SOURCE_DOCUMENTS/journal_012_2.txt

JOURNAL OF SEARCH FOR MEANING Volume 12, Number 2 Fall 1989 
CONTENTS 
Caring: The Ethical Imperative of the Healing Arts and Sciences . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 *HansW. Uffelmann Logotherapy as Homecoming . . . . . . . . . . . . .. . . . . . . . . . . . . 74 *James D. Yoder Finding Meaning in Suffering . . . . . . . . . . . . . . . . . . . . . . . . . 82 *Robert C. Barnes Exposing Prisoners to Logotherapy . . . . . . . . . . . . . . . . . . . . . 89 *Mignon Eisenberg Logotherapy for Former Prisoners . . . . . . . . . . . . . . . . . . . . . . 95 *Rosemary Henrion Logotherapy and Nursing Practice . . . . . . . . . . . . . . . . . . . . . . 97 *Charlotte Stefanics Existential Vacuum in Grieving Widows . . . . . . . . . . . . . . . . . 101 Jay I. Levinson Moral Judgment and Meaning in Life. . . . . . . . . . . . . . . . . . . 110 Moshe Addad and A vraham Leslau The Meaning of the Moment . . . . . . . . . . . . . . . . . . . . . . . . . 117 Sandra A. Wawrytko Book Review . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . 124 
* Papers read at the Seventh World Congress of Logotherapy received too late for inclusion in the Proceedings of the Congress published by the Institute. 
VIKTOR FRANKL INSTITUTE OF LOGOTHERAPY P.O.Ilox 156 • Berkeley, CA 94704 • (415) 845-2522 
85 years of Milestones In the History of Logotherapy Stephen s. Kalmar 
This list presents chronological data of outstanding events during the 85 years of Viktor Frankl' s life. For a detailed bibliography of Frankl's publications see E. Fizzotti and F. Vesely in V.E. Frankl Logotherapy und Existenzanalyse, Piper, Munich, 1987. 
1905 Viktor Frankl is born in Vienna 
Sigmund Freud, in his "Three Contributions to the Theory of Sex," modifies his sexual seduction theory, saying that childhood seductions are usually the product of a child's fantasy. His new modified sex theory lifts his professional isolation and becomes the basis for psychoanalysis 
1907 C.G. Jung, a Swiss-born psychiatrist, joins Freud in Vienna 
Alfred Adler publishes his Study ofOrgan Inferiority 1908 First International Congress of Psychoanalysis meets in Salzburg. 1909 Freud and Jung lecture in the United States 1910 The Psychoanalytical Society is formed in Vienna 
The International Journal for Psychoanalysis is started Adler criticizes some of Freud's theories, maintaining that not all 
neuroses are caused by unfulfilled sexual urges Adler forms the Society for Individual Psychology Adler publishesOber den nervosen Charakler (The Neurotic Character) 
1912 Jung separates from Freud, forms his own theories about the unconscious, libido, archetypes. PublishesTheTheory ofPsychoanalysis. 
1913 E. Husserl publishes ldeen einer reinen Phaenomenologie (Ideas about a Pure Phenomenology) Adler publishes Heilen und Bilden (Healing and Development) 
1914 Adler starts the International Journal for Individual Psychology 1916 Jung publishes The Psychology of the Unconscious 1920 Frankl, 15 years old, delivers a lecture about "Meaning in Life" 1921 Frankl becomes interested in Freud's theories and contacts him. A 
long correspondence develops. 
M. Scheler publishes Vom Ewigen im Menschen (TheEternalMan) 1922 Frankl graduates from high school with a graduation paper on the psychology of philosophy 1924 Frankl's article Z.Ur mimischen Bejahung und Verneinung (Mimic Approval and Denial) published in the Intern'! Journal of Psychoanalysis 1925 Frankl joins the Society for Individual Psychology Frankl's articlePsychotherapie und Weltanschauung (Psychotherapy and Worlview) published in the Intern'! Journal for Individual Psychology 1926 M. Heidegger publishes Sein und ait (Being and Time) 
Frankl lectures at the 3rd Intem'l Congress of Individual Psychology, "The Neurosis as Expression and Tool and the Search for Meaning" 1927 Rudolf Allers and Oswald Schwarz, mentors of Frankl, leave the 
Society of Individual Psychology Frankl is expelled from the Society of Individual Psychology Anna Freud publishes Einjuhrung in die Kinderpsychologie 
(Introduction io Child Psychology ), the first use of psychoanalysis in treating children 
Adler publishes Menschenkenntnis (Understanding Human Nature) 1928 Frankl becomes head of the Youth Counseling centers in Vienna 1929 E. Husserl publishes F ormale und Transzendentale Logic (Formal 
and Transcendental Logic) 
1930 Frankl graduates from the University of Vienna as M.D. 
Frankl is appointed to the Neuropsychiatric Clinic in Vienna 1931 Adler publishes What Life Should Mean to You 1932 K. Jaspers publishes Philosophy 1933 Adler publishes Der Sinn des Lebens (The Meaning ofLife) 1934 Adler establishes residence in New Y orlc 1937 G.W. Allport publishes Personality: A Psychological Interpretation 
Frankl opens his own psychiatric practice in Vienna Adler dies in Aberdeen, England 1938 Freud emigrates to London Jaspers publiches Existential Philosophy 1939 The term "paradoxical intention" is introduced in the literature in Frankl' s article "Philosophie und Psychotherapie" in the 
Schweizerische Medizinische Wochenschrift 
Freud dies in London 1940 Frankl becomes head of the Rothschild Hospital in Vienna 1942 Frankl is taken to the concentration camp 1945 Frankl is liberated and returns to Vienna 1946 Frankl becomes head of neurology at the Poliklinik Hospital, Vienna 
He publishes Arztliche Seelsorge (Medical Ministry), later published in English as The Doctor and the Soul. Frankl publishes Ein Psychologe erlebt das Konzentrationslager (A Psychologist Experiences the Concentration Camp). Its English title became Man's Search for Meaning 
1946-50 Frankl publishes 12 books, most of them not available in English 1947 Frankl marries Eleonore Katharina Schwindt. They have one daughter, Gabriele Vesely, and two grandchildren Katherina and Alexander Frankl is appointed assistant professor of neurology and psychiatry at the University of Vienna 
1948 Logotherapy is called the "Third Viennese School of Psychotherapy" in W. Soucek's article "Die Existenzanalyse Frankls" (The Existential Analysis of Frankl), Deutsche Medizinische Wochenschrift 
Frankl publishes Der unbewusste Gott (The Unconscious God) 1949 Frankl receives his Ph.D. from the University of Vienna 1950 Frankl becomes president of the Austrian Society for Psychotherapy 
He bcomes professor of neurology and psychiatry, University Vienna 
1954 The first article about Frankl in the US is published in the Women· s Home Companion, "We Are Born to Believe" by Arthur Kline Scheler publishes Philosophische Weltanschauung 
1955 Frankl publishes The Doctor and the Soul 1956 Frankl publishes Theorie und Therapie der Neurosen He receives the Austrian State Prize for Public Education 1957 Frankl's first lecture tour in the US, sponsored by the Religious and Education Foundation under Randolph Sasnett 1959 Frankl publishes From Death Camp to Existentialism, later renamed Man's Searchfor Meaning 
1960 Second lecture tour in the US 1961 Frankl becomes Visiting Professor at Harvard University 
A.J. Ungersmaa publishes The Search for Meaning 1962 Frankl's Man's Search for Meaning is published 1963 Frankl lectures in Berkeley, California, and meets Joseph Fabry 1965 R.G. Leslie publishes Jesus and Logotherapy 1967 Frankl publishes Psychotherapy and Exi.stentialism 1968 Fabry publishes The Pursuit ofMeaning 1969 J.C. Crumbaugh,with L.T. Maholick, develops the Purpose in Life test 
Frankl publishes The Will to Meaning 1970 Frankl receives his first honorary degree, from the Loyola University in Chicago. Since then he has received 20 more honorary degrees Frankl becomes Distinguished Professor of Logotherapy at the United States International University, San Diego He receives the City of Vienna Prize for scientific achievement 
1972 E. Lukas presents her doctoral dissertation at the University of Vienna, "Logotherapie als Pe~nlichkeitstheorie" (Logotherapy as Personality Theory) and develops the Logotest 
1976 Frankl publishes The Unconscious God 
1977 Fabry organizes the Institute of Logotherapy in Berkeley, California Leslie establishes the Viktor Frankl Library and Memorabilia, Berkeley World premiere of Frankl's play,"Synchronization in Buchenwald," 
Berlceley 
H. Takashima publishes Psychosomatic Medicine and Logotherapy 1978 Frankl publishes The Unheard Cry for Meaning Fabry starts The International Forumfor Logotherapy, published semi
annually by the newly established Institute ofLogotherapy Press 1979 Fabry, R.Bulka and W. Sahakian, publish Logotherapy in Action 1980 Lukas publishes Auch Dein Leben hat Sinn (Your Life, Too, has 
Meaning), the first of ten books she has published on logotherapy The 1st World Congress of Logotherapy is held in San Diego.sponsored by the Institute of Logotherapy. Frankl is keynote speaker 1982 Proceedings of the 1st World Congress,Analecta Frankliana are published The 2nd World Congress ofLogotherapy is held in Hartford.Conn. 
1983 The 3rd World Congress is held in Regensburg, Germany 
Frankl receives Grand Medal of Honor with Star of West Germany 1984 The Institute of Logotherapy Press publishes Lukas' Meaningful Living The 4th World Congress ofLogotherapy is held in San Francisco 
1985 Frankl receives the Oskar Pfitzer Award at the annual meeting of the American Psychiatric Association, and gives the award lecture Takashima publishes Humanistic Psychosomatic Medicine 
During this period a number of German-speaking Logotherapy institutions were founded: A German Institute has been diversified into a German Society ofLogotherapy, Bremen (K.D. Heines, director); a Society for Logotherapy and Existential Analysis, Vienna (A. Llingle, director), a South German Institute for Logotherapy, Fiirstenfeldbruck (E.Lukas, director); a Hamburg Institute for Integrative Logotherapy 
(U. Mschemeyer,director), and an Institute for Logotherapy and Psychology for the Working World , Bielefeld (W. BOCkmann, director). Many institutes, societies, and centers of Logotherapy have been founded, including those in Argentina, Australia, Brazil, Canada, Finland,Holland,Israel, Italy, Mexico,Poland, South Africa, and Spain. 
1986 The 5th World Congress ofLogotherapy is held in Toronto, Canada 
V. Lieban-Kalmar ·develops a Training and Certification Program for the Institute of Logotherapy , accepted by the National Board for Certified Counselors 
Proceedings of the 5th World Congress are published Lukas publishes Meaning in Suffering 
A. Llingle publishes Wege zum Sinn (Roads to Meaning) 1987 The 6th World Congress is held in Buenos Aires,Argentina Frankl publishes Logotherapie und Existenzanalyse, containing a list of close to 100 doctoral dissertations about logotherapy 
A tablet is revealed at the house in Vienna where Frankl was born, stating that he lived there from 1905 to 1942, "from the day of his birth to the day of his deportation to the concentration camp" 
1988 Frankl receives the Grand Silver Medal of Honor with Star for his services for Austria Fabry publishes Guideposts to Meaning 1989 The 7th World Congress of Logotherapy is held in Kansas City Proceedings of the 7th World Congress are published 
The name of the Institute of Logotherapy in Berkeley is changed, with Frankl's permission, to the "Viktor Frankl Institute of Logotherapy" 
Frankl is honored in Copenhagen with his most recent, the 21st, honorary doctorate, presented to him by the Queen of Denmark 1990 Frankl celebrates his 85th birthday, March 26. 
The above list has been compiled from many sources and makes no claim of completeness 
STEPHENS. KALMAR, Ph.D. is 'historian' for the Institute of Logotherapy, Berkeley. 
Argentina: 
Meaning Crisis In Affluent Argentina 
Jose V. Martinez Romero, Silvia M. Munton, Mario A. Payarola, Adriana A. Saenz 
Frankl has shown that success does not equate with meaning, nor failure with despair,3,P-63, 1,P-71 'Success' includes lucky breaks, wealth, health, favorable living conditions. 'Failure' includes bad breaks, poverty, ill health, unfavorable living conditions. Today's existential frustration and crises of meaning are often experienced by people who are well off but do not enjoy life, are bored, irritable, and satiated, see no meaning in living. Statistical research has shown that in affluent societies 20% of the population fall into this group."3,P-64 
Affluent adolescents are not exempt from existential frustration. Inner meaning fulfillment is relatively independent of external circumstances; it can be achieved even in adverse circumstances. Material comforts, success, and riches may actually work against the search for meaning. In times of prosperity. there is a higher rate of suicide, drug addiction, delinquency, and perverse inclinations because existential frustration exists even when all material needs are satisfied. 
On the basis of these ideas we assessed the degree of inner meaning fulfillment in a specially selected group of upperclass students in Argentina. We compared their attitudes with the normative distribution of attitudes that Lukas has published.4 
Historical Background 
Latin American countries have been colonized by Spain and Portugal. At the end of the 19th and early in the 20th century, large numbers of immigrants from Europe arrived in Argentina, Uruguay and southern Brazil. This resulted in changes in the traditional composition of the social classes and alterations in the cycles of the economy. The composition of the population, the European immigration, and the internal migration of workers from rural areas to the large cities have modified political power and forms of government. Latin American countries are in various stages of transition, from traditional societies to fully representative democracies. 
In the first stages of independence, the traditional pattern of social structures prevailed without change. Later, unifying autocracies appeared, continuing the inflexible traditional pattern in some cases, and in others resulting in social and economic changes (foreign investment, massive immigration). 
In Argentina, a limited representative democracy existed early in this century. It was established by the growth of urban areas in which the lower and middle classes dominated and the percentage of upper-class participation was small. Several times the development of democracy was interrupted by military elites. In 1983, democracy was fully re-established. 
The small upper class had two different origins. One came from the aristocracy, the other was based on export of primary products. After World War I and the economic crisis of 1930, a large middle class evolved because of increased industrial activity and the rapid growth of urban populations. 
Today, some 36% of the population in Argentina belong to the middle and upper classes. In comparison with other Latin American countries with a middle-class level of less than 15%, Argentina has three middle-class levels: high, medium, and low, with psychological and political identities, ethnic and cultural homogeneity, national identification, and a considerable participation in different areas (university levels, technical education, urbanization, and industrial production). 
Social mobility is less impeded in Argentina than in other Latin American countries. Ascent is possible in the lower and middle classes, depending on the acquisition of property and goods as well as a university education, open and free to all. 
Subjects and Test Instrument 
We tested 79 affluent students (44 males and 35 females) 16 to 18 years old from a specially selected high school founded by Scottish settlers who wanted to educate their children and other English-speaking students. The school is situated in a residential suburb of Buenos Aires with large houses and gardens. Fees are high (approximately $450 per month while the minimum salary is about $100). We consulted with the heads of the school who were interested in preventing attitudes considered dangerous in Argentina's economic, ethical, and political situation. Our sample was made up largely of sons and daughters of land owners of prestigious families, members of the upper middle class, and of important government officials and diplomates. Students attend classes all day. In the morning official subjects of the national school program are taught in Spanish; in the afternoon the curriculum is based on European levels and taught in English. Pupils take Cambridge exams and receive a School Certificate and General Certificate of Education. Many students travel abroad to complete their education. Importance is given to spmts, especially rugby, hockey, and swimming.Intramural,interschool,and international competitions are held nearly every weekend. This is in contrast with most official schools where little importance is given to sports. 
We used the Logotest4 at our "Sentido" (Meaning) Research Center in the English version because the pupils were bilingual and the Spanish version is not yet standardized. 
The test helps counselors detect noogenic problems. "[It]helps physicians, psychologists, educators, social workers, and ministers discover how securely their clients are anchored in a positive value and meaning orientation, or to what degree they are in danger of plunging into an existential vacuum.4,P-1 
The Logotest is scored by accumulating points indicating unfulfillment, dissatisfaction with life, existential frustration, noogenic neurosis. High points, therefore, are warning signs about psychological wellbeing and indicate that, from a logotherapeutic point of view, there is cause for concern. The total test population is divided into quartiles: 
•The 
first quartile (Ql) holds 25% of the test population, with scores from 0 to 10, indicating good inner meaning fulfillment (IMF), the basis for stable psychological health. 

•The 
sum of the second and third quartiles (Q2+Q3) comprise 50% of the test population, with scores from 11 to 17, indicating medium IMF, no basis for danger. 

•The 
fourth quartile (Q4) holds 25% of the population, with scores from 18 to 32, indicating poor IMF. The fourth quartile is subdivided into two decils in the following manner: 


The highest decil (D 1 o) comprising 10% of the population, with scores of 22 to 32, indicates extremely poor IMF, a basis for noogenic neurosis or depression. 
The second highest decil (D9), comprising 10% of the population, with scores 19 to 21, indicates poor IMF, a basis for existential frustration. 
This leaves 5% of the population, Q4-(D9+D10), with a score of 18, indicating modest IMF where caution is advised. 
Table I. Logotest Results 
~ IMF Mm Females Tula! 0-2 0 0 0 3-4 0 0 0 5-6 Good 0 (13.6%) 1 (22.9%) 1 (17.7%) 7-8 (Q1) 2 3 5 
9 -10 4 4 8 11 -12 7 8 15 13 -14 Medium 7. 6 13 15 -16 (Q2+Q3) 10 (56.8%) 4 (60.0%) 14 (58.2%) 
1 1 4 
18 19 -20 21 -22 23 -24 25 -26 27 -32 Total  Poor (Q4)  1 6 4 2 0 0 44  (29.5%)  3 1 1 0 (17.1%) 1 0 35  4 7 5 2 1 0 79  (24.1%)  
Table 2.  Diagnoses and Prognoses  

Score 1-10  % 17.7  
11-17  58.2  
18  5.0  
19-21  10.1  
22-32  8.9  

Diagnosis Very good 
IFM 
IFM neither very good nor very ml 
Watch out! borderline existential frustration 
Existential frustration 
Noogenic neurosis 
Consequently 
Existentially secure,even under bad conditions 
Neither very secure nor en
dangered. Stability may not hold in crises 
May lead to life 
crisis with criti
cal psychological 
consequences 
Basis f. neuroses, 
depressions.psy
chopathy, addict
ion, sexual per
version 
Danger to life. A 
No to life includes a No to get well 
1 0 
Prognosis Very good 
Open. May develop in a positive or negative direction 
Good if guided in the search for meaning 
Successful only if intervention is logotherapeutic 
Urgent logotherapy treatment needed 
In a detailed analysis of individual answers to the items in our 79 logotests (comparing "meaning factors," "reactions to existential frustration," and "life attitudes") we found that our sample was characterized by differences between males and females, and between individuals ranked in the different quartiles as to which meaning factors they chose. The sample was also characterized by the influence of the adolescent stage and cultural patterns as to how inner meaning fulfillment is achieved. (Table 2 scores are evaluated according to Frankl' s concepts formulated by Lukas in her Logotest.)4, pp.18-21 
Practically all tested adolescents accepted the following meaning factors: self-actualization, social aspects, and experiences (nature, art) regardless of sex or quartile. These are apparently non-conflict areas in all life stages of adolescents of any social class who search for identity or try out adult roles. 
Affluent adolescents, however, are motivated by upbringing and education to seek experiences not common to other classes -aviation, skiing, sailing, polo, and traveling abroad. They reject (as appears in the test) "service based on conviction" (religious or political) and "overcoming distress," probably because they have not experienced suffering or distress. 
As to political convictions: Argentina had a recent history of authoritarian governments, backed by upper classes that discouraged democratic political convictions in their youngsters and instead emphasized economic achievement as a means to self-realization. 
Lack of religious conviction may explain their lack of attitudinal values when faced with frustration. Resistance to religion may be due to the typical rebellious attitude of this age as well as to the repression of spiritual values in our mass society, so well described by Frankl.2,p225 
Our results show that pupils with a score showing very good inner meaning fulfillment find meaning in both work and family. Those in the medium-range group, however, differ in their evaluation of these concepts according to sex; while males find meaning in studying for a career, females value family and maternity, as though the boys had a clearer idea of vocation and occupation while the girls were concerned with family and had few outside interests. This could be related to the importance of family in Argentina, and Latin America in general, and to clearcut differences in the roles of men and women. 
Participants with poor inner meaning fulfillment didn't value specific occupations or well-being. Being well off and having a pleasant life had not been enough for inner meaning fulfillment. 
Inner meaning fulfillment is difficult to achieve in our mass society. Frankl, addressing university students in Mendoza, reminded them about their commitment to freedom but also to responsibility. He confronted them with their lack of tolerance to frustration, which is being reinforced by most present-day educational tendencies. He urged them to actualize their future and to self-transcend. This, he said, was demanding but justified; the youngsters were under the influence of what he called the tragic triad of our times: aggression, depression, and addiction. 
This triad appeared in all quartiles (although aggression was more noticeable in Q4) when participants reacted to frustration with aggression, depression and flight reactions. 
In discussing test results with institution heads, we obtained confirmation that these flight reactions became pathological when children addicted to drugs were leaving school. Institution heads also were worried about students who wasted time without being able to define their future careers. These adolescents may feel lost without the security of the school, not knowing how to use freedom responsibly since they had no behavior patterns to follow when faced with the world outside. 
On a previous occasion we had asked pupils of another school with affluent students what subjects they would like to talk about. They chose themes related to aggression, depression, and particularly suicide. We believe that, contrary to other social levels, affluent adolescents, because of their education, do not direct their aggression so much against others as against themselves in the form of depression, guilt, addiction, and ideas of suicide. In the conference in Mendoza, Frankl stated that "there are many tests that show the degree to which a person inclines to suicide. But we should ask ourselves what is it that keeps them alive, what is it that helps young people to survive depression. We are asking about resources for survival, because then we shall know how to prevent suicide attempts. This is valid, too, for drug addiction." This may be true for the whole American continent which Frankl called "the continent of hope." 
Hope always refers to the future, and this is where we find meaning when we realize that life has meaning under any circumstances. Success in itself should not be the guide for younger generations but meaning can be found within success through a positive attitude. "A positive attitude to one's success is seen as meaning-oriented and self-transcending behavior under fortunate living conditions that helps persons to do something useful within their position of success. It is the readiness to use one's own good fortune to help others less fortunate."4,p.14 
In our sample, a very small number showed a positive attitude toward success. As they will be our future leaders, we must recommend a logotherapeutic guide to help them in their search for meaning, as role models for a sound, cohesive behavior to avoid existential frustration, the basis for noogenic neuroses. 
Our findings agree with Frankl that the search for meaning is relatively independent of external circumstances; and that, indeed, material comfort, success, and riches may even work against the search for meaning. In times of prosperity there is a higher rate of suicide, delinquency, and drug addiction. In our sample of affluent students our results were not far from the norms obtained from Lukas' standardized data. 
We did find many positive values related to meaning, probably because Argentina encourages a society where community and family are still important, drug addiction is rejected, and people in general are opposed to abortion. We have maintained that "the relationship between community and individuals is reciprocal. We don't accept the collectivist view which stresses the value of community and may lead to oppresion; neither do we accept an individualistic point of view which ignores the value of solidarity and love toward others. The solution lies in a balance, the person in the center but not 
isolated from the community."5 
Logotherapy can act as social education for every person lacking a sense of meaning. The Logotest "helps us discover how securely individuals are anchored in a positive value and meaning orientation, or how much they are in danger 
of plunging into an existential vacuum."4,p.1 Educational psychology is an important field for studying and applying Frankl's basic concepts, especially freedom and responsibility and their relationship to meaning in life. 
Commitment to personal freedom leads to greater commitment to one's country and to the rest of Latin America, eliminating historical barriers, working toward the wellbeing of other countries, maintaining values such as family, maternity, work, solidarity, faith, and love toward others, all of which should minimize the danger of war in this region. 
Logotherapy has a mission to prevent the spread of mass neurosis. As Argentine logotherapists we accept the challenge and hope to find the means to reach this goal. 
JOSE V. MARTINEZ ROMERO is director of Sentido Clinical and Research Center, Buenos Aires. SILVIA M. MUNTON is a child and adolescentpsychologist at the Buenos Aires Italian Hospital. MARIO A. PAYAROLA is professor of child and adolescent psychotherapy, Salvador University, Buenos Aires. ADRIANA A. SAENZ is a family therapist at the National Gendarms Hospital, Buenos Aires. 
REFERENCES: 
1. Frankl, Vik.tor E., The Will to Meaning, New York, New American Library, 1970. 
2. ___, Teor[a y terapia de las neurosis, Madrid, Ed. Gredos, 1964. 
3. 
Lukas, Elisabeth, Meaning in Suffering. Berkeley, Institute of Logotherapy Press, 1986. 

4. 
__, "Logotest." Berkeley, Institute of Logotherapy Press, 1989. 

5. 
Martinez Romero, J.V., "Group Logotherapy in Latin America." International Forum for Logotherapy, 11(2), 1988. 



Australia: 
Logotherapy in Reproductive Medicine 
Christopher S. E. Wurm 
Studies have shown that about 20% of neuroses are noogenic, arising from conflicts between different values -from moral conflicts rather than conflicts between drives and instincts.1 For reproductive medicine, one study4 found that in 7% of the women with functional pelvic disorders, the symptoms are the result of problems in attaining meaning in their lives. To overcome distress, they need to look beyond their symptoms to opportunities for meaning in the world around them. This can be made easier by the use of dereflection. Some types of psychotherapy may actually aggravate the situation by encouraging patients to look even more closely at their inner thoughts, but dereflection attempts to remove these introspective ruminations. It encourages patients not to get carried away analysing their motives and feelings, and instead to look beyond themselves to see if there are any unrecognised tasks or experiences which would give them meaning again. 
Logotherapy is also suitable for treating female orgasmic failure and male impotence. The technique used here is another form of dereflection instructing the couple not to proceed to intercourse, although they may still engage in mutual stimulation, with the proviso that the patients pay more attention to their partner, rather than dwell on their own sensations and performance. Frankl first described this approach in 1946 in German and in 1952 in English,2,3 well before Masters and Johnson published their findings. 
Reproductive medicine deals with many instances of unavoidable suffering and loss. Obstetrics brings practitioners into contact with families dealing with miscarriage, stillbirths, congenital defom1ities, infant deaths, and also with problems of infertility. Gynecologists and general practitioners have to help patients with chronic pain from pelvic inflammatory disease or endometriosis and, along with oncologists, radiotherapists and palliative care staff, treat terminally ill patients with malignant diseases of the reproductive organs. After hysterectomy for benign conditions, some women may register loss of womb as a source of grief, and others at menopause may mourn the passing of their youth and the end of their reproductive years. 
In many instances nothing can be done to change the situation. Good analgesia and control of constipation and nausea may help diminish the suffering of terminally ill patients, and short-term minor tranquilisers may occasionally help patients with insomnia or severe anxiety following a crisis. Supportive counselling and various forms of practical aid can often be valuable in some of these situations. However, these patients inevitably go through a great deal of sadness and suffering. Logotherapy can be used to acknowledge their suffering, and to see whether it is possible to find an attitude to enable them to bear suffering more easily and find meaning behind their misfortune. One particular example was the mother of a woman in her twenties who was significantly intellectually disabled and in need of constant care and supervision. Without bitterness, she explained that she and her husband still looked after their daughter at home, and although they had wondered why they had to have a retarded daughter, they decided that it was so that other parents would realise how lucky they were to have normal children. Anyone who is able to find such a courageous attitude in the face of such suffering will find that, though the situation remains unchanged, it is easier to cope with because it will havebecome meaningful. 
CHRISTOPHER S. E. WURM, M.B, B.S.,F.R.A.C.G.P is a family practitioner at the University ofAdelaide, Australia, and in two teaching hospitals. He is the coordinator ofthe Adelaide Logotherapy Group. This article is based on a paper presented at the 15th Congress of the Australian Society for the Psychomatric Aspecs of Reproductive Medicine, Phuket, Thailand, April\1988. 
REFERENCES: 
1. 
Frankl, V.E. The Will to Meaning~ N.Y., New American Library,1969. 

2. 
__. The Unheard Cry for Meaning. N.Y., Simon and Schuster,1978. 

3. 
Hill, K. A. "Meta Analysis of Paradoxical Interventions." Psychotherapy. ~ 1987. 

4. 
Prill, H. J. "Organneurose and Konstitution bei chronischfunktionellen Unterleibsbeschwcrden der Frau." Zcit,;;chrift fiir Psychotherapie .5., 1955. 


Austria: 
Existential Analysis Psychotherapy 
Alfried Langle 
Logotherapy is mainly applied in two ways. In both cases clients are helped by receiving "information." In one case the information comes from the philosphy of successful living described by Frankl; this is existential instruction. In the other case the information is basically advice given by the therapist on specific situations of the clients to help them find possible meanings in them; this is existential explanation. In both cases therapy is based on a philosophy of living without which life would be chaotic and meaningless. 
The advice provides clients with information which enables them to lead their lives on their own. Frankl saw logotherapy as supplement to traditional psychotherapy.1,P242 This was the way it was applied by Frankl and his followers for half a century: the defiant power of the spirit was called on to help clients lead a life worthy of human beings, especially in hopeless, concentration-camp-like situations. Here, logotherapy is an important supplementary and rehumanizing therapy -as cure and prevention in counseling and education. 
The Need for Existential Analysis Psychotherapy 
Sometimes, however, clients know what advice they should follow but have difficulties: lack of motivation or judgment, inability to act upon the advice, lack of staying power, inhibitions, emotions, to name just a few. In such cases, advice or infonnation will not help, may even be discouraging and overdemanding. Clients may even break up the therapy. 
In facing such difficulties, should logotherapy be limited to a merely meaning-oriented method? Doesn't it have specific methods for psychogenic disturbances for which Frankl sees logotherapy as "unspecific therapy"?2p.20l My practice has convinced me that beyond logotherapy an existential analysis psychotherapy is needed. 
But for noogenic neuroses, too, for which logotherapy is considered specific therapy,2,P-201 treatment originating in the spirit 3, P-172 may not be sufficient. In addition to treating noetic conflicts, a therapy of neurosis sometimes must pay attention to the psyche (phobia, hurt feelings). On the other hand, treatment of psychogenic neuroses may need to consider somatic and 
noogenic aspects. This is based on practical experience as well as on existential analysis theory which considers neurosis a disturbance of the total human being, including psychological and somatic functions. 
Existential analysis leads clients to a fresh view of themselves and the world.5 The method aims at shaping a new person, under the guidance and supervision of the therapist. Existential analysis therapy, like traditional therapy, runs on two rails,although in different forms: 
a) 
Strengthening the self: emphasis on greater efficiency, awareness of latent abilities, on the positive and healthy. 

b) 
Relief from negative aspects of self: clearing of deficiencies, hurts, and disturbances. 


The therapy aims at shifting the balance from weakness toward strength. The difference with traditional therapy lies in the special anthropological background. The existential analysis therapist sees clients as persons challenged to act responsibly responding to the questions life asks. The method is phenomenological -the therapist pays primary attention to the effect the events of life have on the clients and how they handle them. 
The Structure of the Method 

Existential analysis demands from the therapist: 
1. to be "with" the clients on a noetic level.3,PP· 87,91 2.to understand the clients' motivations (will to meaning) 3.to help clients relate to themselves and their world, 
especially through modification of attitudes. 
This requires years of professional training, cultivation of personality, and practical experience4,PP-3-5 -our training goals at the Society for Logotherapy and Existential Analysis. 
Ad 1: Existential analysts must remain on an existential level, enabling them to "participate" in the clients' problems and open them to the process that is effective in therapy or, where no illness is present, to personality changes. This opens the existential space in which clients can develop. 
Ad 2: Existential analysts must open themselves for what motivates clients, their will to meaning. It is less important what clients experienced, but how and why they experienced it and why they took this particular attitude to it. The same is true for their actions: not so much what they did but why. Understanding clients in this way deepens the therapeutic process and leads to a better self-understanding of the patients. 
Ad 3: The existential analyst helps clients to achieve a breakthrough to their authentic selves and find meaningful relationships to the therapist, to others, and to themselves. Their capacity is activated to be responsive to others and in the dialogue with themselves. An attitude is achieved that restores the clients' meaningful relationships and frees them from the bonds of their problems and inner psychic emotions. 
Existential analysis counseling does not always deal with problems of meaning, the main concern of logotherapy. It often deals with aspects of self-development: self-understanding, freedom, capacity to relate, trust, attitude, interest, inclination, emotions, abilities -wherever a will to being is expressed. Deper analysis is basically concerned with questions of justification of one's existence, the legitimacy of one's actions, works, demands, one's "being-in-the-world" (Heidegger). But human beings also want to do justice to life, to others, and to themselves, they seek responsibility. And they also want that justice be done to them. Here a third motivational factor joins the "will to being" and the "will to meaning": the "will to justice." 
(A case study illustrating existential analysis will be published in the next issue of the International Forum.) 
ALFRIED LANGLE, M.D., Ph.D .. is director of the Society for Logotherapy and Existential Analysis, Vienna, Austria. 
REFERENCES: 
I. Frankl, V.E. Arztliche Seelsorge. Vienna, Deuticke, 1982. 
2. ___,. Theorie und Therapie der Neurosen. Munich, Reinhardt, 1983. 
3. 
___. Der leidende Mensch .. Bern, Huber, 1984. 

4. 
Llingle, A. "Die Bedeutung der Personlichkeit und der Selbstcrfahrung des Psychotherapeuten ftir den Therapieverlauf -aus der Sicht der Existenzanalyse." Bulletin der Gesellschaft fiir Logotherapie und Existenzanalyse !i(l), 1989. 


5.___. "Das Verstandnis von Krankheit und Kranksein in der Existenzanalyse und Logotherapie" (in press). 
Canada: 
Two Poems Tom McKillop 
I II The desires and feeling You are a unity for food, drink, sex, of body, psyche, and spirit, wannth and touch attempting to become one, are so powerful to you in existence and essence. that at times it's difficult When there is illness to think of anything else. in one area of your life At other times you see it can affect there is a strong thrust the other parts of your life 
to be chosen, in a negative way. recognized, in place, However, if you can to make decisions, strengthen your capacity to have the power to transcend yourself, to be able to lead, to go beyond yourself, organize, and plan. and find meaning, But it isn't long a work or a cause, before you sense then the psyche is steadied the bodily experience and strengthened, is over, and there is the hunger thus disposing for something else. the body to be helped The power can bring you to withstand illness importance and popularity, or a worse growth in illness. but the pains and hassles When there is illness are there with disappointments. that cannot be prevented But the question arises, and is irreversible, after experiencing so much: that is the graced moment Is there all there is? in the spirit to rise up Maybe a death happens, with an attitude to face and then the question arises the unchangeable condition and becomes conscious: and conquer it what is the meaning of it all: in a meaningful way life, clothes, food, drink, through an act of courage. family, friends, money? Now comes a central focuy for you: the pursuit of meaning. 
TOM MCKIUOP, a pastor in Toronto and a dip/ornate in Logotherapy,for 18 years was director ofthe Youth Corps in the Tor onto Archdiocese. The poems are from his book, 
What it's All About -Youth in Search for Meaning. 
Germany: 
Suffering and Religiosity 
Karl-Dieter Heines 
If we ask for the meaning of suffering we overlook that suffering itself poses a question. We, the sufferers, are being asked, have to answer the question life poses, and pass the test. Our answer lies in how we bear unavoidable suffering -an answer given without words, but the only meaningful answer. 
Religion has long provided answers to the question of unavoidable suffering, but today many people repress their religiosity. Logotherapy helps them face their suffering. Karl Menninger said as early as 1954, "Perhaps it is true that we psychiatrists are so afraid of endorsing religiosity ... that we sometimes unwittingly contribute to the shyness of our patients in respect to such thoughts and communications. If so, Dr. Frankl' s work should alert us to missed opportunities. ''2 
More recently, the German theologian.Hans Kling also posed the question why religiosity has been repressed and declared taboo by psychiatry.3 True religion, he maintains, is so forceful because it satisfies the oldest, strongest, and most urgent of all human longings. If frustrated, the result is the existential vacuum and the inability to bear suffering. 
This "flight from suffering" has four symptoms: 
•Denial 
of suffering by a hysterical search for pleasure 

•Avoidance 
of suffering by splitting the thought of death from every-day life 

•Muting 
suffering by cultivating consumerism and sex 

•Masking 
suffering through welfare techniques. 


Kling asks, in confirmation of Frankl's ideas: "Can we really overcome the spiritual crises of our times by ignoring the most profound depths of the human being? We are forced to reevaluate religion within the concepts of psychiatry.3 
Frankl has pointed out that today we don't worry about "the future of an illusion," as Freud called religion but are quite concerned about the reality that religion confronts us with.1 
KARL-DIETER HEINES, MD. is president of the German Society ofLogotherapy and director ofhis clinic in Bremen. 
REFERENCES: 
1. 
Frankl, V .E. Der unbewusste Gott. Munich, K5sel, 1988. 

2. 
Kline,M.A." Born to Believe," Woman's Home Companion, April 1954. 


3. Kiing, H. Freud und die Zukunft der Religion, Munich, Piper, 1987. 
Did You Know You Just Gave A Logotherapy Address? Walter Beckmann 

Many people call their discovery of logotherapy "My Meeting with Viktor Frankl." Mine could be called, in contrast, "Viktor Frankl's Meeting with Bockmann" because when I ran across Frankl I had never heard of him nor of logo therapy. 
It happened in 1968 at an international symposium of the Gottlieb Duttweiler Institute in Rilschlikon near Zurich. The theme, suggested by the economic crisis at the time, was "Inhibiting Structures of the Economy." My invitation was the result of my book, just published then, Million Losses Through Leadership Mistakes. It summarized my painful experiences with the managerial practices of what is called "leadership" by economists. Speakers included Vance Packard, C.V. Parkinson, Gordon R. Taylor, and Betty Friedan. After my address, which had the title "Economic Order as Mirror of its Societal Order," a gentleman came to me and said, "Do you know you just gave a logotherapeutic address?" Somewhat puzzled I said no, and when he added, "My name is Frankl," I could think of nothing better than reply, "My name is Bockrnann" -a piece of information he already had because I had just been introduced as a speaker. I suspect I was one of the few in this international circle who did not know the name Frankl, not to mention logotherapy. 
This moment was the beginning of my close connection with Viktor Frankl and my intensive effort to spread the tremendous philosophy of logotherapy. In my opinion, logotherapy is much more than a school of psychotherapy -it offers a view, not even begun to be fully appreciated in the many fields of human endeavors, of the world and of human nature; a view of the essence of humanness, an awareness of life's fundamental meaning and the human pursuit of this meaning. 
In our "Institute for Logotherapy and the Psychology of Management" we have developed three areas of investigations: 
1. 
Continuing education of high-school graduates working in the helping professions, based on the principles of logotherapy. 

2. 
A special form of psychological counseling in the business world, using Viktor Frankl's philosophy. 

3. 
A seminar model of a meaning-oriented motivation for achievement and leadership in management. 


The models and methods we have developed during the past twenty years have resulted in numerous articles and papers, as well as in books whose logotherapy background is revealed in their titles as, for instance, Those Who Demand Performance Must Offer Meaning, Meaning-Oriented Leadership as Art in Motivation, The Meaning System -Meaning-Oriented Motivation for Performance and Leadership, Meaning and Self, Meaning and System, Psychology of Healing, and From Meaning to Profit (a meaning-oriented school for managers). 
Frankl' s concept of meaning has proved to be the key for solving many problems, especially for analysis, structure and 'therapy' for a variety of personal problems. In West Germany many models are those of Herzberg, McGregor, Blake, Mouton, and others which are partly based on Freud's psychoanalysis or on the semi-analytical homeostatic psychology of Maslow. It is not easy to introduce a new, more productive view, with a clear emphasis on meaning and purpose which is important for leadership, production, and performance -all based on meaning-oriented thought processes inspired by Frankl. 
Our Bielefeld model had its 'world premiere' (in rudimentary form, as seen today) in Austria in 1977 when it was presented, with the help of Profesor Frankl, to the industrial leaders of Austria. In subsequent years it was the subject -often in the presence of Professor Frankl -of numerous congresses, work conferences, and addresses, with proved applicability in many company seminars. The worldwide appliction of our work is restricted by the fact that our literature is not always available in the languages of the participants. 
Freud once said that he saw the significance of psychoanalysis not so much in psychotherapy as in numerous other fields. The same can be said, perhaps with greater justification, of logotherapy. It has proven extremely fruitful for education and management theory, and holds promise, not yet fully taken advantage of, for the theory of culture, psychology (motivational psychology, developmental psychology), sociology, and history. 
WALTER BOCKMANN, Dr. Dip/., is director of the Institute of Logotherapy and the Psychology of Management, llmenauweg 15, D-4800 Bielefeld 11, West Germany, 
Self-Help and Crisis Intervention 
Elisabeth Lukas 
Self-help for psychological problems is desirable for 
several reasons. Treatment by professionals has become 
increasingly expensive. Self-help also makes people realize that 
they are not bundles of misery needing help from the outside. 
That attitude cripples self-initiative and leads to unhealthy 
self-pity. Equally harmful is the attitude, "others have made me 
sick, so others should make me well." Example: A man suffers 
from weak muscles. He blames his sedentary job ("others have 
made me sick") and goes to a masseur to strengthen his muscles 
("others should make me well"). He doesn't think of jogging 
every day to strengthen his muscles. He would think of this 
solution only if he felt responsible for his own health. 
Self-help is also beneficial because it makes us think about our situation instead of being enmeshed in it, to distance ourselves from our distress. Self-distancing is an important concept in logotherapy. It shows us that we are not identical with our sickness -that we are more than our sickness. 
Example: When a woman says she wants to reduce her tendency to temper flareups, she already has grown a little beyond being an angry woman. She is no longer blindly driven by her impulses as by a current, but sits ashore and watches the current, deciding she doesn't like it. And that's the first step, in swimming against the current. 
Now: who sits ashore and who helps whom in self-help? Logotherapy sees it this way: In our spiritual dimension, which is what we are (our essence), we observe our psychophysical condition, which is what we have, and form an attitude toward it. Only in our spirit are we able to rise above the current of drives and, seeing ourselves at a distance, take action. When we help ourselves, we face unwanted impulses and weaknesses in ourselves which, however, we do not have to accept, at least not without an attempt to change and overcome them. 
Example: A woman who always overeats when she is angry. How can she escape this unwanted behavior pattern? 
1. 
View the impulse "anger-overeating" from the distance of her spiritual dimension. 

2. 
See this impulse as lacking meaning. 

3. 
Decide to take action agsinst it. 

4. 
Practice more meaningful reactions to her frustrations. 


Without the human capacity of self-distancing1, P-17 this would not be possible. No animal can observe itself, evaluate its behavior, and decide to act differently. The change would also be impossible for the woman if she, after step 2, would blame someone else for causing her anger and thus her overeating. She would only get more angry and eat more. Nor would she be able to change if, after step 3, she ran to someone to stop her senseless overeating. Then she would rely on the "someone" and not try step 4. 
Self-help means to work on ourselves. Yet to only concern ourselves with the self would not be fulfilling. It is part of human nature, especially our spirit, to reach beyond ourselves, to make use of our capacity for self-transcendence,1, 
P31 
to forget ourselves, to help others. This makes possible, next to self-help, also lay-help, the mutual help of lay people. Its potential has been explored in self-help groups. Helping others means also to help ourselves -we are no longer trapped in our own concerns.While self-help means to work on ourselves, layhelp means to crawl from our snail shell and cross other thresholds; by helping others share their burdens, we forget our own. 
Of course, self-help and lay-help have their limits. I should like to discuss three areas of crisis intervention where they can be helpful, at least as "first aid," although a complete cure may take some time or may not be possible. 
Irrational Feelings 
Irrational feelings are exaggerated emotions, especially fear or guilt. They clearly differ from realistic feelings. 
Example: The fear of falling off a normal, well-built bridge is irrational. But the fear of an inexperienced mountain climber when climbing a difficult rock is based on reality. Or: The thought that a colleague could become sick because we have been unfriendly, is an example of irrational guilt feeling, but awareness of having hurt acolleagueby an unfriendly word is an example of guilt based on realism. 
Irrational feelings go beyond the event that triggered them. Irrational fear of stepping on a bridge, or guilt at the thought of having caused sickness through an unfriendly look causes trouble without an outside reason, become selfcontained, and occupy the mind of the phobics until they cannot think of anything else. 
For such cases paradoxical intention is indicated. Persons afraid of bridges should tell themselves how wonderful 
it would be to take a cool bath in the river below. "Fear of falling in?" they are instructed to say, "That's exactly what I want! I hope I'll slip and fall in, a great chance to refresh myself." 
Paradoxical intention is also applicable in case of irrational guilt feelings, even if the paradoxical attitude seems a little "immoral." But one must keep in mind that we ridicule something because it must not be taken seriously or it will undermine our health. So it is permissible for the person with irrational guilt feelings to intend to look as unfriendly as possible at all colleagues, so they will become sick and get sick leave. 
The human capacity of self-distancing plays a part here. We distance ourselves from fear which is like a blackmailer. The more we give in, the more he demands. He threatens that we will fall into the water, and we avoid all bridges. The blackmailer threatens to send some compromising photos to a newspaper. and the victim pays. The phobic keeps paying tribute to his irrational fear. There is only one way out: to laugh in the blackmailer's face and ask him to send the pictures to many papers, even give him some names and addresses: "I have always wanted to see my photo in the papers!" A victim who speaks that way to the blackmailer drives him off; there is nothing to gain from this victim, he is safe from attack. 
Example of how self-help and crisis intervention may be initiated by a single letter: 
Dear Dr. Lukas, here is my problem: My father, who was a choir director, had a long-standing affair with a singer. Our family, especially my mother, suffered greatly. My husband and I also sang in that choir, so when we moved to another town it was a welcome reason to quit. 
My husband joined the choir of our present town and asked me to join too. I have an unexplainable fear of doing this. My husband laughs it off as "menopause trouble" (I am 54). Recently the fear has grown so bad that I have asthma every time my husband goes to rehearsal although I have no reason to suspect that he goes because of another singer. I have the feeling that sooner or later it will happen. I get so angry that I fear our marriage will suffer. I have read your books but haven't found the magic word. I guess right now I don't have the necessary sense of humor for paradoxical intention. Please help. 
Response: Dear Mrs. X, you realize quite correctly that paradoxical intention could free you from your excessive attention to a situation in which you feel trapped. This insight is valuable because it shows you are aware there is no real threat. 
Before using paradoxical intention I would recommend two corrections in your attitudes. First, that you simply forgive 
your father for what he did wrong in his life. This is a matter between him and his conscience. Forgive him and close the chapter of "childhood." Second, do not link your father's behavior with that of your husband. Your husband is a person in his own right with unique strengths and weaknesses. You do him an injustice when you see your father in him. 
After you have accomplished these two inner corrections you can fight your jealousy and fear with some paradoxical formulations by wishing him many young attractive singers who will hang on his neck and gobble him up. You will see he will always come home in one piece. You will also see that genuine love dissolves fear, sadness, and anger. Love is not concerned with the self but with the partner. With my good wishes ... 
Reaction of patient: Dear Dr. Lukas, thanks for rescuing me with your quick answer. It is so simple that I am surprised I didn't think of it myself. I feel better already and will continue thinking in that direction ... 
Escape from Dependency 
The above case illustrates also a second area where selfhelp is applicable. It illustrates the strange idea of a fateful dependency: "This is what happened to mother, so it will happen to me, too." 
The cause-and-effect result that exists in the physical and psychological area is an illusion in human relationships. IfI cut my finger, it will bleed. IfI am humiliated, I'll be sad. These are cause-and-effect situations. But "because my father cheated, I mistrust my husband," or "because my wife left me, I drink," are excuses for freely made decisions which could just as well have been made differently. 
In our dimension of the spirit we are never completely dependent on physical, psychological, or social events. We are free to decide what to do with our bleeding finger, how to deal with sadness caused by humiliation, and how to live with a miserable childhood or loss of a partner. To ask about the causes of psychological upsets and wrong behavior are wrong questions because our decisions about how we live are not determined by causes but by ourselves -in the face of the causes. 
No causes force us to drink, smoke, look at TV, or cling to others, even if our horoscope says so, our childhood was without love, or our biorhythm shows a low. The only thing that forces our decision is our belief in dependency. 
Belief can move mountains, and the belief in dependency moves them right in front of our door which can no longer be opened and traps us within the four walls of our dependency. The countermeasure is to gather the healthy resources of our spirit and recapture our freedom of choice. Just as humor drives away irrational fears, so defiance frees us from the chains of self-made dependencies. 
Regaining freedom of decision has its price: we have to give up something: the security of old thought patterns and habits, some short-term benefits in favor of long-term goals, or the comfort of the status quo in order to take risks. 
How self-help can be initiated in case of such presumed dependency is illustrated here through an exchange of letters. 
Letter from Norbert to his parents: 
Hello Mom, hello Pop, the attorney probably called you and told you where I am. In the clink again. Probation was called off because I quit therapy. So I failed again. And it looked good for a while, the job training and so. And now? 
I don't want to write about that. I'm so stupid.The city ruined me. Jobs here and there, but the money was soon gone. I wanted to be strong, free, a Rambo. I failed in everything but I wouldn't admit it. Kept pretending, made big plans. I couldn't come home, not even phone. Why now? The mask is off. I'm a pile of shit. I know, Mom, you go to the mail box looking for a letter. You expect an explanation. I know you don't understand me -but what can I explain if I don't understand myself? 
Am I really so helpless that someone always has to tell me what to do? And then I resist it. You know that. Oh, shit! Here I am crying. I'm afraid. But what good does it do now? I must see what I can make of myself. At last I must succeed. Or? 
Please no sermons, don't condemn me, and most of all, don't blame yourselves.You have done everything for me, really. It's damn hard to write this letter. I don't know what you think of me now. Also I need a few things from home. I'm looking forward to your reaction. 
My letter to Norbert: 
Dear Norbert, you will be surprised to get a letter from an unknown. Your mother is a client of mine and showed me your letter. She asked for help. I would like to try because your letter shows so many positive and hopeful signs. 
First I want you to see that your description of your situation has two levels. First, there is Norbert, the failure. He quit therapy, has not written home, has worn a mask and lived by illusions and pretensions. He is difficult to understand, is dependent and immature. One must be afraid of him and for him. All this is in your letter. 
But there is another level, the "real" Norbert. The essence of Norbert. What do we know about him? He is angry at the other Norbert and tears off his mask. He has courage, admits mistakes. He thinks of his parents who daily check the mail box, and contacts them. He wants to be independent and act responsibly, he wants to make something of himself. And he is able to do it, because he can manage difficult things such as writing a letter that is "damn hard" to do. 
So there are these two Norberts in one person, and they fight with each other. Who will win? Will the "real" Norbert surrender to 'Norbert, the failure'? Or will he grow beyond the weak Norbert and become the person he was meant to be when he was born? Perhaps make the world a little better place? 
Everything is still possible, nothing has been decided. And no one will decide for you. Only you can decide which Norbert will win. But please know that I keep my fingers crossed for the "real" Norbert and wish you all the strength. 
Response from Norbert two months later: 
Your letter really surprised me and made me think because you have hit the nail on the her1.d. I first resented that Mom showed you my letter, but now I see it was good she did. 
I want to thank you for your concern and tell you that your letter helped me several times when I was ready to give in. I'm amazed that you care. That honors and strengthens me, the "real" Norbert. I'm glad to tell you that I have decided to go back to therapy in a drug counseling center. I've made up my mind to win the fight against myself. I know there are difficulties ahead, so please keep your fingers crossed ... 
Regaining Well-Being 
In my letter, besides my challenge to a healthy defiance, I hinted at meaningful tasks waiting for him in the world. My intention was to tap the human capacity for self-transcendence. To the extent that we forget ourselves and become involved in a task,we feel well. Just like a child, submerged in play, is happy. In contrast, our well-being suffers when we feel superfluous, with no tasks. Then people may become sick, even suicidal. 
In affluent societies our continuous demands for more and more leads to constant frustration. It begins in school where children expect good grades without any effort on their part. It continues in adolescents who don't appreciate what is being offered to them in sports, hobbies, and entertainment, but become bored consumers of fun, not knowing what to do with their leisure. As grown-ups they are not satisfied with their economic and social progress but wish to "self-actualize" themselves. And the elderly, not grateful about their extended life span, grumble about a world they no longer understand. Of course, these are generalities, but they show a trend that breeds crises, causes dissatisfaction, and reduces the feeling of wellbeing. 
I am not saying there are no grievances to be expressed. But protest needs to be balanced by gratitude for what is good in this world. We have no constitutional right to lead a long, happy, healthy life. This is a gift. We can choose our actions and attitude, but much of what we face is fate -a friendly fate for which we can be grateful, or an unfriendly one which, if unavoidable, we have to accept and, by thinking of still worse alternatives, find a new attitude. 
A Jewish joke, often told by Frankl, makes that point. A man goes to a rabbi to complain about his impossible situation: with a wife and four children he lives in one small room. The rabbi advises him to take in a goat and come back in a week. The man returns in desperation: "We cannot stand it, the goat stinks." The rabbi advises: Take the goat back to the stable and come back in a week." The next week the man beams. "Life is wonderful! No goat -only we six!" 
The following case history shows that gratitude can be kindled even in tragic circumstances: 
An elderly patient came to me with psychosomatic complaints. Any change of weather caused unbearable pain which even strong medication could not relieve. His past had been traumatic. During the last months of the war, when he was 13, his mother was killed. His father had died at the front.The boy was beaten and both legs broken. They healed but not in the anatomically correct position. After the war he learned a simple profession, married, and had two sons. His pains began when his sons became independent and his wife left him. 
While he told his story he wept. He felt betrayed by fate. "I haven't prayed for thirty years," he confided, "but now I wonder if I shouldn't ask God at least to give me a pain-free old age." This was my cue. "You know what," I suggested. "Before you ask for something, start with thanks." The patient stared at me in disbelief. "Yes," I told him, "in the evening, when you lie in bed and !ook back on your life, tell God, or yourself: 'In 1945, during the last months of the war, I could have died by a thousand coincidences. I lived. For that I am grateful.' Then, close your eyes and surrender yourself to sleep. The next evening, in bed, tell yourself: 'For 13 years I had a mother, a good mother. For this I am grateful.' And again close your eyes and go to sleep. The following evening tell yourself: 'In my childhood I went through a cruel time. They broke my legs but they didn't break me. I could work and support my family. For this I am grateful.' And continue in that vein on other evenings. 
A few weeks later I met the patient again. He looked well. "Isn't it strange," he said. "My pain is gone or at least is bearable although I haven't even started with my prayers." 
Well-being has less to do with outer circumstances than one would believe. It has much to do with gratitude for the great gift, "life," and for the meaning life offers to each one of us. It is well to remember that life doesn't lose its meaning under any circumstances, not even the most difficult and painful ones. In every situation it is possible to discover its inherent meaning potential. The way out of an emotional low leads up the rungs of a ladder resting on the ground of fundamental gratitude and reaching into the high level of life tasks waiting to be fulfilled. 
The Place of Self-Help 
Professionals have their place in crisis intervention. But so has self-help and lay-help. The pastor is not the only good Christian, and the trained counselor is not the only good "mother." On the contrary, both may fail in day-to-day life while the lay person, using common sense, may succeed. Here are a few basic rules for success: 
•Don't 
take irrational feelings and fears seriously; defuse them with humor and paradox. 

•Don't 
give in to presumed dependencies; defy them with a deep conviction that humans in essence are free. 

•
Be thankful for the gifts of life because nothing can be taken for granted; much of our good fortune we notice only when it's lost. 


Humor, healthy defiance, and thankfulness are great life supports, and help us out of crises and sickness -and this comes entirely from our own strength! 
True helping professionals will not hesitate to pass on this bit of wisdom so that patients may become more in touch with their own resources. 
ELISABETH LUKAS, Ph.D. is director of the South German Institute of Logotherapy, Fiirstenfeldbruck near Munich, West Germany. 
REFERENCES: 
1. Frankl, V. E. The Will to Meaning. New York, New American Library, 1969. 
Israel: 
With Viktor Frankl in Jerusalem 
Mignon Eisenberg 
The sun shone high in the blue sky over the holy city; yet it was pitch-dark in the freshly elevated catacombs under the Western Wall (Wailing Wall) in Jerusalem. The small group of celebrants moved single-file down the narrow steps and along the winding corridors to reach one of the most recent historic archaeological discoveries in Israel's history -a chamber at the end of an archway leading to the Second Temple (destroyed in 70 A.D.) from which, according to tradition, the Divine Presence never parted. 
The procession was led by the Chief Rabbi of the Wall, with his long patriarchal beard, followed by a small group of people including the celebrant of bar mitzvah, the ceremonial of the rite of passage of a thirteen-year-old boy to full maturity. 
The ceremony was unusual. The celebrant of this bar mitzvah was a silver-haired man, Viktor Frankl, upon whom this unique honor was bestowed on the occasion of his 83th birthday. I had informed him that this was the time when a Jewish man was entitled to celebrate his "second bar mitzvah," thirteen years above age seventy, a precious gift from heaven, like living life over again. Thus, 83 (70 plus 13), is the appropriate time for a rededication to responsibleness, which is what bar mitzvah is all about. 
It all came to pass when, on the occasion of Frankl' s visit to Israel in November 1988, to obtain his honorary doctorate at Haifa University and to inaugurate the Viktor Frankl Institute of Israel, I asked him whether he would like to make the trip to Jerusalem to undergo his "second bar mitzvah." He graciously consented, on condition that it be a modest ceremony, without undue publicity. And so it came about that a small entourage followed the Chief Rabbi to participate in this auspicious event. The group included Viktor Frankl, his wife Eleonor (whom Rabbi Reuven Bulka once called "the ecumenical ingredient of logotherapy"), David Guttmann, codirector of Israel's Viktor Frankl Institute and dean of the School of Social Work of Haifa University which sponsored the invitation to Israel, Max Eisenberg, administrative director of the Institute, and myself. 
We observed the celebrant repeating the Hebrew prayer after the rabbi and wrapping his ta/lit (prayer shawl) around his shoulders. This was followed by the festive donning of the tefillin, two black leather boxes containing scriptural passages bound by black leather straps. We watched as the celebrant first patiently submitted to the rabbi's placing the straps on his left upper arrn ("opposite the heart") and then, as if remembering a dream, continued to wind them by himself, with firrn, fast movements, seven times around the arm between elbow and wrist, then on the hand and the middle finger. He had brought the boxes containing the worn black leather strips from his faraway home. 
The torah scroll was taken out of the ark and Frankl was called to the reading by his Hebrew name, Yitzhak Ben (son of) Gavriel. Over and over he softly exclaimed, "How beautiful!" attesting to the poetic beauty and relevance of many of the verses, repeating the words after the rabbi and yet frequently completing them on his own, obviously conversant with the original Hebrew text. 
The special bar mitzwah ceremony culminated in a makeshift kiddush (sanctification), celebration over cups of wine, with the eyes of all present shining with tears of reverence, excitement, and gratitude, toasting the celebrant, shaking his hands, hugging him affectionately. 
MIGNON EISENBERG, Ph.D., is founder and executive director of the Viktor Frankl Institute, Israel, and regional director of the Viktor Frankl Institute ofLogotherapy in Berkeley. A video tape of the bar mitzvah ceremony is available at the Viktor Frankl Institute, P.OB. 3741, Ramat Radar, Hod Hasharon, Israel. Phone 052-34202. 

Assisting Caregivers of Alzheimer's Victims 
Joseph Graca and Dale Archer 
In July, 1988, H1e VA. Medical Center in Knoxville, Iowa, opened an Alzt1eimer's Day Care Center (ADCC) for Veterans with Alzheimer's Disease or related disorders. It also provides respite relief for the caregivers, monthly support groups, and monthly home visits by a nurse and a psyct·1ologist. The ADCC emphasizes the application of logotherapy principles for Alzheimer's victims and caregivers. 
Overview of Alzheimer's Disease 
Alzheimer's Disease is a type of dementia. Dementia is an acquired persistent impairment of intelligence. At least three of the following areas are impaired:language, memory, visuospatial skills, personality/emot1ons, and cognition.' While numerous diseases can produce dementia, an estimated 50 to 75 percent are of the Alzheimer's type. 6 A conservative estimate is that more than one million persons in the United States suffer from this disease. The number of cases is growing rapidly due to the aging of the overall U.S. population. 
Significant advances have been made in our understanding the disease but there is presently neither a cure nor effective treatment for delaying the disease. It begins with difficulties in memory , and inevitably results m a profound loss of cognitive functioning and the inability to provide for one's daily needs such as eating and toileting. Difficulties in memory include lower ability to learn new information, decline in abstract reasoning, and errors in social judgment. Problems with naming objects is often the first sign of language impairment. Visuospatial functioning also is affected, resulting in difficulties with such tasks as driving. Interest in one's personal hygiene often declines. There may be a loss of social graces and social interests. In the early stages, victims may be acutely aware that something is wrong with their mental functioning, and often become apathetic. irritable, distrustful, or accusatory, with bouts of sadness and grief. 
In the middle stages of Alzheimer's Disease, memory for past as well as recent events becomes impaired. The victims may no longer remember the names of family members nor significant events in their lives such as vacations, marriages, or deaths. They have difficulties comprehending what others say and expressing their own thoughts. They are unable to concentrate and to initiate purposeful behavior. Their difficulty in daily living increases. They may no longer recognize faces. Personality functioning regresses and they may have outbursts of anger and poor impulse control. Apathy and hostility may become more pronounced. 
In the final stages of the disease, language and memory functioning decreases profoundly. The victims need total assistance with activities of daily living. They become unresponsibe to their surroundings except to direct stimuli. Death usually results from a fall or systemic illnesses such as pneumonia. The course of the disease from the early stages of memory loss to death can take anywhere from two to 15 years. In the early stages, caregivers witness the psychological and emotional death of the loved one. As the disease progresses, they watch the patient die before their eyes. In essence, they are forced into a grieving process often long before death occurs. 
The Caregiver's Plight 
Caring for a loved one with Alzheimer's Disease is a stressful experience. Caregivers are affected physiologically, psychologically, and noetically by the stress of caring. Primary stressors for caregiver and victim include the erosion of financial resources, loss of emotional support within and outside the family, loss of independence, and social isolation. The Alzheimer victims' dependency on the caregiver becomes a constant source of stress. Both are often in emotional turmoil as they experience bewilderment, frustration, guilt, depression, and anxiety. 5 
As the patient's needs for assistance and supervision increases, caregivers often feel pressured to quit any outside work and social activities. The mounting stress often has a profound impact upon the caregiver's own feelings of self-worth and sense of meaning and purpose in life. The caregiver role can dominate their entire life and thus become the only source of meaning. Caregiving becomes the standard to judge their selfworth. In essence they live to care for their loved one. 
If the caregivers do not receive assistance from family, friends, or social services, the stress of caregiving can result in their physical or emotional breakdown. This results in the placement of the Alzheimer victim in a nursing home or other structured settings because the caregiver is no longer able to meet the needs of the patient. Once the patient is placed, caregivers often experience an existential vacuum because their primary source of meaning is no longer available. Contrary to many health-care workers' views, caregivers may continue to experience frustration, guilt, and depression long after the loved one has been placed in a nursing home.7 
One of the most effective approaches in reducing caregiver stress is to involve them in a support group.7 Such groups provide recognition that someone cares, a forum for problem solving, and a resource for information on financial, legal and medical issues.5 Other sources of help are day-care services, and brief inpatient hospitalizations to provide respite from the caregiver role. Individual counseling can also be effective in alleviating depression, guilt, and anxiety while teaching the caregiver effective stress management techniques. 5 
Application of Logotherapy 
Application of logotherapy principles are helpful in understanding the effects of the Alzheimer's Disease process upon victims and caregivers. We have applied these principles in three areas: 
•Discovery 
of meaning in tragedy. One of the basic tenants of logotherapy is that "life can be meaningful. ..through the stand we take toward a fate we no longer can change."2 Alzheimer's Disease is a terminal illness. In its early stages, both caregivers and victim are acutely aware of the disease's course. They will often struggle with feelings of hope and despair. It is essential in the early stages, that the patient take a stand toward the disease process. But caregivers are also victims of this process and should develop a meaningful stand toward it. With support and understanding, the Alzheimer victim and the caregiver can take a stand of acceptance without false hope and without overwhelming despair. As one caregiver said in our support group, "It's like he is dying before my eyes. It isn't easy for me, but it is a labor of love. God has forced me to look at what is really meaningful in my life." 

•Maintenance 
of life meaning. It is essential that caregivers maintain other sources of life meaning. They must experience values outside the caregiver role. The importance of maintaining a parallel value system versus a pyramidal value system, clearly applies. 4 As Levinson pointed out,3 many American women find meaning primarily within the marriage relationship, and often rely on few extraneous sources of meaning. This task of finding outside meaning represents a 


55 
challenge for them, yet is congruent with the concept that caregivers must take care of themselves to effectively care for the loved one. Otherwise they also become victims of the disease process. Many times caregivers tend to neglect vocations, friendships, social interests, and hobbies. It is important for them to maintain these contacts and interests as a relief from stress and as sources of meaning. These sources of meaning may come from social support services such as day care and support groups as well as from family and friends. As one caregiver, who still had a part-time outside job, said, "I don't make any money on my job when I add up the cost of my paying someone to care for my husband. But at least I can meet people and feel I am appreciated for what I do." Also, drawing from other sources of meaning becomes crucial once the Alzheimer victim is placed in 
· a structured setting and the caregiver is faced with loss of meaning provided by the caregiver role. Removing this role can lead to an existential vacuum. 
•Self-transcendence. Logotherapy can assist caregivers by motivating them to transcend their current situation by helping others. Some professionals find it difficult to accept that caregivers who are experiencing significant stress and behavioral problems with their loved one, can also find the time and strength to reach out and help other caregivers. Our clinical observation is that transcending one's situation in reaching out to help other caregivers is one of the most effective approaches in assisting caregivers. Our support-group members often comment that they feel uplifted whenever they help one another. One woman caring for her husband in the advanced stages of the disease said, "I feel satisfaction when I can help someone cope with a problem. My suffering taught me a lot about Alzheimer's Disease. Things you don't read in the books but are important to know." 
Caregivers as well as the Alzheimer victims are faced with a profound noetic challenge. Caregivers who are able to confront the challenge are better able to maintain self-esteem, manage caregiver stress, and continue to experience a sense of meaning and purpose in life. 
JOSEPH GRACA, Ph.D., is a clinical psychologist at the VA Medical Center, Knoxville, Iowa. DALE ARCHER, Ph.D., is a former psychology Intern at Knoxville and presently is a clinical psychologist at St. Mary·•s Medical Center, Evansville, Indiana. 
REFERENCT:.S: 
1. 
Cumrnings, J and D. Benson. Dementia: A Clinical Approach. Boston. Bunerworths. 1983. 

2. 
Frankl, V. Psychotherapy and Existentialism. New York, Simon and Sct1uster, 1967. 


3 Levinson. J "Existential Vacuum in Grieving Widows:· The lnlemational Forum for Logo~herapy, 12(2), 1989 
4. Lukas\ F Meaningful Living. Nevv \'orkl Grove Press\ 
1984 
5. 
Mace. N. and P Rabins. The 36-Hour Day Baltimore. The John Hopkins University Press. 1981 

6. 
Martin R.L "Update on Dementia of the Alzheimer's Type" Hospital and Community Psychi.=itry, 40(6), 1989 


7 Zarit S., f\J. Orrl arHj 1J. Zarit. The Hidden Victims of .Alzheimer's Disease: Families under Stress. New York, New York University Press. 1985. 
Japan: 
Work and Play in Education 
Hiroshi Takashima 
The most characteristic difference between work and 
play is that work, in the physical world, is productive and play 
is not. Yet play can be productive from the spiritual point of 
view. If teachers enjoy their work, it is "play" for them. 
The difference between study and play for children is that study can produce distress, and play "eustress," pleasant stress. If children enjoy their study play is producing eustress. 
The difference between play and misdeed, however, is quite different from the relationship between play and study, because play involves freedom and responsibility, while misdeed involves neither. 
From such a viewpoint, logotherapy may give this advice to school teachers, particularly those who are troubled with truants from school. (Poem dedicated to Viktor Frankl) 
Life is "play" obedient to Law. 
Only in obedience to Law 
Freedom can be found. 
Freedom requires Responsibility. 
In undertaking Responsibility 
One can find a Meaningful Life. 
HiIROSHI TAKASHIMA, MD.,PhD. is executive director of the Japan Chapter ofthe Institute ofLogo therapy and president of the Japan Society of Humanistic Anthropology. He is a practicing physician in three clinics in Tokyo. 

38 
Nigeria: 
The Use of 
Pictures in 
Logotherapy 
Charles Okechukwu 
lwundu 
We have used pictures in logotherapeutic counseling as a tool for self-distancing and modification of attitudes. 
For instance, a patient suffering existential frustration, considered suicide. Our Socratic dialogue was supplemented by the three drawings shown. They pictured a man in a tree he had climbed to hang himself. He emptied his pockets and threw down some groundnuts. Another man walked by in search of food. He was delighted to find the nuts. The man in the tree was amazed that the nuts he considered worthless were of such value to the other.If a starving poor man still had so much hope, then life must be worth living.The pictures spoke to the patient's will to meaning in his unconscious and he decided to climb down and make plans for the future. 
Drawings with logotherapeutic messages in the reception room serve as mental preparation of the patients. They get patients in the right frame of mind to find solutions to their problems before meeting the therapist. 
CHARLES OKECHUKWU IWUNDU, Ph.D. is counselor at Rivers State College of Education, Port Harcourt.Nigeria. 



The two men join, share ideas happily, and go home. 
Norway  :  
A  "Case  History"  from  Frankl's  
Fi Ies  

Contributed by Bjarne Kvilhaugh 
The following "case history" is an impromptu interview by Professor Frankl with a patient recently admitted to the Poliklinik Hospital where Frankl was head of the neurological department. The interview took place as part of Frankl' s psychiatry class at the Medical Department of the University of Vienna during the summer semester of 1964 and was taped by one of his students, Bjarne Kvilhaug, Ph.D., who is now a psychologist at the Modum Bads Sanatorium in Norway. Dr. Kvilhaug transcribed the tape and Dr. Frankl kindly permitted its translation and publication. 
Frankl: This patient was admitted to the clinic only a few days ago. He was treated by my assistant. I have not spoken one word with him because I wanted him to tell you his story fresh and first-hand. (To the patient): I have no idea why you are here -what's the problem? Patient: The problem is my fear. It overwhelms me when I go outdoors. Lately, for instance, when I took a walk I suddenly had the feeling I was not able to turn back. The feeling has grown worse to such an extent that I thought the end was near. Frankl: Why? Patient: Because the fear constricted my vessels. Frankl: In other words, you were afraid of the consequences of the fear on your health. Where could such a constriction of vessels take place? Patient: At first around the heart. Frankl: And then? Patient: In my head. Frankl: What happened then? What did you believe would happen if you continued walking? Patient: I would collapse. Frankl: Will you give me your word that you have never read one of my books? Patient: I have not read any books of yours. Frankl (to the students): Why did I ask him to give me his word? Because I have repeatedly claimed that a phobia does not come about through a primary fear but through the reaction to 
this fear. This takes the form of an anticipatory anxiety -one might call it fear of the fear. And what does the phobic fear when he fears his fear? He fears the consequences on his health. A heart attack, stroke, collapse. In my terminology: coronary phobia, stroke phobia, collapse phobia. That's exactly the way this patient describes it. You can read it in my book, Theorie und Therapie der Neurosen. Do you see how important it was that I had not talked to him? Let's go on. So you were afraid you would collapse. What happened then? Patient: I started to walk back. After ten, twenty, thirty steps I felt better. Frankl: In other words, you surrendered to your fear. (To the students): He ran away from the fear. (To the patient): Is it fair to say that? You avoided the attack of the fear by walking back. (To the students): This is the agoraphobic reaction pattern I described in my book. A phobic runs away from his fear. In contrast to obsessive-compulsive patients. A Student: Who run storm against their obsessions. Frankl: Who fight against them, not run away from fears but run amuck against their obsessions. Do you see how this patient follows this pattern, completely spontaneous, not influenced by any readings? Afraid of fear, the consequences of the fear coronary, stroke, collapse -leading to a retreat, an agoraphobic withdrawal from the fear. (To the patient): What else happened? What did you do? What else did you experience? Patient: I stopped smoking, stopped drinking. Frankl: "Secondary gains", Freud might say. Well, has anything gotten better? Patient: Not really. Frankl: Did you seek medical help? Did you see a physician? Patient: The internist prescribed an ergotamine preparation. Frankl: Why? What did he say was the diagnosis? Patient: Perhaps a cerebral ischemia. There was no improvement. Then I was sent to a neurologist. He confirmed: vascular constriction. Frankl: What did he say caused the contractions? The fear? Patient: He didn't talk about that. Frankl: When did he do anything about the fear? Patient: That was practically never mentioned. Frankl: When was the fear first treated? Patient: The fear has really been treated only here by Dr. Kocourek (Dr. Frankl's assistant). Frankl: And what did he recommend? Patient: When I feel fear, I should tell it to become worse, I should collapse, fall into a faint, die. 
Frankl: Die? No less and no more? Patient: It really worked. The next day I had an attack of fear. Frankl: And what did you tell yourself? Patient: I told myself, the fear should get worse. It should get stronger, I should collapse. What do I have to lose? (Laughs). Frankl: You told yourself all this, quietly, under your breath? Patient (laughing): Yes. Frankl: Next time you tell yourself: So now, I go out, to collect my collapses. To get a heart attack, to get a stroke. Yesterday I had two heart attacks, the day before I had three, now I'll get at least four, because three heart attacks, that's nothing within 24 hours. I have enough time to have four, five heart attacks, and I'll throw in a stroke, too. So I'll go out and collect heart attacks. That's the way to talk to yourself. I don't think you'll then experience much fear. (To the students): Now you'll say that's suggestion, not paradoxical intention. Right? Wrong! Suggestion may have a part. But I can tell you cases, and Dr. Kocourek will confirm them, when he told patients to go out, collapse right in front of the hospital, the ambulance would have to bring them back to emergency. And these patients went out an hour or two later, pale like corpses and told my assistant this cannot end well, how can you ask me to do this, how can you take responsibility for what will happen, I am terribly afraid. They were afraid of their fear, afraid to apply paradoxical intention. Isn't it so, Dr. Kocourek? And then the patients came back, smiling, freed from their fear. They had left with a negative autosuggestion, with an antisuggestion as Erwin Wexberg described it, and nevertheless paradoxical intention worked."It hits right on the nose," as one patient once said. Of course, there is a bit of persuasion involved. The thing with yesterday twice, the day before three times, and today four times ... well, today four times, that's paradoxical intention. But the "yesterday twice, the day before three times," that's persuasion. Because he knows that up to now nothing happened, and paradoxical intention builds on this humorously formulated persuasion. You cannot ask a patient to use paradoxical intention without sometimes mixing in some persuasion. As long as he thinks his ECC is miserable, you might as well try to persuade a dead horse. He won't go out and use paradoxical intention before you don't convince him that his fears are neurotic and not based on reality. Is this clear? But then it hits right on the nose, as the patient said. (To the patient): Go on, what happened then? You went ahead and intended all that? Patient: To collapse, to have more and more fears. Then it went away. I didn't have any more of these attacks. 
Frankl: The attacks of fear, the big fear? Patient: The life-threatening fear. But then I began to have dreams which were based on fear. For instance, I lie in bed and someone calls me away, full of excitement, to a house with a garden. The garden is overgrown with weeds, and some 
colleaguesapear and enter the house. I wait outside, enter a long passage. I see a big black hole in the passage and walk back. Meanwhile I see a girl who says if I had gone into that hole it would have cost my life. Then I wake up. Frankl: Furious, or what? Patient: Yes, I was furious because she said that. Frankl: Why? Where did the anger come from? Patient: I'm not quite sure. Frankl (after a few moments of reflection): How many children do you have? Patient: I have two. Frankl ( probing): Does your wife want more children? Patient: No. Frankl (direct): Do you? Patient: My wishes are conditioned by her refusal. Frankl: Ah. (To the students): The long narrow passage is a symbol of birth, the dark hole is a feminine genital symbol. A woman warns and threatens him about entering the passage and the hole. I asked him cautiously, so not to influence him, if he is afraid to have more children. It turns out that his wife wants to have nothing to do with it, she doesn't want him to enter the long narrow passage. So you see I didn't prepare this. You know enough about psychology that you know this is improvised. But I have just now demonstrated what I have stated in the German original of The Unconscious God in 1948: that logotherapy, within certain justified limits, uses psychoanalytical methods, including interpretation of dreams, associations, and so on. As I said then, we march together but fight separately, because the psychoanalytic method illuminates merely the unconscious instinctual and emotional dynamics while logotherapy also is concerned with the noological (rather than psychological) dynamics (what I have come to call "noodynamics"), and the existential frustrations of the patients. (To the patient): Tell me, how long have you had these fears? Patient: To that strong extent, for about six weeks. Frankl: And when did they start in the first place? Patient: Ten or fifteen years ago. Frankl: And how long have you been married? Patient: Eighteen years.(Returning to the first question): As a boy ... I wanted to talk to someone and knew he didn't like me. Then I already was afraid. Frankl: Then you already had a tendency toward fear, didn't you? But tell me something else. Has something changed in your life within the past six weeks? In particular, have you ... Do you feel an emptiness inside, a spiritual void that makes you dissatisfied, unfulfilled? Patient: Yes, I could say so. Frankl: In what way? Patient: It's my job. The work has been basically the same for years, and even at home I cannot find any hobbies that are mentally stimulating. Frankl: And this problem has become more pressing, during the past few months? Patient: That's right. Lately, during the past four months, it's become especially bothersome. Frankl: Ah. You're running idle, spiritually idle. (To the students): An existential vacuum, we could call it. (To the patient): You feel unfulfilled, empty, life is somehow without a content ... would these be appropriate words? Patient: Without a content, certainly. Frankl: Busy but dissatisfied. Patient: Busy, yes. The working hours are relatively long. Frankl: Your day is full but your spirit remains empty. Patient: That's right. Frankl (to the students): This vacuum is invaded by those circle formations, those feedback mechanisms which we experience as fear of the fear, the running away from the fear which makes the fear only worse. (To the patient): I thank you. It was very interesting, this talk with you. We have learned much from it. (The students applaud). This applause is for you. (To the students): Could you follow? There is this existential vacuum which is invaded by all these feedback mechanisms, fear of fear, anticipatory anxiety, fear of harmful consequences of the anxiety. And now this: I told you that we have here an agoraphobic reaction pattern, the running away from the fear. Eysenck, the London behaviorist, would agree. The behaviorists also say that from a reflexological point of view it can be explained that a phobia is formed only if the patient tries to avoid the situations that cause the fear. We also see that here. In this connection, I may perhaps tell you what I have told no one yet, an experience I had last year. I went to the mountains with a young man, a friend of my daughter, whom I wanted to introduce to the "art" of rock climbing. After we had arrived at the foot of the wall, I sat down on the rocks to prepare our ascent. It was rainy and foggy and I therefore expected the climbing to be somewhat difficult. Suddenly I noticed that the young man had begun to climb without being secured, that is, without being connected with me -as his guide -by a rope. To make things worse, he had started among the brittle rocks. Angrily I shouted at him: 'Don't climb up without the rope!' But it is too late. I hear a rumble, and I see a man-sized boulder break loose and crash toward the young man who plunges down into the abyss ... a frightful sight! Then, on a ledge, he stumbles and the boulder falls on top of him, he tumbles down . . . disappears in the fog. I call him but receive no answer. Eventually I myself jump down into the abyss and find him, 200 yards below, unconsciosly in a pool of blood. After administering first aid and counteracting his shock caused by the trauma, the transportation to a hospital was organized. There he had to spend two weeks. And what did I do? Two weeks after the accident I went to the same place where it had occurred, meeting there -asit happened -the same bad weather conditions. But defying them, I started that climbing which I had had to cancel last time, thereby preventing an anticipatory anxiety to establish itself, that means thwarting that behavior pattern which is the real cause of any type of phobia. 
BJARNA KVILHAUGH, Ph.D. is a psychologist at the Modum Bada Sanatorium, Norway. 

Mexico: 
V. Frankl and V. Havel Two Lives in One Time 
Guillermo Pareja Herrera 
1990, the beginning of the last decade of the last century of the second millenium of the Christian era. 
In their attitude to time we sometimes develop "chronolatry" (time worship)--"time is money"; "chronophobia" (fear of time )--"don't talk to me about time!"; or "chronophilia" (love of time)--"oh, the good old days!" 
Like it or not, we are affected radically by this kind of categorizing. This moment takes me to ... 
1979. Summer-Autumn. I am in Vienna to reconstruct my manuscript on the life and work of Viktor Frankl, lost in the rubble of the earthquake in Mexico City. Unforgettable days in Vienna, with the Frankls. Afterwards a long trip through Czechoslovakia, Poland and Germany--glimpses of human freedom withstanding tragedy: Terezin, Auschwitz-Birkenau, Dachau, Turkeim, Kaufering death camps where prisoner No. 119104, Viktor Emil Frankl, spent the years 1942 to 1945. 
Fresh in my memory are the warm conversations I had with Viktor and Elly about the Europe which today, ten years later, confirms with deeds the basic ideas of logotherapy on liberty and human responsibility -that both socialist totalitarism and capitalist "consumptionism" can be dehumanizing systems. 
Prague, Crakow, Warsaw--cities witnessing again, in spite of all, the hope of the poet who said: 
All the flowers can be uprooted 
but no one can stop the return of spring. 
1989. Winter. December -a decade later. Viktor Frankl, the Viennese neuropsychiatrist of Prague and Moravia descent, and Vaclav Havel, the playwright born in Prague-there is a surprising coincidence in their manner of understanding human nature and several parallels in their lives: the prisons, spiritual freedom in the face of difficult situations, and the call to serve as the voice and awakeners of conscience. 
1979. Autumn. October 22-23. I was in Prague these two days when Vaclav Havel and his companions were sentenced to five years in prison. Their crime: to sign and defend the "Letter of the 77 ," a human rights defense group. 
In his dark prison Vaclav Havel survives by writing letters to his wife Olga and in them finds two lifelines: love for his wife and a meaning no one can take from him. In his silence he meditates on "the crisis of human identity, the disintegration of the human being within himself and the loss of everything that gives significant order to existence. I Havel writes: 
What is in reality human responsibility and to what is it related? It is a relationship in which there are two poles: one person who is responsible and something to which he is responsible ... Modern persons if they do not understand this responsibility as a relationship with God have many answers to his question. I 
To believe that responsibility is "only" a relationship with people or that it is simply our conscience as though it were something that comes with our "biological equipment" --similar to Freud's superego--is limited. These explanations are empty and do not go to the heart of the matter: 
They tell us as much about responsibility as the model of an atom tells us about the essence of matter or a tacheometer tells us about the essence of movement. I 
Positivist explanations fail because they "reduce" 
responsibility to something that is relative, finite and transitory: Responsibility is not only the mutual relationship between two relatives but is the relationship between a limited being and a non-limited Being. I 
Who is Vaclav Havel who writes this? He is a human being devoted to the theater, who spent years in factories as a worker-playwright, in prison several times, and yet kept his people's conscience awake. In 1989 he went to prison for defying authority by laying flowers on the tomb of the student who set himself afire to protest the invasion of Soviet troops in Prague in 1968. A few months later, Havel was set free and the people asked him to accept the presidency of the republic. 
Before he was captured, Havel was asked to emigrate to the United States--like Viktor Frankl many years ago--but he would not go. His reason: 
When our people need us, we should be guided not by what is most agreeable for us but what makes most sense: the brotherhood with our people. I 
In prison he confirmed his attitude before the world: to himself, government, political parties, and the artistic world. In his works he proclaims a better world and denounces present conditions where the transitoriness of life, conformity, totalitarianism and "consumerism" are corrosive acids: 
The intellectual must question all systems, all powers and give testimony against their lies. He must oppose unjust laws and continue being unclassifiable. I have no advice to give to anyone. I can resolve no problems for others. Each must find his own solution to the meaning of life.1 As to the "mega-systems" of the East and West he says: The political debate between the right and the left is traditionally concerned with ownership--to determine whether property should be left in private hands or nationalized. This is not the most important question. What is fundamental is that the human being be the instrument by which to measure structures--including the economic ones-not that he adapts to them.1 
To Havel maturity consists of the harmony between the individual and a community in which personal responsibility is not "diluted" and human value is not determined by membership in institutions or parties but by loyalty to oneself. Havel sees the principal cause of the failure of political, social and economic systems in the internal dehumanization of society, converting human beings into pieces of machinery or objects with a price. 
In our societies we often do not accept responsibility for our actions or their consequences. We try to justify human and ecological disasters without exercising true self-criticism by placing the causes "outside" of ourselves. This self-criticism must speak in socialist countries where personal identity is obscured in anonymity as well as in western societies where people believe that drugs are the door to an authentic existence. 
The years continue to offer opportunities for the human race to overcome the narrow vision and attitudes that divide the world into East and West, North and South, black and white, junkie and clean, communists and capitalists; to discover a little more of that freedom and responsibility to which Frankl and Havel have given testimony in this turbulent century. 
(Translated from the Spanish by Mrs. Bobbie Brock) 
GUILLERMO PAREJA HERRERA, Ph.D. is professor at the University of Chihuahua, School of Medicine, and founder of the first "Mexican Institute of Existential Analysis and Logotherapy, Viktor E. Frankl." 
REFERENCE: 
1. Mergier, Anne Marie. "Proceso Semanario de lnformacion y Analisis." No. 68915 enero; Mexico, pp. 42-48, 1990. 
Poland: 
Universal Truths 
Kazimierz Popielski 
Viktor Frankl's concepts of human nature have been expressed by thinkers in a variety of fields. They indeed contain universal truths. 
I should like to compare Frankl's ideas with those of Karol Wojtyla who was professor of philosophy at the Catholic University of Lublin, now Pope John Paul II. His concepts 
67
are taken from his writings listed in the references.5, , 
Both scholars see human beings as deciding subjects rather than manipulable objects -free, responsible, continuously developing, and self-transcendent. These characteristics, and the emphasis on three-dimensionality (body, psyche, spirit) make for their uniqueness. Both thinkers warn that disregard of the human spirit leads to dangerous reductionism. 
In times of crises and confrontations like the present, Wojtyla writes, the need to find meaning and purpose is especially strong.7, P·6 Frankl shows that this search has more than theoretical implications. It plays a crucial part in the existence of the individual who, feeling spiritually isolated, may react to the reality of life with a neurosis originating in the spirit (noos) which Frankl calls a noogenic neurosis.1,P·74 Such patients bring to the psychiatrist a medical as well as an ethical problem. They function properly but "feel bad." Both Frankl and Wojtyla see human nature expressed in more than physical functions and psychological reactions. Human beings function on a physio-psychological level but also aspire to fulfill themselves as individuals of the spirit. 
Wojtyla formulates a dual ethical principle which is the basis for human dignity. The positive part says, "Individuals are of such high value that they are properly treated only through love."And the negative part: "Individuals are of such high value that they must not be treated as an object of use.5 P-31 Therefore, a person cannot be an object of use, only an object of love. 
Frankl, too, regards as characteristic of love that it does not consider human beings as objects but respects their subject quality.4On the basis of such a personalistic view Frankl sees logotherapy as a "rehumanization" of psychotherapy.3, P-341 
Wojtyla sees the human being as an individual fully capable of self-determination.6 This capacity forms the basis for managing oneself and giving oneself to others. This is in accordance with Frankl's contention that self-actualization is only an unintended side-effect of self-transcendence; it is selfdefeating to make it the target of intention.2, p.35. 
In logotherapy, Frankl arouses the defiant power of the 
1, P-133
human spirit in patients to take a stand against the limitations of body, psyche, and environment -to act within, and often even against, unavoidable handicaps. Similarly, Wojtyka writes: "Human consciousness and freedom, the essence of the human spirit, give human beings the strength to conquer their somatic and psychic dimensions. ""7.p.lO 
Both · .ola define human beings not through what they think but primarily through how they act. In their acts they reveal themselves in their truest and deepest reality. When people think, they can lie. When they feel, they can change. But in their acts they show the unique truth about themselves. In their acts they show how they express their freedom, responsibly or irresponsibly, according to their true self. 
KAZIMIERZ POPIELSKI, Ph.D., is professor of psychology at the Institute of Philosophy, Catholic University of Lublin, Poland. 
REFERENCES: 
1. 
Frankl, V.E. Psychotherapy and Existentialism, New York, Washington Square Press, 1967. 

2. 
____. The Unheard Cry for Meaning, New York, Simon and Schuster, 1978. 

3. 
____. "Psychotherapy on its Way to Humanization" in Sandra A. Wawrytko, (ed.) Analecta Frankliana, Berkeley, Institute of Logotherapy Press, 1980. 

4. 
____. "The Meaning of Love," The International Forum for Logotherapy .l.Q(l), 1987. 

5. 
Wojtyla, Karol, Milosc i Odpowiedzialnosc, Krakow, 1968. 6•~---· Osoba i Czin, Krakow, 1969. 


7.____. "Osoba: Podmiot Wspolnota" in Roczniki Filozoficzne 24(2), 1976. 
South A  Africa: Lesson for Me South Africa  and  
Patti  Havenga  


I met Viktor Frankl in 1966 when he came to South Africa as guest lecturer at the University of Stellenbosch. I was then working for the Atomic Energy Board at Pelindaba, and one of my tasks was to arrange visits of scientists from abroad. After getting him through customs, some professors from the University of Pretoria waited to greet him. They had asked him to lecture at Pretoria, which he had declined. I challenged him and told him that I had neither the money nor the time to fly to Stellenbosch (1300 km awaylHetook me aside. He would try to come to Pretoria on one condition: not to be bothered with idle socialising, and no formal reception or lunch after his lecture! He only wanted a "bun and a cup of coffee." 
He kept his promise, I met him at the airport. The next day I went to his hotel to take him to the University. He was preparing his lecture, making funny little scribbles (I know now they were stenographic notes). The time ticked away and I had to tell him we had to leave. Unrushed, with a smile on his face, he carried on until he was ready. The lecture hall was packed and buzzing but when he started to speak there was not a sound, not a movement, it was as if the audience had stopped breathing. I could only find room to sit on the steps. Halfway through his lecture he announced -which was news to me -that he had invited me to study with him in Vienna. 
In July 1967 I flew to Vienna. I went to the Poliklinik, ready to absorb every word of wisdom. He greeted me warmly and asked me if I had noticed that the sun was shining in Vienna. Of course I had not, I am a spoilt South African· and used to the sun shining in the morning. He asked me to please go out and enjoy the sunshine. What a disappointment! 
It was only later that I realised how much I had already learned about logotherapy, just by being with Viktor Frankl. His immediate personal reaction to people, his spirit-to-spirit communication with them, his disregard for pretense and prestige, his self-transcending quality, his attention to the meaning of the moment, however trivial it may seem! 
Years later, driving him from Johannesburg to a lecture in Pretoria, I asked him, "Are you nervous?" He did not answer at first, then gave a wise answer to a superficial question, asked because I was nervous for his sake. He pondered: "Nervous? I have not time to think about it." When he received an honorary 
51 
doctorate from the University of South Africa, he sat on the 
platform, oblivious of himself, intently watching the black, 
Indian, and white students getting capped. At the TV station I 
saw his amusement when the producer tried to make him sit in 
positions that were unnatural for him. Once the lights went on, 
he broke the producer's rules, shifted into his own comfortable 
position and had everybody, from the most junior cameraman to 
the producer hanging on his lips. 
Viktor Frankl in action is like nobody I have ever seen. Every word is carefully chosen, statements are masterfully timed, and all this comes effortlessly. He works for days on his speeches. Often my late husband, W.B.Coetzer, and I had to scramble for dictionaries to find the precise word he was looking for. He writes, sketches, thinks, rethinks, but ultimately it looks as if he hardly ever consults his notes. His presentation, his timing, his body language come from a man who never pauses to study himself. Frankl uses certain examples over and over to illustrate a point, and once my husband suggested using different examples. Frankl considered it and did just that, and those two or three sentences we tampered with were the only bit of criticism I ever heard. Although my husband was right in saying that there are many other examples illustrating the same point, those that Frankl used over and over have clout and illustrate the point to perfection. 
Elly, his wife of 42 years, is a beauty, serene, strong. 
· She works with him when he is writing, preparing a lecture, appearing in public. I admire her dedication, and her friendship is precious to me. Both have given me something precious to them: time. Frankl has rejected high speaking fees because it would take away time. Time is one thing you cannot buy. 
Frankl has many talents. Once in Vienna he played the piano for Elly and me, and asked whether I recognised the tune. I did not. It was his own composition. In his seventies he planned to take up parachuting. I was horrified. Others must have persuaded him to learn flying instead and he got a pilot license. Sitting at our dinner table he unceremoniously called for pen and.paper and drew the face of the woman who brought us the coffee. He excels in drawing caricatures of himself. 
You hear about Frankl and his philosophy in South Africa from the most unexpected sources. The principal of an Afrikaans university told me he uses Frankl' s principles often in chairing university meetings. A Jewish rabbi does the same in counseling members of his congregation. An Afrikaan minister quoted Frankl to illustrate a point during a radio sermon. A housewife, after reading Man's Search for Meaning, responded by looking at her every-day tasks in a new manner. A student found a new attitude toward his intimidating matric exams. A businessman told me he replaced an empty cliche in his annual report by a meaningful phrase from a Frankl book. 
I often wonder how these insights might be combined for the new society forming in South Africa.The solution lies in our schools, in education. South Africa has been blamed for every real and imaginary sin. It can emerge from the present situation richer and better if Frank.l's philosophy is widely used. It can become a fine society because it has this one advantage: it is critical of itself, self-examining its motives. Its history is like no other country's. Such self-examination, of course, could lead to depression but I think we are halfway out already. Frankl, like no other thinker, helps us uncover the will of the nation toward meaning. His philosophy is applicable to all South Africans, from high-school students to those in authority. 
•Responsibility: 
it is a myth to think responsibility applies only to those in power. We all have to accept responsibility not as a burden but freely, as opportunity to find meaning. 

•Attitudes: 
Our attitudes have long changed. We only need the awareness that this is the case. 

•Freedom: 
The cry for freedom has different meanings for different people and is abused by those with ulterior motives. Sometimes it is used in the sense of "freedom to kill" and becomes a licence for indecent behaviour. 

•Humour: 
South Africa has been battered internationally. In the process we have become oversensitive, introspective, and humourless. 

•Self-transcending 
our negative image, and without trying to impress the world, we have to accept the wonderful opportunities to reach out -to others, to new ideals. 


South Africa is a country of many groups, languages, cultures. It is difficult to find uniformity of outlook and behaviour. Frankl said that there are only two groups of people, and that the decent will always be in the minority. We are in a better position than any other country to know that this does not automatically mean people of the same colour,culture,or religion. 
Frank.l's philosophy can contribute immensely to making South Africa one of the finest countries. What other nation has been made so aware of its faults, mistakes, and short-comings? We have been forced to examine our every motive. The will-toaccept-responsibility rests with every one of us. 
PATTI HAVENGA, Ph.D., is director of the Viktor Frankl Foundation I of South Africa, Houghton, South Africa 
Sweden: The Logotest in Sweden 
John Stanich and Ilona Ortengren 
Traditional correlational methods of analyzing psychological tests have advantages and disadvantages. They allow the test analyst to compare how well two tests are related to a particular variable.But they also allow erroneous interpretations. Arguments based on correlations can be stretched to an extent that preconceived beliefs contaminate the conclusions. 
An oft-overlooked method of test investigation is the indepth soft-data analysis. This technique is used in field studies when hard-data alone cannot provide fruitful results and also when the researcher must work with what people write or say. 
In the Logotest are boxes for checks and yes/no responses, but also the test takers are asked to provide short descriptions of their own situations in life. This description is well suited for the in-depth soft-data analysis. Thus, much more information than the usual risprocured through the Logotest. 
Initially we had planned to standardize the Logotest for Sweden, but preliminary results caused us to wait. We decided not to standardize without taking notice of the wealth of softdata. Putting the soft-data to maximal use through analysis* and combining it with correlational techniques may provide greater test validity than if either method were used separately. 
Method 
Between August and December of 1988, 150 subjects in and around Gothenburg, Sweden, were asked to complete the Logotest and the Eysenck Personality Inventory (EPI). Administration of the tests was conducted by ourselves and our assistants. To minimize the risk of bias, we chose assistants who had little or no knowledge of logotherapy and the Logotest. We asked them to distribute our materials and instructions to their students, friends, acquaintances, and co-workers. Our intention was to obtain as broad a sample as possible in spite of our limited time and budget. 
Data were gathered from local offices, adult-and evening schools, and university classes. Subjects took the tests home for completion and returned them in person or by mail. 
Skepticism ran high from the outset -many potential subjects were apprehensive about what the information would be used for, despite an introductory informed-consent page and our assurances that the information was intended solely for test analysis purposes. In an effort to improve our rate of return, in October, 1988, we provided tests and oral instructions together with self-addressed, stamped envelopes. This strategy was of little advantage; no significant difference was noted between the in-person-testing and SASE-testing techniques. 
According to feedback we received, those who initially agreed to participate but did not return our materials were regretful, suspicious, or simply changed their minds. In all, 59 Logotest/EPI's were returned. Participants received one copy (male or female version, as directed) of the Logotest (translated into Swedish by us) and with Form A of the EPI (standardized in Sweden in 1965 by Bederoff-Petersson, et al.1 They also were given, orally and in print, the directions outlined by Lukas in the Logotest Manual.2 The EPI instructions are stated on its introductory page, thus no oral instructions were necessary. The EPI makes no sex distinction and although two forms of it exist, Eysenck reports that, for experimental purposes, it makes no difference which of the two forms is employed. l,p.4 In all cases the Logotest preceded the EPI in the test package. 
The Logotest 
The Logotest is based on the ideas of Viktor Frankl and measures degree of inner meaning fulfillment and existential frustration. The test is made up of three parts with a total of 18 statements and questions (toward which respondents are asked to take stands). Also included is a self-inventory in which respondents are asked to describe their own "case" (or "situation", as we have called it). The Logotest is scored such that higher scores indicate a lesser degree of perceived inner meaning fulfillment while lower scores indicate a greater degree of perceived inner meaning fulfillment. 
Part I of the Logotest has nine statements centering around potential meaning orientations which may be present in the respondents' lives. They may respond "yes" (and receive 0 points), "no" (2 points) or leave the question unanswered denoting uncertainty or refusal to take a stand (1 point). The specific meaning-providing factors of each item in Part 1 are: 
1) Own well-being 5) Social Aspects 
2) Self-actualization 6) Interests 
3) Family 7) Experiences 
4) Occupation 8) Service 
9) Overcoming distress 
Part II consists of seven statements responded to with "often" (2 points), "once in a while" (1 point) or "never" (0 points). The statements deal with reactions to existential frustration and take into account the following specific areas: 
• 
Aggression •A reasonable coming to grips with 

• 
Regression the situation (reverse scored) 

•(Over)compensation 
•Neurosis 

•Flight 
reactions •Depression 


Part III begins with three brief paragraphs depicting persons of the respondent's own sex in three different life situations. Then two questions are asked: "Which man/woman is happiest?" and "Which man/woman suffers most?" Each answer is scored 0, 1, or 2 points, with higher points suggesting higher existential vacuum. 
The final portion of Part III asks respondents to describe their own "case" (situation). Our subjects were encouraged to use the back of the page if the space provided was too small. This self-inventory is scored for two values: a) "meaning" value (0 to 4 points), with higher points suggesting less inner meaning fulfillment; and b) "attitudinal" value (0 to 2 points), with higher points suggesting less optimistic attitude. Scoring for these two values is covered in detail in the Logotest Manual. 
Point values for the whole test are summed to get a Logotest total score which places the respondent within one of four quartiles (units of 25%). These are Q1 (rich inner meaning fulfillment), Q2 (good inner meaning fulfillment), <23 (fair inner meaning fulfillment) and Q4 (poor inner meaning fulfillment). Within Q4, two smaller domains of 10% each exist: decile 9 ("09) indicates presence of an "existential frustration" and decile 10 (D10) indicates "noogenic neurosis." The remaining 5% is denoted as Q4 -(09 + D10) placing the respondent in a "caution area" where risk for existential frustration exists. Space is also provided for the test administrator's use. Here, notes regarding any therapeutic relevance of the completed test may be made. 
The Eysenck Personality Inventory 
The EPI is a questionnaire in which respondents check "Yes" or "No" to a series of 57 items. These items test two factors of personality: degree of extroversion/introversion and degree of neuroticism (stable/unstable personality). Twentyfour items are devoted to each of these two factors. Nine items designed to expose "social desirability" are included as a liescale. Upon completion of the EPI, scores for the two traits and the lie-scale are converted to standardized stanine scales. 
Hard-data results 
Our average (mean) Logotest score was 13.95 (standard deviation= 4.1) compared with the German study M = 13.76, SD = 4.99 and the American M = 11.45, SD = 3.92. Spearman rank order correlations between individual test parts and total score were: .81 (Part I), .54 (Part II), and .47 (Part III), all significant at the .01 level. 
Age was negatively correlated with Logotest scores (p < .05), as expected from Lukas' observation that younger persons are in the process of finding meanings while older persons are more likely to have already established meanings. The average age of our sample was 39.4 years (range= 16 to 91). 
An item-by-item examination of the responses to Part I of our Logotest results revealed the results shown in Table 1. 
Table 1  
Focus  M  N  
Social aspects Experiences Own well-being Occupation Family Self-actualization Interests Service Overcoming distress  0.15 0.19 0.48 0.49 0.49 0.71 0.97 1.17 1.61  6 6 18 19 20 23 32 36 50  

(M = mean score. N = number of subjects who scored 1 or 2 points.) 
Most of our subjects indicated that they perceived high inner meaning fulfillment with regard to "social aspects" and "experiences" whereas few answered positively to "overcoming distress." The composition of this statement ("My life is darkened by suffering, worry or sickness, but I make great efforts to improve the situation") has led us to conclude that either our subjects suffered little distress or had not uncovered "meaning in suffering". 
The Logotest and the EPI 
Ten of the EPI's were not completed as required. Some respondents failed to check the appropriate "yes" or "no" box, others checked in between the boxes. Since there is no mention of how to score such tests, they were omitted from our data. For N = 49, the correlation between the Logotest and the EPI extroversion/introversion score was -.06 (not significant). The correlation between the Logotest and the EPI neuroticism score was +.40 (p < .01). This statistically significant result prompted us to examine the Logotest subtests (Parts I, II, and Ill) in relation to the EPI neuroticism score. Parts I and III correlated positively, but the results were not statistically significant. Part II, on the other hand, correlated +.62 (p < .01). 
The Logotest Manual states: "Part II attempts to psychometrically define the phenomenon of 'existential frustration.' Experimental psychology has found seven reactions to an existential frustration: aggression, regression, (over) compensation, flight reactions, a reasonable coming to grips with the situation, neurosis, and depression." And further on, "(T)he assumption in Part II was that persons who find that only few of such reactions to frustration have validity for themselves are not suffering from a strong existential frustration. Those who can identify several of these reactions (which all indicate an insufficiently experienced meaning in life) suffer from a strong existential frustration. "2 Thus, the relation between Part II of the Logotest and the EPI neuroticism score is expected. 
Soft-data results 
As mentioned above, Part III of the Logotest asks the respondents to describe their own situations. Forty-two of the 59 subjects complied. Responses ranged from a few lines to several well-detailed paragraphs. Each response was analyzed to obtain a meaning score and an attitude score as outlined in the Logotest Manual. Additionally, we analyzed the responses via the in-depth soft-data technique. 
The in-depth soft-data analysis works as follows: the written data are analyzed with as few preconceived ideas as possible; hypotheses are generated; the ideas upon which hypotheses are based become part of a "code" which is successively built up as new ideas are generated; and the process continues until a discovery is made which can be checked and cross-checked to ensure correct and verifiable conclusions. 
By following the in-depth soft-data process outlined above, our analysis led to the following three questions: a) What did the respondent write (specific content)? b) How did the respondent express his or her own situation? c) Were there any inner meaning fulfillment areas not tapped by the Part I items? The two first questions were to some degree covered in the "attitude" and "meaning" scores; however, it was necessary to pose them in order to validate answers to our third question. 
In part 111, it appeared that respondents elaborated upon what they were asked in earlier test parts. This proved beneficial to our analysis -we could check how well earlier "box" answers agreed with the written responses. 
Focuses not explicitly covered in Part 1 but present in self-inventories (Part Ill) included: understand more, find oneself, flexibility, inner harmony, solve problems, success, and obtain a family of one's own". This last focus is mentioned but appears as one of three components of a single item. 
More importantly, we found 12 rather than 9 areas where resondents did perceive meaning within the Part I items. Two items contained more than one focus. For example, item 3, "I feel happy in the safety of a home, within my family, and would like to help my children to gain a similar foundation", presents three focuses -security at home, family, and helping my children -toward which the respondent is expected to answer "yes" or "no." An important precondition embedded in this item is that the respondent has a family. Should this not be the case, the answer must be "no" or blank. Implicit, however, in this item is the idea that inner meaning fulfillment must include having a family, home, and children. What about a single person who finds fulfillment in simply the first focus (i.e., security at home)? Also, consider a couple who, despite forming a family of two, cannot have children? 
The directions to Part I state "You may leave the box unmarked if you find the decision difficult." This is understandable in light of the complexity of the two items, but we have reservations in this case because the items can provide important information, particularly when the goal of the Logotest is to establish the respondent's degree of inner meaning fulfillment in any area where meaning may exist. 
The other item with more than one focus is Item 1, "I prefer a peaceful, pleasant life without great difficulties and with sufficient financial resources." Here are two focuses that seem related but can (and did, in our sample) warrant separate "yes" responses. 
We question whether the items should have been formulated in a different manner. For example, statement 3 could be reformulated into three separate statements and statement 9, "My life is darkened by suffering, worry or sickness, but I make great efforts to improve the situation", could be reformulated to say "I make great efforts to improve any suffering, worry, or sickness in my life." Here, two problems are overcome. First, the statement "I make great efforts to improve" becomes the focus of the item instead of hyperreflective "suffering, worry, or sickness." Second, the "but" is removed. If the Logotest is to hold true to its logotherapeutic tenets then we feel there should be no "but" (which is synonymous with "in spite of'). There should be an "and" which implies "living with" suffering, worry, or sickness. 
Concluding remarks 
Users of the Logotest may consider our suggested revisions for Part I. We plan to test them in the near future. Part II neatly covers the intrapsychic factors in a mere seven questions. Part III proves valuable despite its low correlation with the rest of the test. 
The interested reader may consider the following information we gained while working with the Logotest in Sweden: a) Accurate translation (however simple a statement or question may appear at first sight) is essential, particularly when cultural and class differences are present; b) Clarity in any test is vital for its validity, particularly so when discussions take place on international and intercultural levels; and c) We psychologists must assure the up-to-datedness of our instruments. In a world where traditions are crumbling even faster than they did twenty years ago (consider item 3: what do "family" and "helping children" have to do with an individual who has decided solely upon a career?) we must be all the more alert to new areas of potential inner meaning fulfillment. 
JOHN STAN/CH, M.S. and ILONA ORTENGREN, M.S. have just concluded a five-year post-baccalaureate program in Clinical Psychology at the University of Gothenburg, Sweden. This article is an adaptation oftheir Master's thesis. 
REFERENCES 
1. 
Bederoff-Petersson, Jagtoft and Astrl>m. "Eysenck Personality Inventory: Observations and Data from Swedish Investigations," Psykologi/FMaget, Stockholm, 1980. 

2. 
Lukas, E. S. "Logo-Test," Franz Deuticke Verlagsges. Vienna, 1986. 


*"Uings upptiicktens vag" (eng. tr. "Along the Road of Discovery") by Lars Dahlgren, et al. provided us with the essentials of soft-data analysis. the book is derived from the principle ideas in Glaser andStrauss' classic sociological work ''The Discovery of Grounded Theory." 
60 
United States: A Modified Logochart for Youth 
Bianca Z. Hirsch 
Khatami, in explaining use of his logochart,2 describes the human being as "the sum of an automatic self and an authentic self." The automatic self represents the automatic (gut level) reaction to a situation, and the authentic self the core and essence of the self. The automatic self is the biological and psychic aspect of the individual derived from heredity and environment, the authentic self is the creative, responsible, and meaning-oriented aspect. Reacting from the automatic self may create turmoil when past responses no longer fit the present situation. When these two levels of reaction are clarified and understood, clients can direct their behavior accordingly. Khatami teaches his clients to identify their automatic and authentic reactions and sort them in three categories: cognition, meaning, and response/behavior. In the automatic column clients list their reactions based on biological and psychological influences. In the authentic-self portion, their reactions are identified from the attitudinal noetic level.2 
A modified version of the logochart can be a useful tool in helping children make meaningful choices. Therapeutic work with children and adolescents does not necessarily follow the implied medical model of "ill health" and "recovery," but focusses on wellness and wholesomeness. Youngsters do not seek help because something is wrong but because they need to share or explore a more wholesome way to perform. Their goal is not "emotional equilibrium" but establishing a relationship, mastering a situation, or finding a satisfactory daily routine. Reducing tension is not the primary goal of the therapy because noetic tension may be needed to motivate and initiate action. The focus of logotherapy is to help clients realize that they are responsible creatures who must actualize their potential of meaning, and that their meaningful aim is not self-actualization but self-transcendence. Only to the extent to which we commit ourselves to the fulfillment of life's meaning, can we also actualize ourselves--it is a side effect of self-transcendence.1 
To help children cope with daily demands, to improve interpersonal relationships, they must be led to see that they are not helpless victims; they have choices, and are responsible for their attitudes, even if they are unable to change the situation. 
Applying the Logochart 
Tom, a teenager, was referred to me because of inappropriate behavior on the tennis court. When playing badly or losing a game he would throw the tennis racket onto the ground, even breaking it. Although he was an excellent player, his behavior threatened his tournament eligibility. School performance was minimal, with many C and D grades. His social behavior was poor and saddened the family. 
He insisted that winning was the most important part in playing tennis. His entire free time was spent practicing and he hoped to receive a college scholarship on the basis of his tennis skills. The first therapy session focussed on his goals, objectives, his positive attributes. We made lists of how he perceived himelf and how others ( family, friends, teachers, opponents on the court) perceived him. We talked about issues over which he had control, such as scheduling his time, making space for home work, his attitude toward teachers and grades, how much effort he wanted to invest in making changes.Lukas points out that correcting attitudes and wrestling with meaningful goals is one of the most difficult and painful parts of therapy and requires a great deal of patience, care, and empathy.3 
Using an adaptation of Khatami's logochart,2 we began identifying specific issues. The "Automatic Self' column was renamed "My Usual Behavior," the "Authentic Self' column was renamed "Behavior I Expect of Me." Cognitive aspects were discussed in terms of "What do I Think?" Meaning aspects were listed as Purpose and Goals, and "Response/Behavior" was renamed "What do I Do?" 
Issue; Homework My Usual Behavior Behavior I expect of me 
•What 
do I think •Boring, busy work •Get it out of the way; stop about this? complaining about it 

•What 
is my •Keep teacher off •Practice could help me learn; 12uniose/goal? my back will get better at it 

•What 
do I do • Procrastinate •Set a time, do it, then have about this? fun with tennis and things 


Issue; Tennis My Usual Behavior Behavior I expect of me 
•What 
do I think •Get angry when I don't •Enjoy game, chance to about this? play well.win at any price play with excellentplaycrs 

•What 
is my •Fame, money •Play well, enjoy sport and puniose/goal? other activities 

•What 
do I do •Lose my temper; blame • Accept that I did my best about this? myself and others and so did my opponents 


Once Tom identified his expectant behavior, he was able to set reasonable goals for himself. When he wrote about the game, cognitive distortions came to the foreground. He discovered that tennis had ceased to be an enjoyable game but had become a focus for power and fame. In logotherapeutic terms, he did not seek the limits of his own potential and then compete with himself, but instead focussed on competing with and beating others. The level of his aspiration had become so skewed that he looked upon losing as a catastrophe -a failure in his eyes and the eyes of his peers and family. We discussed areas of responsibility, choice, and actions, and explored alternative areas where rules superseded his own preferences. Realistic goals included concentrating on doing his best instead of triumphing over others. He was encouraged to live by this principle on the tennis court, in the classroom, and in interpersonal relationships.When a family event was planned, we rehearsed scenarios anticipating situations and conflicts, reviewing appropiate responses, and then actually following through in real situations. Tom discovered that when he knew what to expect, he was able to make plans, offer alternatives and make choices that led to successful resolutions within the family. Such plans offered more opportunities for success than discord, and success was within reach. From the logochart he was able to see that when his focus was on winning, winning became his goal rather than a by-product of playing well. The more he focussed on learning rather than on homework, the more interested he became in studying. He stopped being concerned with the obligation (homework), but became involved in the process of learning with its far-reaching goals. Temporarily he gave up tournament playing and played tennis just for fun. He returned to the tournament circuit with a new attitude. Winning was important but being on the courts with excellent players was exhilarating. At last report, he did well in school. 
BIANCA Z. HIRSCH, Ph.D., is a school counselor in San Francisco and president of the Board ofDirectors of the Viktor Frankl Institute ofLogotherapy, Berkeley. 
REFERENCES: 
1. 
Frankl, V.E. Man's Search for Meaning. NY, Simon & Schuster, 1985. 

2. 
Khatami, M. "Clinical Application of the Logochart," International Forum for Logotherapy 11(2), 1988. 

3. 
Lukas E. Meaningful Living. Institute of Logotherapy Press, 1984. 


63 
The Story of a Bestseller 
Robert C. Leslie 

Vik.tor Frankl's Man's Search for Meaning has become one of the longest "bestsellers" in English. In the postscript of a letter written to me on November 20, 1988, Frankl wrote: 
Perhaps it is of interest to you that so far Man's Search for Meaning has sold at least 2,843,409 copies solely in its English versions and they have added up to 78 printings; together with 129 printings of editions in other 20 languages they come to 207 printings. Small wonder that--as I heard from my American publishers a couple of years ago--Man' s Search for Meaning was Number One in a new list called Longseller. This list refers to those bestsellers which throughout decades, do not stop bestselling. 
This book is the second of Frankl's books published in English., after The Doctor and the Soul: An Introduction to Logotherapy. Reading this book (in English) led to my taking my first sabbatical from Pacific School of Religion in 19601961. This book, a basic reference for Frankl's work, is less graphic than the autobiographical material in Man"s Search for Meaning. It was published in a second, expanded edition in 1965, with some of the deficiencies in translation corrected. 
The history of Man's Search for Meaning begins in 1957 when Frankl was sponsored by The Religion in Education Foundation for the first lecture tour to American universities. The director of RIE was Randolph Sasnett. His wife Martena wrote to me about Frankl's meeting with Gordon Allport at Harvard University, referring to the earlier edition of the book. 
The first edition found recognition in The Religion in Education Foundation. Vik.tor was glad then for any organization in higher education which could give him an introduction to American audiences through bookings in colleges of medicine. Viktor met Gordon Allport who hosted him at Harvard on the first RIE tour in '57. (Randolph knew Allport since '52 when Allport read and was enthusiastic about Randolph's manuscript The Mind ofJesus and the Future Mind.} 
Sasnett persuaded Beacon Press to publish Frankl's book. He was helped by the endorsement of Allport who was well-known in American psychological circles. Allport was so captivated by Frankl's presentation in his class that he asked Frankl if his story had ever been written down. Frankl gave him an English translation of the German Ein Psycholog erlebt das Konzentrationslager (A Psychologist Experiences the Concentration Camp), translated by Ilse Lasch, a native of Vienna and a nurse with the British forces in occupied Austria. She had read his book in German and was deeply moved by it. She had voluntarily translated it. and sent it to Frankl as an expression of gratitude for his writings. Allport read it in one sitting, was enthusiastic, and wrote a preface which placed his stamp of approval on the material. Beacon Press accepted the suggestion of Sasnett backed by Allport and agreed to publish the book with the proviso that Frankl write a brief exposition of logotherapy. The book published in 1959 carried the title From Death-Camp to Existentialism: A Psychiatrist's Path to a New Therapy. 
Allport wrote a letter dated October 24, 1966 to Sasnett describing Frankl's reactions to a subsequent paperback edition. 
His jubilation of the sale of the paperback edition is under
standable. From his outselling Kinsey one might draw the 
inference that meaning is more important than sex; I am sure 
this inference has not escaped him. I personally am pleased 
with the sales since they vindicate my original judgment. Did 
you know that Beacon Press tried to pull out of publishing it 
even after the agreement was made? They had financial dif
ficulties, but now must be glad that they stood by the deal. 
In the same letter Allport goes on to set the record straight on his part in introducing Frankl to America. 
Viktor gives me credit for introducing him to America, but 
actually, of course, the credit is yours. Without your 
mediation, I never should have encountered him .... 
Frankl acknowledges Sasnett's role on opening the way for him in the United States. The article by Frankl, "The Feeling of Meaninglessness: A challenge to Psychotherapy," American Journal of Psychoanalysis, J.2.,(1 ), 1972, carries a note which reads: "To J. Randolph Sasnett who introduced me to Academic America, gratefully." The RIE Foundation, under Sasnett, eventually sponsored five major American tours for Frankl. 
The title From Death-Camp to Existentialism: A Psychiatrist's Path to a New Therapy was a good one for a book published in 1959. Interest in concentration camp experiences was high in those years but for the long run a more general title was needed. Thus when Frankl revised the book for Beacon Press in 1962, a new title was given: Man's Search for Meaning: An Introduction to Logotherapy. The preface by Gordon W. Allport was included in this and in all subsequent editions of the new title. At the end of Allport's preface in this revised edition, the publisher printed a statement about Allport: 
Gordon W. Allport, a professor of psychology at Harvard 
University, is one of the foremost writers and teachers in the 
field in this hemisphere. He has written a large number of 
original w_orks on psychology and is the editor of the Journal 
of Abnormal and Social Psychology. It is chiefly through the 
pioneering work of Professor Allport that Frankl's moment
ous theory was introduced to this country; moreover, it is to 
his credit that the interest shown here in logotherapy is 
growing by leaps and bounds. 
Allport concluded his preface with these words: 
I recommend this little book heartily, for it is a gem of 
dramatic narration, focused upon the deepest of human 
problems. It has literary and philosophical merit to the most 
significant psychological movement of our day. 
Because Frankl had numerous requests for an enlarged treatment of the theoretical section of logotherapy which followed his autobiographical death-camp experiences, he expanded Part II, "Basic Concepts of Logotherapy." The revision was done in 1960-1961 while I was studying with Frankl in Vienna. Three American professors from different theological schools, Paul E. Johnson from Boston University School of Theology, Boston, Massachusetts, Melvin A. Kimble from Lutheran-Northwestern Seminaries, St. Paul, Minnesota, and I from Pacific School of Religion, Berkeley, California, assisted with written comments on Frankl's revised manuscript. 
Since the Beacon Press hardback edition in 1962, many paperback editions have appeared, including those by Simon and Schuster, Washington Square Press, and Pocket Books. Of particular interest is a 1984 edition which includes a chapter called "The Case for a Tragic Optimism." It is based on a lecture presented at the Third World Congress of Logotherapy at Regensburg University, West Germany, in June, 1983. This is thus an updating of Frankl's best-known work. 
Of special interest to followers of Frankl's writings is a new German edition which makes available the original telling of the death-camp experience which has long been out of print: 
... Trotzdem Ja zum Leben sagen (Ein Psycholog erlebt das Konzentrationslager). The book includes "Synchronisation in Buchenwald," a philosophical dramatization of the concentration camp. Frankl commented that this edition of the book offered a "stereoscopic view" of his death camp experience. 
ROBERT C. LESLIE, Ph.D. is curator of the Frankl Library and Memorabilia, Graduate Theological Union Library, Berkeley, California. 
The Evolution of Noos Joseph Fabry 
Last summer, in Germany, I came across books by 
Hoimar von Ditfurth, only one of which is available in English. 3 Von Ditfurth, a psychiatrist, was also an evolutionist and biologist and supported every statement with research results from reputable scientists. He never mentioned Frankl by name but I was surprised how his findings in the biological field confirmed logophilosophy. 
Frankl has been gratified that ideas that came to him by 
, P-34
pure intuition, were later corroborated by research results. 2 I shall now report one aspect that to my knowledge has never been discussed in the literature: the biological basis of Frankl's concept of the noos. Since I am not a biologist, this is strictly a report on von Ditfurth' s work.3.4.5 
The Evolution of Dimensions 
Frankl sees the human being as a totality of three dimensions -body, psyche, spirit -living in a world that also contains a suprahuman dimension. Von Ditfurth sees us as the temporary end product of an evolution that began with the Big Bang of the universe some 13 billion years ago and brought into existence our galaxy, our solar system, our planet, life on earth, and eventually the human species. In the course of this unimaginably long time, species evolved with a brainstem that has exclusively vegetative tasks, serving circulation, breathing, hormonal regulation, and other functions of a multi-cell organism. Gradually, after billions of years, the "brainstem" creatures evolved a midbrain, the seat of inborn reactions over which they have no control, such as drives and instincts. Evolution went on and the "midbrain" creatures developed a forebrain, first tiny, then increasingly larger, until in humans it takes up the greatest part of our skull. We are the first and (so far) the only species on this planet that has consciousness. ''The forebrain grants us freedom of action unknown to previous species: it opens up the possibility of self-reflection, consciousness of ourselves, the capacity to see the environment as an objective world that can be manipulated according to our plans, and the capacity to foresee the consequences of our actions. We have the freedom to disregard and even oppose the inborn programs of our instincts.These are dimensions of reality 
which did not exist on earth before. With the forebrain, life on 
this planet has reached a new step of development.5 P-306 
It is easy to see the parallel between this gradual evolution of the brain and Frankl's three human dimensions -the soma (with its vegetative functions), the psyche (with its automatic instincts, drives, and emotions), and the noos (giving us freedom to disregard, even oppose, the limits of body and psyche). Frankl calls these three areas "dimensions"(and not levels or steps) because they relate to each other like the three spacial dimensions.Space includes all three. The same is true of the parts of the brain. The brainstem, with its vegetative functions, is a biological precondition for the existence of the midbrain with its instincts, and both form the biological basis on which rests the forebrain that gives us consciousness. 
The Biology of the Suprahuman 
But the parallel goes farther. Yon Ditfurth repeatedly warns against the belief that we humans are the ultimate goal of evolution. There is no more reason to think that evolution will stop with the human species than to believe it would have stopped with the ants. Though the development of the human forebrain was a giant jump, it presents just an early stage of further development. Our descendants, millions of years hence, will consider us the "Neanderthalers" of the evolutionary progress: the first to have a primitive consciousness, a limited freedom held back by emotions, and a moderate capacity to understand the world as it really is. As von Ditfurth shows through biological research, our brain has not reached the potential to grasp the world in its fullness. If creatures of advanced evolution would try to explain to us the world as they perceive it, we would no more grasp it than a dog can understand our explanations. Having existed for no more than a few thousand years, our capacity to see the world objectively is still rudimentary. 
The biological difference between the human forebrain and that of other higher mammals lies in the prefrontal lobes. It affects personality, sequencing events, planning ahead. Research of brain pathologists, biologists, and behaviorists have convinced von Ditfurth that the prefrontal lobes make available several billions of nerve cells which are the "material base for the inexhaustable variations of human actions and attitudes. It expands the range beyond anything that was possible on earth before. An almost unlimited field of possibilities is opened from metaphysical thought to the building of concentration camps, from works of art to criminal acts, from selftranscendence for the sake of others to the capacity to act worse than animals:~ p.254 
Von Ditfurth sees all present functions of the human brain as still belonging to the psyche. He does not speak of spirit (noos) but he does see consciousness as a specifically human quality sometimes referred to as "soul." Students of Frankl will find it justifiable to see the human forebrain as the biological basis for noos -an area of freedom that goes beyond the psyche and the body, yet includes them. 
We are only at the start of the next evolutionary development: in an interim stage between a species dominated by the instinctual midbrain and a species whose forebrain allows truly free thought and judgment. Our actions and thoughts are still heavily influenced by the emotions controlled by our midbrain [and forebrain].3,p.263 The next, by no means final, stage of evolution may be a species with a more clearly developed freedom from emotions, a more explicit sense of responsibility, and a more distinct voice of conscience. What other human capacities evolution may still develop we cannot even guess. Such future creatures may reach dimensions that indeed could be called "suprahuman" but they, too, will have evolved from a biological base. 
Meaning and Values 
Frankl calls values "universal meanings,"2p.3? transmitted through tradition, while meanings -being unique are a matter of personal discovery.2 p.38 Von Ditfurth sees the difference in biological terms. "Midbrain creatures" are incapable of learning from their own experiences. They survive only through the experiences of their ancestors passed on, as instincts, through the genes. The human species, with its highly developed forebrain, is able to learn through the individual's personal experiences.4,P308 This is another way of saying that human beings, through the capacity of the forebrain, can find "the meaning of the moment" in their specific situation. But having evolved from "midbrain creatures" we can also rely on the experiences of our forebears which Frankl calls "unversal meanings" or values. We are always "under the influence of the programs stored in our midbrain" 4,P-273 but we have achieved, in our forebrain, some freedom to take a stand against that program. We can, in Fran.id's terminology, self-distance ourselves in our spiritual dimension from the limits forced on us by body and psyche. 
69 
Von Ditfurth stresses the order that exists in the universe: the order of physics in the cosmos, the order of chemistry and biology in living things. Order is the base for meaning.l,p.34 It exists everywhere but, as far as we know, only the human species has the brain to be conscious of it. 
JOSEPH FABRY is editor of the International Forum for Logotherapy. 
REFERENCES: 
1. Fabry, J. The Pursuit ofMeaning. Boston, Beacon Press, 1968. 
2. Frankl, V .E. The Unheard Cryfor Meaning, New York. Simon & Schuster, 1978. 
3. 
Von Ditfurth, H. The Origin ofLife, San Francisco, Harper & Row, 1982. 

4. 
____. Der Geist fiel nicht vom Himmel., Munich, Deutscher Taschenbuch Verlag,1980. 


5.____. Im Anfang warder Wasserstoff, Munich, Deutscher Taschenbuch Verlag, 1981. 

The Unemployed Appalachian Coal Miner's Search for Meaning 
Richard W. Greenlee 

During the 1980s unemployment became widespread in the coal fields of Appalachia. Strict environmental laws and advances in mining technology led to a massive lay-off of coal miners in the region which historically has relied primarily upon the coal industry as its major employer. 7 
Many coal miners, unemployed, used up their economic resources and became eligible for welfare benefits. These include young coal miners who have few transferable work skills to seek and compete for other jobs, and also seasoned coal miners too old or too uneducated to find work in a tight job market. Their poverty and, for some, welfare dependency is pervasive and consuming. They have few other options. 
The Will to Meaning 
Frankl stated that "man's search for meaning is the primary motivation in life ... "3,p.121 and that unemployment may result in an "unemployment neurosis,"1 when persons become unemployed and see themselves as "useless" and subsequently believe that their lives are now meaningless. This is a common condition among unemployed Appalachian coal miners. 7 
A coal miner told me, "My biggest thing to fight now is humiliation and the feeling that I'm worthless." A miner's wife described her husband's condition: "It destroyed his morale. He feels useless, like he was nobody." These statements support Frankl' s notion that unemployment can trigger a decrease in people's ability to perceive a sense of meaning in their lives.1 
Miners have difficulty finding a sense of meaning and purpose when they can no longer work. When one unemployed miner was asked why he just doesn't give up and go on welfare permanently he replied, "We've got more pride than that. don't want to live on their system. I have a lot of dreams that are still there, but I know that they're never going to happen." As Frankl has stated with great insight, "Man does not live by welfare alone."1,P-26 
Frankl suggests three ways in which we may find meaning: by creating a work or doing a deed; by experiencing something or encountering someone; and by the attitude we take toward unavoidable suffering.3 Most coal miners I have had the opportunity to know and work with, found meaning by working in the coal mines and providing for their families. Their identity as coal miners gave them a sense of meaning and provided them with a purpose in life. When they were unexpectedly laid off, many perceived their lives as meaningless. 
The Existential Vacuum 
The Appalachian coal miner believes in the value of work. For many, working in the mine is much more than a job. Traditionally, a coal miner's son becomes a coal miner. It is also a tradition that the husband will be the primary provider for the family. 7 No longer finding employment creates major changes in the traditional family which consists of a husband working in the mines, a wife working in the home, and the male children entering the mines after graduation from high school. 
These traditions and values have fallen apart. In many Appalachian families the wife has had to go to work because she is more employable in the service-oriented positions that now dominate the local economy. The husband may be forced to stay home and act as house-husband. This creates drastic changes in the traditional roles of the family members, creating stress. Meanwhile, the young men of the region are no longer able to find employment and become bored, which often results in substance abuse, creating more stress for the family. 
The Appalachian miners and their families are no longer able to experience meaning through their participation in the coal mining culture and have developed an "existential vacuum." Without the meaning of work, this vacuum becomes filled with ,substance abuse, anxiety, depression, and boredom. 
A miner's wife describes the effect of unemployment on her husband and their relationship: "It was so depressing and his nerves were so bad. He would be in and out of the house 4050-60 times a day. In and out, in and out, in and out, and eat constantly. He was always at the refrigerator. I mean, I thought we were gonna get a divorce. Our marriage was really bad." 
An unemployed coal miner describes his psychological reaction to long-term unemployment: "We never really had someone close to us die in the family, but it's got to be a little bit like that but ya know, it takes a long time to heal and get over ..." 
Existential Depression 
Lantz and Harper7 have written about how unemployment can trigger an "existential" disruption which makes it difficult for the Appalachian family to "perceive and experience meaning" in their lives. This can result in existential depression, "a form of depression which occurs reactive to a disruption in the person's ability to discover, create, and/or 
5
experience meaning."3, ,7 This kind of existential depression is 7
often a response to socioeconomic deprivation.5, 
The coal miners' breakdown of their social network and their existential disruption has seriously impaired their ability to encounter meaning opportunities. They are not unlike the Appalachian region's undiversified economy. They have failed to diversify the ways in which they discover meaning in life. They have focused all their energies on experiencing meaning through work and failed to use the meaning potentials they could gain by experiencing something or encountering someone, and by the attitude they take toward unavoidable suffering. This left them extremely vulnerable to the socioeconomic conditions that limit their opportunity to experience meaning through work.7 
Socratic Dialogue 
The goal of the logotherapist is to help clients find meaning in their life situations.2,9 Socratic dialogue and network intervention are two logotherapy activities that have the potential to provide unemployed coal miners with increased opportunity to create, discover, and experience meaning in their 
7
lives.6, In the Socratic dialogue the therapist uses questions, 
comments, interpretations and sincere personal interest to stimulate and facilitate clients' reflection about meaning opportunities and potentials which exist in their past, present and future.2,6,7 
Frankl reports that prisoners in concentration camps could not see the end to their "provisional existence' and were subsequently unable to set goals for the future. 3 He states that the unemployed worker is in a similar situation.3 
The Socratic dialogue assists unemployed miners in getting in touch with their noetic unconscious. 2.4,9 The therapist asks questions in a way that helps clients become aware of their own spiritual dimension, their strengths, hopes, meaning opportunities, and achievements.1,2,7,8,9 
The unemployed miner often becomes preoccupied with the past. Frankl states, "Such people forget that often it is just such an exceptionally difficult external situation which gives 
man the opportunity to grow spiritually beyond himself. "3,p.93 A vivid example of this are coal miners who refuse to accept the fact that they will not be called back to work. They 
keep their hardhat, lunch bucket, belt, and hard-toed shoes neatly and ritualistically placed in the comer for years, ready to be put into use should the coal company suddenly call them back to work. This type of behavior indicates that these miners are living in the past. This fixation with the past prevents them from discovering meaning in their present situation. 
A logotherapist who has developed a caring and trusting relationship with the unemployed miners, can assist them by clarifying their accomplishments and strengths in their present situation. This can provide them with the opportunity to discover meaning in their suffering and subsequently move out of the past and into the future. 
Network Intervention 
Frankl believes that unemployment neurosis is caused by equating being jobless with being useless; and being useless with having a meaningless life.3 To overcome existential depression caused by unemployment, Frankl persuaded patients to volunteer with youth and other organizations. Volunteer work enabled these patients to replace an excessive amount of free time with a meaningful activity that led to the relief of their depression.3 This is a good example of network intervention. 
We have used network intervention to increase the unemployed person's chances to establish and reestablish a sense of meaning through new social activities, social relationships and social opportunities.2,6,7,8,9 
Unemployed miners have benefitted from the meaning potential inherent in volunteering as a youth sports coach or some other volunteer activity. They were motivated to use this opportunity to reestablish meaningful relationships with spouses and other family members they had neglected because of time constraints in the past. Others benefitted from developing creative and productive activities such as woodworking and performing music. Hunting and fishing are activities through which rural coal miners discovered experiential meanings in nature. As one unemployed miner commented, "The only thing that keeps me goin' is that I love to be outside and hunt." 
Finally, unemployed miners discovered a sense of meaning by becoming a committed member of a support group for other unemployed miners. The purpose of these groups was to assist others by providing emotional support; referral and linkage with community resources and benefit programs; job search assistance; and political action for the social and economic needs of all unemployed coal miners in the Appalachian region. 
RICHARD W. GREENLEE, ACSW, is a graduate teaching associate and doctoral student at The Ohio State University College ofSocial Work. 
REFERENCES 
1. 
Frankl, V. The Unheard Cry for Meaning. New York, Washington Square Press, 1978. 

2. 
___. The Unconscious God ... New York, Simon and Schuster,1975. 

3. 
___. Man's Search for Meaning,. New York, Washington Square Press, 1959. 

4. 
Graca, J. "Logos and the Farm Crisis in America," The International Forum for Logotherapy .2.(2), 1986. 

5. 
Jilek, W. Salish Indian Mental Health and Cultural Change. Toronto, Holt, Rinehart and Winston, 1974. 

6. 
Lantz, J. and R. Greenlee, "Existential Social Work with the Vietnam Veteran," Journal of Independent Social Work, in press. 

7. 
__and K. Harper, "Network Intervention, Existential Depression, 

and the Relocated Appalachian Family," Journal of Contemporary Family Therapy, 11, 1989. 

8. 
__and J. Lantz, "Meaning, Tragedy and Logotherapy with the Elderly," Journal of Religion and Aging, ..S., 1989. 

9. 
__, "Family Logotherapy," Contemporary Family Therapy, B,, 1986. 


Meaning and Midlife Crisis A Logotherapy Approach 
Karen V. Harper 
Human life includes joy and tragedy. Many individuals 
experience a sense of satisfaction gained through meaningful interaction with others or in striving for important goals.1,2 A sense of meaninglessness may occur during and reactive to a tragedy. Some persons experience tragedy as children or young adults. Others are not confronted with a tragic situation until they reach middle age. 3,4 
The Case of Mrs. Z. 
Mrs. Z., 48, married, was suddenly struck by a lifethreatening cardiac disorder which caused her to feel unable to experience meaning. She allowed her condition to disrupt her meaning world and decided that suicide was less painful than the meaning vacuum she entered after discovering her heart condition. 
She was referred to a psychiatric hospital by her physician who, because of her seriously depressed state, considered her a suicide risk. She had received a pacemaker and was in poor physical health. She had undergone several months of diet and drug therapy for her cardiac ailment. Within days of learning that she was a candidate for surgery, Mrs. Z. began experiencing heart palpitations, profuse sweating, poor sleeping, and a serious loss of appetite. Two months after surgery she continued to experience loss of energy and appetite, crying spells, and suicidal thoughts. Her severe depression throughout the post-operative period was first thought to have been brought on by a physical reaction to anesthetics or to antiinflammatory medications. She had no prior history of depression and responded poorly to anti-depressant medications. The idea that her depression was medically or physically based became suspect. In this clinical situation Mrs. Z. was hyperreflecting about her physical problems and experienced 
what Viktor Frankl identified as existential vacuum.1 Her meaning vacuum was filled with fear of aging and symptoms of anxiety, depression, and some psychosomatization. Hyperreflection about her physical illness had disrupted her ability to discover and experience meaning. 
Socratic Reflection 
Mrs. Z. and her husband were seen together in logotherapy sessions. During the first interview she expressed disappointment with life. Her twin sons had moved away from home. She lamented that just when she had become free from homemaking and child rearing she was admitted to the hospital with chest pain and a pacemaker was implanted in her chest wall. Its presence and her daily medication were constant reminders that she was "old and ill." Therefore life was "not worth living" and she wanted to die. 
Mrs. Z. was asked to name five things in life she would miss after dying. She named her husband, her children, the feeling of a sea breeze, her backyard vegetable garden, and going to church. The logotherapist suggested that these things are "more fun to think about than the pills you take and the physical problems you must endure." She started to cry and told her husband that "when I think about my pills and notice my pacemaker I forget about the good things in life." 
In the second session, Mrs. Z. stated that she had "some free time" which she described as "endless now that my sons are grown." Her meaning vacuum had also been accentuated by a change in roles and purpose in life. The therapist encouraged her to take a "meaning history" to help her become more aware of meaning connections from the past and see meaning potentials in the future. Such reflections and Socratic questioning helped her discover meanings that could not be disrupted by her physical problems. She felt considerable relief when she realized that she could still experience meaning in life and that suicide was counter to her values and cut off meaning opportunities. Toward the end of the treatment, Mrs. Z. reported that she had found new meaning in living as a survivor of cardiac surgery. 
Logotherapy Action 
The loss of physical health was perceived by Mrs. Z. as a tragedy. This perception had been heightened by loss of her mothering role, which hampered her recuperation and acceptance of her "medically controlled" physical condition. She was encouraged to talk about her sons and her feelings of having an "empty nest." She described her fear of aging and being useless and expressed her wish "to help others be more involved in living." To facilitate self-distancing she was encouraged to enroll in a woman's civic group that provided volunteer services for the homebound. Her own compassion began to build through serving others, using self-transcendence. She reported 
that her thoughts of being "over the hill" were silly when she compared her situation to the people to whom she delivered meals. She became part of the community-based volunteer network, held meetings in her home, recruited new volunteers, and edited a newsletter for the organization. She found new meaning in her own life through service to others. 
A Meaning-Seeking Voyage 
Logotherapy can be exceptionally useful with middleaged clients who are experiencing tragedy in addition to the normal stress of midlife role changes. Such changes include children, living as widow or widower, adjusting to remarriage, realization of aging, change in physical abilities, loss of health, shift in employment, and change in income. For many, the midlife stage means considerable loss because of changing roles. Individuals bring different inner resources to this stage. Some seek resolution of their roles in the outside world while others seek meaning within the family or their personal world. The search for midlife resolution is a meaning-seeking voyage. It is essential that mental-health workers recognize that normal coping with midlife role changes can be disrupted by tragic events such as physical illness. The goal of logotherapeutic intervention with middle-aged clients who are experiencing a tragedy is to assist in the midlife search for meaning. 
KAREN V. HARPER, Ph.D., LISW, is assistant professor at The Ohio State University College of Social Work and a research and consultation specialist at Village Counseling Associates, Columbus. 
REFERENCES: 
1. 
Frankl, V. The Doctor and the Soul, New York, Random House, 1955. 

2. 
Lantz, J. and K.V. Harper. "Logotherapy and the Hypcrsomatic Family" International Journal of Logotherapy, 11(2), 1988. 

3. 
__. "Meaning, Tragedy and Logotherapy with the Elderly," Journal of Religion and Aging, .5.(4 ), 1989. 

4. 
Sheehy, G. Passages, New York, E.P. Dutton and Co., 1976. 


The International Forum for 
LOGOTHERAPY 
JOURNAL OF SEARCH FOR MEANING