others and to develop a rapport which can lead to "encounter"-type relationships. It takes time to develop genuine and meaningful relationships, but in the meantime one may increase interpersonal skills and learn to differentiate between complementary and destructive personalities. The latter should be avoided, because such encounters can never be formulated successfully. | |
| As the result of an encounter each person is needed by another; this fulfills the needs of both since the real basis of each need is to be needed by others. Through being needed personal identity is established, satisfaction is felt, and this ultimately provides true meaning and purpose in one's life. This, in turn, gives individuals a feeling of being somebody. 2• r-89 While some people are successful with encounters, other may feel that their skills here are poor. For these the"Act as Ir'exercise is workable,2• PP· 97ff and provides a springboard which helps them feel comfortable emotionally with others. They progress through five steps from practicing alone, with strangers, acquaintances, friends, and eventually in conflict settings. They begin to feel "as if' they arc the self-confident, successful persons they would like to be. ' | |
| Dereflection | |
| The fifth and final step of searching for new purpose and meaning is dereflec | |
| tion, the core of the logotherapeutic process. When patients dereflect from their | |
| shortcomings to their assets and successes, they find new goals and make their | |
| lives worthwhile. Involved with other human beings they fulfill the need to be | |
| needed by others. Having grown emotionally through the materialistic stage of | |
| life, they experience what may be called the spiritual encounter. | |
| Most patients have not prioritized their value system or even thought about the ramifications of a value system. This is accomplished by the Meaning in Life Evaluation Scale,2• PP-105-ios which lists 20 values and helps iri.dividuals to rate them in order of preference. | |
| Patients complete the rating at their leisure. At the following class each Meaning in Life Evaluation Scale is discussed individually, and the five top values are identified for each individual. We also discuss the five lowest values and the need to avoid them. By this time patients have developed deeper levels of awareness of what causes major problems and what they have to do to avoid pitfalls and to increase chances of success. Meanings evolve eventually from selected values; and as patients test their new-found values, these will be reinforced by appropriate life experiences. This, in turn, helps develop personal identity and ultimately the feeling of being Somebody. I caution patients that this may not occur within the brief periods of the program. They must work consistently to accomplish their goals. | |
| Feedback From Patients | |
| As patients successfully complete the program, the treatment team receives positive feedback about logotherapy through patient-planning conferences. Patients report drastic changes in behavior, especially from negative to positive attitudes. The principles of logotherapy are often applied in family therapies. | |
| Logotherapy has been found a significant and worthwhile treatment modality in cases when a patient's behavior indicates little or no purpose and meaning in life. Patients with diagnoses such as depression, cancer, stroke, paraplegia, quadruplegia, cardiac conditions, manic-depressive, psychosis, schizophrenia and Huntington's Chorea have successfully completed the program. The approach is: (I) catharsis, (2) assessing the levels of patients' competencies and limitations, both physically and emo!ionally, and (3) assisting patients to reach the maximum potential as r,uman beings (self-actualization) with purpose and meaning in life. | |
| Perseverance and determination are significant elements in making the commitment to follow the five steps in searching for new purpose and meaning in life. In finding meaning, patients will develop causes, and most people need a cause to make life meaningful. We probe the genuineness of verbal assurances that patients have a sincere desire for a new purpose and meaning in life. Some tend to intellectualize -a barrier to getting through to real feelings. This topic, too, is explored in-depth in logo-psychotherapy groups. Patients progress at their own pace; I continue to assist those who show sincere interest in developing their maximum potential. | |
| The success rate for our alcoholic-treatment population is about 20 to 25 percent. This may not seem a high return for expending so much energy, but we feel that if one individual is successful in finding purpose and meaning in life, the effort is worthwhile. It is evident we place a high -a priceless -value on human life. | |
| ROSEMARY HEN RION, MSN, M.Ed., RN is a psychiatric clinical nurse specialist in the Veterans Administration Medical Center, Biloxi, Mississippi. | |
| REFERENCES: | |
| I. Crumbaugh, J.C. Everything to Gain. Chicago, Nelson-Hall, 1973. | |
| 2. ____ Logotherapy: New Help for Problem Drinkers. Chicago, Nelson-Hall, 1980. | |
| 3. | |
| ---~ and L. T. Maholick. Manual Instructions for the Purpose-in-Life Test. | |
| 4. | |
| Dorland's Illustrated Medical Dictionary. Philadelphia, W. B. Saunders, p. 1151, 1965. | |
| Scheler's "Philosophy of the Heart" and Frankl's Understanding of the Self | |
| William Blair Gould | |
| Max Scheler (with Edmund Husserl and Martin Heidegger) is one of the "founding fathers" of modern phenomenology. He also influenced other key thinkers of the twentieth century, including Martin Buber, Gabriel Marcel, Henri Bergson, Ortega y Gasset, Paul Richoeur, and Ludwig Binswanger. | |
| Scheler insists that each person must develop his or her own unique, metaphysical understanding. Every person is a co-creator with the Ground of Being. Scheler envisions an essential harmony among God, the self, and the world. The dynamics of this harmony allows human spirit and drive to interact in the exercise of personal freedom and responsibility. The stress on testing life turns Scheler from an emphasis on foundations (metaphysics) to how we know how to act and think (epistemology). | |
| Scheler's noological method (also central in Frankl's thought) emphasizes that the meaning of being lies in the exploration of spirit (Greek: Noos). The discovery ofthe nature and role of spirit is not an escape from life, but a turning to life, to find how noos enables the self to be fully human, as the bearer of values. Scheler's noological method is realistic, putting the burden of self on a person's place in the world (Dasein). Scheler opens the way to Daseinanalyse rather than depending upon a formal rule such as Immanuel Kant's moral categorical imperative. | |
| Scheler does away with the old body-spirit dualism that has haunted philosophy since Descartes, by focusing on the nature of the person as person. Thus, the human being is free to explore how spirit and body work together, in the formation of the person and the person's relationship to the world. Scheler's noological method, expressed phenomenologically, avoids the self from ever being isolated. Rather, the self remains a vital part of the world. | |
| Schelcr's noological method uses reason as well as action. He views philosophy's task of involving the self in what he calls "essential knowledge," which includes "loving participation in being." Essential knowledge comes from the thoughtful, active response of the "loving participation in being." | |
| Schelcr, in his comprehensive study of ethics,9 turns from metaphysical and epistemological issues of his earlier work to a philosophy of value. What distinguishes him from other philosophers of this time is not the place ethics occupies in his thought, but the way he relates ethics to what he calls "the philosophy of the heart." | |
| His "philosophy of the heart" receives its inspiration from Blaise Pascal and his well-known aphorism "the heart has its reasons that reason knows not why." Scheler's philosophy is an ontology of the self verified by the world ofexperience in which the rational and empirical aspects of life interact with the intuitive. | |
| Scheler's emphasis on "the nature and ordering of love" provides the rationale and the power for the self as the bearer of value. He defines love as "the movement wherein, every concrete individual object that possesses value achieves the highest value compatible with its nature and ideal vocation; or wherein it attains the ideal state ofvalue intrinsic to its nature. "7, P· 161 Love has cognitive power; it is a shared dynamic value, and provides the means for a true understanding of the self. | |
| For Scheler/ate is one of"the givens" oflife. It is blind to values and limited to those events in our lives that are determined by our character traits and by concrete events. In contrast, destiny is not what happens to the self, but an integral part of selfhood. Destiny is tied to how we respondto events through the insights we bring to a situation, and how we utilize the ordering of love. Thus, fate and destiny have important but different roles in how persons see themselves and how they respond to life. | |
| Human beings may face fate in two ways: they can be so tied to it that they don't even recognize it as such; or, they can acknowledge it and take a stance against it, using self-transcendence. In so doing, they learn to exercise their freedom through what Frankl calls "the defiant power of the human spirit." | |
| The ordering of love awakens the self to authentic self-love. It is "the mother of spirit and reason itself," and the essence of the world order in which the self is called to participate. Essentially, the ordering of love serves as source of all individual and social values, in the present and future. | |
| The ordering of love is at the center of Scheler's "philosophy of the heart," which involves the whole person and reaches out to the whole world. The heart gives the self its moral sense, it is the "microcosm of the world of values. "8, p. 116 Love, while aware of the past, helps the person to cultivate those values that will contribute to a future in which both the individual and society will bring true values to fruition. While the body may weaken and the will may flag, love does not weaken or fail. It remains the essence of the self. It is alive and present, ready to furnish true knowledge, correct errors, control passions, and guide the self toward achieving an authentic form of love. | |
| When Scheler speaks of the role of spirit he carefully distinguishes between control (Lenkung) and guidance (Leitung). The spirit guides. It does not control. The spirit helps persons express their intentions so they can fully make their own choices as to how and where to love. But the conditions that permit freedom also permit strife. Intentions are formed and validated or invalidated, as the self freely wrestles with its own impulses and drives. Scheler's recognition of the need for creative tensions is adapted by Karl Jaspers who, however, goes beyond Scheler to give strife an ontological status as the truth of Existenz (all existing life), rather than just an opportunity for spirit to manifest itself. | |
| Experience is not something added to life. For Scheler, it is validation oflife, necessary for judging the authenticity of the person's intention. He agrees with Martin Buber in seeing the I-Thou relationship validated by the "we." Through the I-Thou relationship the individual calls upon a higher dimension of the self (spirit). When this happens self-transcendence occurs. | |
| Scheler, who during the First World War witnessed its after-effect on his native Germany and the rest of Europe, was aware ofthe subordination ofvital societal values by both nationalism and utility. He urged that this situation be reversed i,n two ways: by recognizing true values and acting as value bearers; and by understanding what it means to be bearers ofvalues as individuals, as well as a "collective person." He urged that the self keep a sense of one's own individuality while relating to others. He emphasized that we share in a special solidarity in which people in a societal unit are co-planners and co-a_ctors in choosing values. The higher the values they choose and act upon, the greater chance there is for such solidarity to occur and to continue. | |
| Scheler is realistic about the acceptance and application of his societal plan. He comments that "the main thought in Pascal's ordre du coeur [order of the heart] and logique du coeur [logic of the heart] have been revitalized in our era with its immense desordre du coeur [disorder of the heart]. "9, P-xxm | |
| Scheler follows his diagnosis of "the disordered heart" with a suggested cure. Ressentiment can be overcome by the person he describes as the "noble man," the person who can exercize what Frankl calls" the defiant power ofthe human spirit": the person aware of his own self-worth, and the value of others. Scheler's optimism concerning the human self begins with the individual; it is completed by a society of value-bearers, united and dedicated to "the ordering of love." | |
| Strife is an area of both order and disorder. It is rooted in the very nature of life itself; is part ofits spirit and drive. Drive is the essential dynamic quality that keeps a person from what Frankl calls homeostasis (stability without growth). Strife is essential in the formation of value-theory because, through self-testing, it brings out the ensuing struggle for meaning and keeps us from envisioning a utopia for ourselves or our societies. | |
| Scheler and Frankl | |
| A contemporary philosopher says that Viktor Frankl's chief contribution has been described as "calling attention to the fact that man must be understood as a creature who needs meaning to life."5• P· 284 He goes on to say, "religiously minded people will find classic themes such as the meaning of suffering appearing throughout his writings in secular vestments. Equally significant are numerous insights from Scheler which Frankl has incorporated into his own theories. "5 This summary section selects and critiques key insights that Frankl shares with Scheler, concentrating in three areas: (I) Methodology, (2) Ethics, and (3) Teleology. | |
| I. Methodology. William Sakahian states that, "logotherapy is a form of phenomenology", and that the phenomenology to which logotherapy is most closely related is that of Max Scheler. "6• P-57 He goes to the heart of Frankl's methodology when he points out that "not only does Frankl define 'meaning' as 'what is meant"' as Scheler does, but he agrees with Scheler about the phenomenology of experience, especially that "meanings are among the contents of phenomenological experience ... logotherapy is a personalistic philosophy like Scheler's phenomenology."6· P· 57 Both Scheler and Frankl are similar in their view of the self. and in their approach to selfhood: they share the noological method and agree that the noetic dimension of the self is a "given" (a priori). Further, they insist that the noetic is not only the key to the understanding ofthe self, but that it is the intrinsic quality which makes a person a person. While Scheler does not deal directly with the issue, he appears to agree with the conclusion Frankl reaches; that while the noetic may be blocked or ignored, it cannot become ill. Frankl goes beyond Scheler to hold a holistic view of the self, showing the interaction of mind, body, and spirit. | |
| Frankl shares with Scheler the concept that the a priori qualities of life, especially the noetic, are tested by experience. Both men have ben influenced by Martin Buber's idea that the "I-Thou" and "I-it" relationships of life must be expressed and tested by the "we." Frankl's analysis of Buber is not opposed to Scheler's, but his emphasis differs. Scheler, in his value sociology, stresses the horizontal reaching out of the "I-Thou" to the "we." Frankl, while not denying the horizontal expressions of the "I-Thou", points to the vertical in the encounter between the "I and Thou". The vertical dimension becomes the basis for Frankl's height psychology. | |
| Self-transcendence is the essential aspect of the noetic affirmed both by Scheler and Frankl. For they agree that it is through self-transcendence that the self receives both perspective and direction for life, including its values. But even self-transcendence does not erase the ambiguities or conflicts, as Scheler and Frankl show in their understanding of strife and suffering in human existence. While he does not use the term, "dimensional ontology". Scheler's phenomenological approach to the self is in harmony with Frankl's outline of dimensional ontology and its two laws: (1) "one and the same phenomenon projected out of its own dimension into different dimensions lower than its own is depicted in such a way that the individual pictures contradict each other; (2) different phenomena projected out of their own direction into one dimension lower than their own are depicted in such a manner that the pictures are ambiguous. "4• P-23 Dimensional ontology accepts the contradictons and ambiguities of life and affirms that, while facing both, the noetic dimension gives the self the power to deal creatively with life and to find value and meaning. Scheler and Frankl see ethics as a value-bearer to be the most important area of concern for the self. | |
| 2. Ethics. Frankl and Scheler came out of a Neo-Kantian academic background. In their study of ethics, they go beyond Kant. Instead of adopting a Kantian formalistic framework, they use a vitalistic and value-oriented understanding of the self Scheler focuses on "the ordering of love," Frankl on the search for meaning. Scheler gives a hierarchy of values for his ordering of love, while Frankl bases action of the self on three types ofvalues: creative, experiential, and attitudinal. Attitudinal values are the key, for through them the creative and experiential are integrated so that meaning is achieved. | |
| The importance of attitudinal values is the understanding they bring to ethics as the expression of freedom and responsibility. Scheler and Frankl are concerned both for the status ofthe nature of an object (Sosein)-What it is -and for the status of its existence (Dasein) --Where it is. They are careful to | |
| distinguish between the two, while noting their interdependence. This distinc | |
| tion allows them to explore: The (I) nature of the self (its being), (2) how the self | |
| is formed (phenomenology), (3) the selfs relation to the situation in which one | |
| finds oni::self existing, (4) and the role of the ethical in each. In so doing, they | |
| seek out the full dimensions of a person, avoiding the old philosophical split | |
| between rationalism and empiricism which was faced, but not resolved, by | |
| James's pragmatism. Scheler and Frankl go beyond James to show how the | |
| noetic can utilize both reason and experience in ways that allow the self, as a true | |
| bearer of values, to truly be a person of conscience. | |
| Scheler and Frankl's noological approach expands the dimensions of conscience. Frankl, using Scheler's understanding of phenomenology, defines conscience as "the intuitive capacity of man to find out the meaning of the situation." This includes "the power to discover unique meanings that contradict accepted values. "4• r. 63 Thus, for both Scheler and Frankl, human conscience is the value-centered core of the self that acts on its intuition and in so doing, reflects true freedom and responsibility. Scheler's moral philosophy focuses on the self as value-bearer. It is the raison d'etre for his measurement of the origin and the expression of values. Frankl goes behind these ethical scales, to explore the common denominator of values. He defines it as meaning, related to the affirmation of a life of meaning. At first glance, it might appear that Frankl's meaning analysis has little or no relation to Scheler's "philosophy of the heart" centered in "the ordering of love." But a closer look shows that there is, indeed, a kinship. Each begins with an ethical task, the need to awaken the self as a bearer of values through which meaning is achieved. Each also affirms that "conscience, the centerpiece of the noetic dimension is as much a part of reality as body and psyche. "2• P-67 Each points out that while the conscience may speak to the self, a person remains free to respond "yes" or "no" to it. Each agrees that to be fully human -the self must be led not driven. Scheler's understanding of the person matches Frankl's definition that "he is a being who continuously decides what he is: a being who equally harbors the potential to descend to the level of an animal or to ascend to the life of a saint. "3-Thus, for both, | |
| P-40 | |
| conscience is free, "a personal, intuitive outreach into the world of unique meaning potentialities. "2• P-77 As such, conscience is ultimately the instrument of the progress for humankind. Scheler and Frankl are realistically optimistic about the future of the human race, including our progress, despite Scheler's shock and disillusionment concerning the First World War and Frankl's incarceration in four Nazi concentration camps in the Second. Finally, each affirms essential trust in the human. It is expressed by what Frankl calls Monanthropism, "an awareness that we are all members of one humanity regardless of color, religion, and political beliefs. "2• P-93 | |
| Teleology. Scheler's and Frankl's philosophies move from a grounding in the noetic, to how the noos is applied to lived values. They conclude with a teleology that reflects an optimism that is reasoned, experiental, and intuitive. | |
| Both Scheler and Frankl view society as a major dehumanizing factor in human life. While Frankl offers therapy to overcome what he calls the noogenic neurosis caused by society, Scheler offers a plan centered in sociology. Scheler writes that "man before he is an ens cog it ans (a thinking entity) or an ens volens (a willing entity) he is an ens amans (a loving entity). "8• P-111 He concludes that "where his 'heart' is attached, there, for him is the 'core' of the so-called essence of things. "8, P-111 Frankl essentially agrees, indicating that the less the heart is attached the more the self is dehumanized. But he adds another dimension, saying that only the search for meaning can lead to a life of meaning where "the heart" can come to terms with the past, live responsibly in the present, and plan with realistic optimism for the future. | |
| As we review the lasting value of Scheler's thought for Frankl, selftranscendence emerges as an essential quality for the understanding of the self. | |
| Frankl writes of self-transcendence taking place through a task worth doing and/ or a person to love. The latter -· a person to love -is, in effect, a restatement of Scheler's "ordering oflovc." Neither Frankl nor Schcler are exact in their definition of how love is to be ordered or with whom it is to be shared. This is not vital. What is important is that they point toward the ordering oflove as a concept and an act that releases the self from its egocentric entrapment and --by so doing -enables the individual to find new meaning. | |
| In this discussion of Scheler and Frankl we have argued that "the mind and heart of love" is central to the thought of each. As indebted as Frank! may be to the pioneer phenomenological work of Scheler, we must conclude that Frankl has not only used Scheler's insights but transmuted them in the process. As a result Frankl presents a more fully developed understanding of the noetic dimension, as expressed in logotherapy. | |
| At the conclusion of his discerning analysis of Scheler Alfons Deeken says of | |
| Scheler what could also be said of Frankl: | |
| His ideas may not offer a perfect blueprint ... They do, however, | |
| offer a considerable number of building-stones for the ethical, social | |
| and cultural foundation of a future world civilization. 1, P· 2ss | |
| WILLIAM BLAIR GOULD. Ph.D. is Chairman, Division ofthe Humanities and Professor of Philosophy and Religious Studies, University of Dubuque; diplomate, Institute ofLogotherapy. This article is a revision ofa paper given at the Annual Meeting of the Southern Society of Philosophy and Psychology, April 1987. | |
| REFERENCES: | |
| I. Deeken, Alfons, Process and Permanence in Ethics: Max Scheler's Moral Philosophy. New York, Paulist Press, 1974. | |
| 2. | |
| Fabry, Joseph, The Pursuit of Meaning. New York, Harper & Row, 1980. | |
| 3. | |
| Frankl, Viktor E. Psychology and Existentialism. New York, Simon and Schuster, 1967. | |
| 4. | |
| ____ The Will to Meaning. New York, New American Library, 1969. | |
| 5. | |
| Sadler, William A. J. Existence and Love. New York, Scribner and Sons, 1969. | |
| 6. | |
| Sahakian, William, "Logotherapy -For Whom?" in Logoterapy in Action, (Fabry, Bulka, Sahakian eds.) New York, Jason Aronson, 1979. | |
| 7. | |
| Scheler, Max., The Nature of Sympathy. London, Routledge and Kegan, 1979. | |
| 8. | |
| ____ cited by Lachternam. Selected Philosophical fasays. Evanston, Northwestern University Press, 1973. | |
| 9. | |
| ____ Manfred Frings, and Roger L. Funk, Formalism in Ethics and Non-Formal Ethics. Evanston, Northwestern University Press, 1973. First published in German in 1913. | |
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