Volume 6, Number 2 Fall/Winter 1983 
CONTENTS 
Logotherapy in Israel 
Mignon Eisenberg ............................................ 67 
Practical Steps in Logoanalysis Robert R. Hutzell ............................................ 74 
The Viktor E. Frankl Scholarship 1983 Stephen S. Kalmar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 
The Pursuit of Meaning for Youth in the 1980's Wendy L. Pohlers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 
Logotherapy and "Drawing Anxiety" Frederic H. Jones ............................................. 89 
Logotherapeutic Treatment of Neurotic Sleep Disturbances Heinz Gall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 
I Remember Edith James D. Yoder .............................................. 95 
Edith Weisskopf-Joelson James B. Klee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 
Remarks from a Free-Floating Spirit Edith Weisskopf-Joelson ....................................... 98 
Love and Work in Frankl's View of Human Nature Elisabeth Lukas .............................................. 102 
Patients' Perception of the Meaning of Suffering Patricia L. Starck ............................................. 110 
A College Test of Logotherapeutic Concepts Ernest J. Nackord ............................................ 117 
Book Reviews .................................................. 123 
This issue of the International Forum for Logotherapy is dedicated to the 
memory of Professor Edith Weisskopf-Joelson. 
@ Institute of Logotherapy 

The Meaning Crisis in the First World and Hunger in the Third World 
Viktor E. Frankl 
The following is Dr. Frankl's introductory statement made in a dialogue with the former Chancellor ofAustria, Bruno Kreisky. The "two grand old men of Austria," as the newspapers referred to them, had heen invited hy the Vienna TV station to publicly discuss the subject of "The Meaning Crisis in the First World and Hunger in the Third World" in Vienna's Technological University. The photo ahove shows Chancellor Kreisky and Dr. Frankl with the moderator. 
In one of my books you'll find the following sentence which I should like to quote: "What seems to me the most important thing is to oppose the idea that life has no meaning." This sentence, however, was not written by me, l only quoted it~ it comes from an interview given by our Chancellor, Dr. Kreisky, to a reporter of a Viennese newspaper in 1976. 
You see that we both are justified to talk on the subject of "meaning crisis" and "starvation." Kreisky, too, knows about meaning, and I know about hunger. During the first World War I went to the farmers begging for a slice of bread, and then during the second World War I lived for some time (in a camp) on 850 calories a day and weighed 80 pounds. 
But also between the two wars I met starving people. Within a program "Youth in Distress," sponsored by the Vienna Workers Union, I was entrusted with the task of giving psychological care to the youthful unemployed. It is exactly 50 years ago that I published my experiences in the Sozialarztliche Rundschau, a journal dealing with social and medical questions. In my article I was able to prove that the depression of the young people was caused by their attitude: "I am unemployed, therefore I am useless, therefore my life has no meaning." Thus it was basically their feeling of meaninglessness that had triggered the depression! I could prove this by the following observation: In the moment that I succeeded in involving these people in a youth organization or a public Ii brary or an ad ult education program where they were given an unpaid, voluntary task which appealed to them -in this same moment the depression vanished although their stomach still growled because at that time the unemployed literally were starving. But I'll never forget what many unemployed shouted to me: What we want, what we need, is not only the money we could Jive on, but primarily something we could live.for -something that gives meaning to our Jives! 
In us human beings there exists not only a hunger for bread but also a hungering for meaning! To this even the welfare state pays too little attention, also in the area of unemployment. The so-called social safety net, I would say, is too wide-meshed. The existential distress of the unemployed, their feeling of meaninglessness. falls through. 
But this feeling of meaninglessness, and the depression triggered by it, is not restricted to the unemployed, it can also be observed among the working population. For instance, the director of a New York clinic using behavioral therapy reports that many oftheir patients complain that "they have a good job, they are successful but they want to kill themselves because they find life meaningless." 
Do you see what is at stake here? Depression does not entirely depend on whether people are unemployed or not, but rather on whether they consider their lives meaningful or not. Not only the stomach can feel empty, there is also an existential emptiness, and this we find in people with work and without work, in spite ofwork, and sometimes even because of work. This is a phenomenon I explored and described many decades ago --the existential vacuum, that meanwhile has grown into a worldwide mass neurosis which has been confirmed in tests and statistics by scientists all over the world. 
The aim of the industrial society is to satisfy all our needs, and in its desire to increase consumption it often creates needs in order to satisfy them. Only one need remains unfulfilled: the most human of all needs -the need, the thirst, of the human being which I have called the will to meaning. This remains widely frustrated. 
This ubiquitous feeling of meaninglessness and emptiness manifests itself concretely in boredom and apathy. Boredom may be defined as lack of interest, and apathy as lack of initiative. People today are lacking a genuine interest in the world, and even more so the initiative to bring about changes in the world. As far as interest is concerned,just consider the statistical fact that the Austrian on the average "consumes" half a book a year, and as far as initiative is concerned, I only have to remind you of the tendency "not to bother about politics" which unfortunately is becoming more widespread. 
What people lack is a commitment to a cause worth committing oneself to, a devotion to a self-chosen task. And this is the reason why -according to an Austrian poll -29 percent of the Austrians find too little meaning in their lives. According to a West German statistic, this figure among youth is 42 percent. 
This lack of meaning is made worse by something else: a lack of role models who would demonstrate through their lives a devotion to a task! There is statistical evidence for this phenomenon, too: A public research institute has found out who is most respected by Austrians. 
Not the great scientists, nor the important politicians, not famous artists nor popular sports figures, but people who have "bravely shouldered an adverse fate" and -leading all others -"people who bring great personal sacrifices to help others." This group of people accounted for 47 percent. And how about our much maligned youth? Among the young people the figure is not 47 percent but. according to the results of a parallel research of another institute, 83 percent expressed their desire to help others. 
The most hopeful thing is that this whole feeling of meaninglessness is one big anachronism. We have to expand our horizon only a little to notice how relatively well off we are -in comparison with other countries that are either politically repressed or are suffering from hunger, or both. At any rate, all those who are still able to become enthusiastic about something have enough to do -many tasks are waiting. There is enough meaning available. 
Seen psychologically, orientation toward meaning is important not only for living but for surviving. If you knew as I do. the scientific literature about prisoners of war but also personally knew some of these men, as I also do, who had endured up to seven years in captivity, you would see how much survival was dependent on orientation toward the future. 
And now consider the potential danger, seen psychologically, for our young people who have come to call themselves the "no-future" generation. The danger is that into their existential vacuum may enter the mass neurotic triad of depression, addiction, and aggression; that is, suicide, slow suicide in the form of drug dependency, and violence against others. But experience over many decades indicates that even such young people can be "won over," that in fact they are grateful if they are challenged -confronted with a task that places on them a demand in which they see a meaning. Do you know the story of the statues in Frogner Park in Oslo, Norway? Time magazine reported about it. Young vandals had damaged the statues, wanted to destroy them, just as they had cut open the leather seat covers on the street cars. The police arrested them. And let them go again to organize volunteer bands that patrolled the park at night and the street cars by day -and persuaded other vandals not to make the same mistake. 
And here we have arrived at the critical point of my arguments: What conclusions can we draw? If voluntary commitment to a common task can overcome aggressiveness and violence -would that not also work on a large scale, not only for individuals and groups but also for humankind as a whole? Here, ladies and gentlemen, I see the real significance of global concerns such as. to mention just a few, protection of the environment, establishment of peace and, you have guessed it, help for developing countries. As far as the last is concerned. we can see an ideal solution which relates directly to the title of my address: To the extent to which the First World sees its task in fighting the hunger in the Third World, it helps itself to overcome its own meaning crisis: We give them bread, they give us meaning -not a bad bargain. 
V!KTOR E. FRANKL. M.D., Ph.D.. isprofessorofpsychiatryandneurology, Universitr of Vienna. 
Logotherapy as an Answer to Burnout 
Reuven P. Bulka 

Burnout is a state of mind that can afflict those who work with other people, often but not exclusively in the helping professions, and who receive less from their clients, supervisors, and colleagues than they give. It is "the result of constant or repeated emotional pressure associated with an intense involvement with people over long periods of time. "10. p. 15 
The behavioral cluster associated with burnout includes exhaustion, detachment, boredom and cynicism, impatience and irritability, a sense ofimpotence, suspicion of being unappreciated, paranoia, disorientation, psychosomatic complaints, and depressicn. Although burnout is usually associated with one's job, it can manifest itself in almost all spheres of life, including young adulthood, parenthood, and marriage. JO Students face particular stresses which make them prone to burnout. Parents are locked into roles which condemn them to drudgery, with nothing to show for it. Marriages too can be invaded by boredom, a feeling of dis-ease, a climate which may escalate petty annoyances into a conglomerate of upsets potent enough to rupture the relationship. 
But it is in the workplace that burnout is most prevalent. Frustration at not making a significant contribution, the feeling of going around in circles, of aimlessness, helplessness, and hopelessness, have invaded the workplace with the overwhelmingness of an epidemic. People in ostensibly prized positions leave suddenly, inexplicably. Many in responsible positions lose their lust for work, and simply go about as automatons, going through the motions and picking up their paychecks. This office malaise often spills over into the home, and vice versa. Disenchanted workers can easily become disenchanted parents or partners, thus making burnout a massive problem which threatens to eat away at the very fiber of society. 
Societal Sources of Burnout 
Burnout derives from choice. We choose a profession or job but the results of that free-willed decision are not the choicest. The budding frustration and eventual desire to move out, to change jobs, are expressions which emanate from having the freedom to opt in, opt out, and search for different goals. However, while freedom may be the component which allows the burnout syndrome to evolve, the conditions which cause burnout are a different matter. Sweeping generalities may explain the causes but, being generalities, cannot hope to be all-encompassing universals. If the search for meaning is the primary motivational force in humans,4, p. 154 then the loss of a sense of meaning is undouhtedly a major factor contrihuting to hurnout. 111-p. 145 Freudenherger calls hurnout "a demon horn of the society and time we live in and our ongoing struggle to invest our lives with meaning.'') r 2 
We live in a disjointed society. Parents are separated from children and grandchildren, the work scene is far removed from home life, the people we pass on the street are faceless strangers. Performance pressures rob us ofvital human experiences which every human being needs, to feel a part of the world. Uni4ueness and irreplaceahility were once inextricable parts of the social fabric, and could be attained in such tasks as running errands, babysitting, or minding the store. These values have given way to a specialized spoiled society in which experts fill these roles. Where a sense of meaning and importance is missing, one searches even more desperately for it and subse4uently is made even more vulnerable. Where everyday gratifications are denied, we search for the "Big Payoff," but still we are likely to be confounded.9-r l84fl 
The irony of burnout is that precisely those individuals who are idealistic and meaning-oriented are most susceptible to it. Freudenberger asserts that "I've never met a Burn-Out who didn't start with some ideal in mind. "9. p. 12 Similarly, it has been observed that the "people who start out with the highest ideals ... are likely to experience the most severe burnout."10. p. 34 As opposed to job alienation, which stems from an "I don't care" attitude, burnout is directly linked to an "I care" 9ttitude. "In order to burn out a person needs to have been on fire at one time. "10. r-4 
Burnout is often a search for meaning gone haywire. It remains to be seen whether this is an empirical indictment of the proposition which places meaning in the center stage ofauthentic human endeavor, or whether burnout is rather a case of a well-intentioned but improperly based search for meaning. 
Another factor contributing to burnout is the assembly-line syndrome which characterizes the North American work pattern. The age of specialintion has sacrificed a superior being in favor ofa superior product. Specialists in hooking up steering columns have a narrow field of interest, the repetitiveness of which dooms the practitioner to boredom and anomie. Often the workers are so distanced from the finished product that they cannot gain a sense that the job is useful. In social services a feeling of malaise may develop because, in spite of excessive expenditure oftime and energy, the individual or group situation does not perceptibly improve. The helping ideal is far removed from the frustrating reality. 
Many professionals suffer from lack of recognition and acknowledgment for their efforts, however successful they may be. Two groups which often fall prey to this reality are nurses working with terminally ill cancer patients, and dentists. The nurses deal with clients who, being doomed to imminent death, are understandably irritable and unlikely to show appreciation for the nurses' efforts, despite massive emotional energy expended by them. Dentists may do excellent work, but their patients, being in varying degrees of pain, are cager to leave as quickly as possible. These patients then return to the next encounter anticipating new pain, by which time they have forgotten the good job done by the dentist in the past. 
Some components of burnout, then, may be unchangeable, others reflect subjective interpretation and are thus adjustable. What follows is a suggested use of logotherapy to approach the problem, showing how logotherapeutic concepts and techniques can be helpful as preventives and potential cures for burnout. 
The eight areas where logotherapy may reverse burnout are: ( I) philosophy of 
work: (2) dereflection; (3) experiential values; (4) self-detachment; (5) facing the 
unavoidable; (6) appreciating finiteness; (7) self-transcendence toward mean
ing; (8) human ingredient in work. 
Philosophy of Work 
According to Frankl, "life is a task."5• p. xiv Work, or the individual's calling, 
should not be confused with the individual's life task. What we work at is not 
necessarily what we are or the vehicle toward becoming what we ought to be: 
"There is a false identification of one's calling with the life task to which one is 
called. "5• r-99 It is possible to achieve the life task through work, but not on~y 
through work. 
Orientation around a task in life is crucial to individual wellbeing. In Frankl's 
words, "There is nothing in the world, I dare say, which helps man as efficiently 
to survive and keep healthy as the knowledge of a life task. "3• P-20 
Finding a task in life requires trial and error. We must be prepared for the 
possibility that the approach taken is not the correct one. 
It sometimes happens that one task will not yield to man's efforts, while another, with its complement of values, presents itself as an alternative. Man must cultivate the flexibility to swing over to another value group if that group and that alone offers the possibility ofactualizing values. Life requires of man spiritual elasticity, so that he may temper his efforts to the chances that are offered.s, p. 34 
Additionally, it is useful to harness our "spiritual elasticity"toward recogniz
ing that there is more to life than work, and that often we will not find the 
answers to life in work, but outside it. 
Thus, a healthy attitude to work that tempers idealism with reality and sees 
work as just one component oflife, is helpful in preventing inflated expectations 
from causing disappointment and burnout. 
Dereflection 
Burnout, however, may be triggered by more than inadequate rewards. "Hyperreflecting" upon rewards may work against the professionals who expect them. The awareness of not being rewarded leads them to seek reward, but even after having received a reward, they remain less than satisfied and desire more. These individuals possess a frame of mind which says "I am not really appreciated," hence it becomes extremely difficult for that frame of mind to change, no matter how much appreciation is shown. Nothing is enough; even a testimonial dinner may be followed by the blues. 
One way of countering this situation is to expand our reward horizons, by looking for recognition from coworkers and clients instead of only from supervisors or management. 1<J. r 7X-79 
A possible alternate approach is the logotherapeutic technique of dereflection. In instances characterized hy a fight for a pleasure or reward, logotherapy recommends dereflection as a technique to counter the hyperreflection on the self and on what we expect or desire. For sexual neuroses rooted in hyperintention and hyperreflection, the patient is dereflected from striving for potency or orgasm and is reoriented toward the partner, forgetting the self and concentrating on the other. This approach is a specific application of the logotherapeutic view that pleasure and happiness "cannot be pursued but rather must ensue. "7. r 35 
Happiness, pleasure, even self-realization, are not achieved through intention but as a by-product of the fulfillment of meaning, or of loving another human being.". rr 40. 146 
This technique may also have specific relevance to burnout. While it is 
debatable whether burnout resulting from inadequate reward is a case of 
"hyperintention" upon reward, it is nevertheless clear that some level of inten
tion on reward is present. Learning to dcreflcct from expectation of reward, and 
instead applying ourselves almost onesidedly on the job at hand to elicit 
meaning, is potentially advantageous. By not expecting reward, there is no 
disappointment at not receiving any compliments. If compliments are offered, 
they are like manna from heaven, an unexpected gift which is doubly appre
ciated because it was not anticipated. Through dereflection, quantitatively 
small rewards are inflated into qualitatively significant accolades. Dereflection 
is thus a useful tool in confronting burnout. 
Experiential Values 
If burnout is related to placing too much emphasis on work as the central 
motif of life, and expecting too much from work, then the logical antidote to 
this pattern would be in finding sources for fulfillment outside work. Instead of 
placing so many identity eggs in the work basket, it is helpful to be open to other 
aspects of life, be they the love of a spouse, the development of a child. or the 
setting of the sun. Hence, we can effectively "inoculate ourselves against burn
out by getting into the habit of noticing and nurturing the unspectacular good 
things that happen to us. This may require a conscious effort at first. ~ince we are 
unaccustomed to viewing our lives from this particular vantage point, but it will 
prove to he a worthwhile effort. " 1• r 20 
Mikaly Csikszentmikalyi2 describes the internally motivated person who 
engages in "autotelic" experiences as less likely to be prone to burnout. During 
an autotelic activity, we experience a sense of "flow," with little distinction 
between the self and the environment, or between past, present and future. 
These flow, or peak experiences, can have a far-reaching effect on us. giving a 
sense of coherence and meaning even in the face of the seemingly meaningless 
work activity. 
Frankl\ notion of different types of values in human life relates directly to 
this aspect of the burnout syndrome. Creative values are what we give to life, 
and experiential values are what we take from the world in terms of personal experiences. If work constitutes that area of life which is most conducive to creative values. the world outside of work is open to the experience of beauty. kindness. and warmth. Even if we are frustrated by the lack of fulfillment at work. there is still another world out there waiting to he experienced. with many opportunities for a peak experience. that single moment \\hich "can retroactively flood an entire life with meaning ... ,. p. 15 Floods. as is well known. are excellent preventives for fire and burn~. 
Self-Detachment 
The dedicated worker has a sense ofcommitment to the job. hut the burnout victim is often overdedicated. Overcommitment means an all-consuming emotional or intellectual bondage to an idea or causc.x. p. 74 Instead of the person having the ideal, the ideal "has" the person. 
Overidentification with work has been implicated as a major factor in burnout cases. The workers have merged the self with the job. leaving themselves open to the loss of self and increasing vulnerability to disappointment. disenchantment, and even depression from a job that cannot satisfy human needs. 
"The most idealistic and highly committed 'social servants' are the ones who have the greatest difficulty detaching themselves and as a result tend to burn out relatively soon."10 To counter this difficulty, a "detached concern" is recommended, a combination of concern and detachment, which conveys sympathy and understanding but at the same time retains an element of distance in order to maintain objectivity. 
Again, a logotherapeutic notion seems to have particular applicability to this aspect of burnout. In developing the concept of an individual's free will, Frankl speaks of the human capacity for self-detachment. Instinct, heredity, and environmental factors partially determine human behavior hut we can accept, reject, or manipulate these factors according to our will. We can rise above the psychic and somatic determinants into a new, distinctly human. dimension of the spirit. From the vantage point of this dimension, we can look down at the potentially dehumanizing forces and decide whether and how these forces will steer us. In the noological domain. we exercise the distinctly human phenomenon of self-detachment. detaching our self from ourselves and deciding our future. 
For the potential burnout, self-detachment is a useful exercise. We look at ourselves with a sense of distance that we usually reserve for looking at others. Whether through thinking, talking, or writing about ourselves. the sense of distance admits objectivity into self-awareness, and also maintains a sense of self which can prevent merging the self into work. a condition which often is the first step to burnout. 
Facing the Unavoidable 
Frankl, in speaking ahout human suffering, emphasizes attitudinal values 
the attitude we take to a situation of suffering. "The right kind of suffering -facing your fate without flinching -is the highest achievement that has been granted to man."'· r '" Frankl is concerned not with avoidable. unnecessary. and possibly masochistic suffering, but with unavoidable suffering1. PP 126-127 where, through the proper attitude, we may transcend the suffering. 
When speaking of suffering in job burnout, it seems appropriate to include the workplace as one of the areas where we may be called upon to "face fate without flinching." 
Because "in the vast majority of cases of burnout the major cause lies in the situation,"10-r-0 some situations cannot be changed. "One of the ways we can strengthen ourselves is by learning to acknowledge that the world is the way it is and accepting that fact as one of the conditions we have to live with, ''9. r 205 or to adopt a realistic attitude to unchangeable realities. 
Often the burnout stems from the disparity between the ideal and the real, and from the frustration deriving from this disparity~-the frustration of trying to change reality to conform to the ideal and finding that we are knocking our head against a brick wall. 
One preventive of burnout is a balanced enthusiasm which strives toward a helping ideal within inherent limitations. With diminished expectations based on the "unavoidables," we are less likely to be disappointed, and rather learn to live with reality instead of fighting it. This should not be interpreted as a defeatist attitude. Every individual must make a so her judgment about what can be changed, should be changed, and whether one possesses the strengths and capacities to effect these changes. As Frankl puts it, "Things are bad. But unless we do our best to improve them, everything will become worse. "4. p. 15-lo To do our best is the imperative, but that means realizing limits as well as expanding horizons. 
Appreciating Finiteness 
Victims of burnout often suffer this fate "because they've pushed themselves too hard for too long. They started out with great expectations and refused to compromise along the way. "9-P-12 The high expectations may relate to work, or to one's self. Those who take on too much and refuse to come to grips with reality are pushing themselves to the burnout brink. "We must be aware of our realities and limitations as human beings. "X. P-75 
With an awareness of limitations, one is less likely to become the allconsuming executive who must be at all meetings, reply to all letters, and take care ofall matters personally. Instead, in recognizing limits, one can delegate to others, or have others take up part of the slack. 
Limitations within the logotherapeutic framework notwithstanding, "we must never be content with what has already been achieved. Life never ceases to put questions to us, never permits us to come to rest. "5. r-105 Because the human being is constantly confronted with new frontiers. there is always room for more achievement. 
But what matters is the striving, not the attaining. 
That he must aim at the best is imperative; otherwise his efforts would come to naught. But at the same time he must he able to content himself with nothing more than approaching nearer and nearer. without ever quite attaining his goaJ.5. r 49 
The human heing is finite, therefore imperfect. These imperfections make for individual uniqueness and irreplaceahility, and also make perfection impossible. To attain perfection would make the person existentially dead, with nothing more to achieve. im iting the dreaded existential vacuum. Human reality is lived out in continued striving which militates against ultimate attaining, or actualiling the infinite. "A human being, it is true. i~ a finite being. However, to the extent to which he understands his finiteness, he also overcomes it. "6-r 86 Coming to grips with our finiteness is important. "This acceptance offiniteness is the precondition to mental health and human progress," while the inability to accept it is characteristic of the neurotic personality.""· I' 47 The inability to accept finiteness and limitations is also characteristic of the burned-out individual. 
Self-Transcendence toward Meaning 
Professionals who devote many years to study and training for a career enter that career with the expectation that it will provide a steady challenge and opportunity for self-actualization. However, when this does not materialize, when their talents and skills are stifled, they become candidates for burn out. 10. P· 154 Additionally, in such areas as the social services, the emotional flow goes onesidedly from worker to client, leading to a possible emotional depletion, with any emotional "refill" highly unlikely. Thus, those who come into their professions with high ideals, hoping to find a meaning, instead become burnout victims. Is this a case of the search for meaning gone haywire, an argument against the primariness of the search for meaning? After all, the search leads to a dead end. 
A careful understanding of logotherapy and a more precise reading of the burnout scene indicates that the fault lies not in logotherapy but rather in the burnout victim's distortion of the search for meaning. Some degree of value distortion is implicated in most burnout cases. 
Frankl, on practical grounds, pleads for self-transcendence, and not self-actualization, as a primary human focus: 
The true meaning of life is to be found in the world rather than within man or his own psyche, as though it were a closed system. By the same token, the real aim of human existence cannot be found in what is called self-actualization. Human existence is essentially self-transcendence rather than self-actualization. Self-actualization is not a possible aim at a!L for the simple reason that the more a man would strive for it, the more he would miss it. For only to the extent to which man commits himself to the fulfillment of his life's meaning, to this extent he also actualizes himself. In other words, self-actualization cannot be attained tf it is made an end in itself, but only as a side effect ofselftranscendence.4. r. 175 
Frankl is not moralizing, he is advising. On a purely pragmatic basis, selfactualization as an intended goal does not work. There is a subtle but pronounced difference between self-actualization and the authentic quest for meaning. In self-actualization, we actually yearn for self-satisfaction. In the authentic 
quest for meaning, we yearn for the fulfillment of an other, be it an ideal or a person; we indulge in self-transcendence. The self-defeating nature of self-actualization and the ultimate viability of self-transcendence as the primary human dynamic in striving for meaning is best encapsulated in the following. 
Time and again we have found that, in a given organization, individuals hunger 
for appreciation. While these people feel unappreciated, they almost never 
reach out to show appreciation ofsomeone else's work. In our experience, we 
have found that one of the best ways for individuals to encourage other 
people to pay attention to their work is to start acknowledging the good work 
of others. When individuals. on their own, reach out to give each other 
needed support and needed appreciation, the reaching out mushrooms and 
grows exponentially. JO. r-12 
In sincerely focusing on others, we not only dereflect from ourselves. we also create the ambiance of praise and acknowledgement, and unexpectedly find the fulfillment which is so elusive when intended. Precisely because they enter with an expectation of a self-actualizing experience, this goal is frustrated for so many human-service professionals. The burnout syndrome is thus an empirical validation of logotherapy. Moreover, it becomes clear that the logotherapeutic concept of quest for meaning is a dynamic force to avoid burnout. 
Human Ingredient in Work 
Many dentists who are frustrated by lack of appreciation respond by taking on more patients. In effect, they have given up on being appreciated, and decide that they may as well get rich. However, the dentist who is deeply affected by the emotional coldness of the profession can make a self-transcending leap which will bring in less money but can create a happier environment and invest life with deeper meaning. This is a worthwhile trade because studies have shown that "people who received appreciation, satisfaction, and a sense ofsignificance from their work were more likely to be content with their income, no matter how low it was."W. r 72 
For dentists, the way out of the debilitating trap called burnout is to have fewer patients and more patience. If they were to spend more time with their patients, allowing them to express their fears, and then allaying those fears or putting them into an optimistic perspective. and also explaining what they are doing and why. dentists will have added the vital human ingredient in an heretofore purely mechani1ed technique. 111 -p. x Instead of treating a root canal they would be treating a person. Instead of being dentists they would be human beings practicing dentistry. This can spell the difference between a morose patient and a grateful one. between a burned-out dentist and a reinvigorated one. 
Long before burnout became a popular issue, logotherapy was proposing an attitude toward work which. if adopted.~ ould have prevented many instances of burnout. For the specific case of the medical doctor. Frankl observed: 
The meaning of the doctor's work lies in what he docs beyond his purely 
medical duties: it is what he brings to work as a personality, as a human being, which gives the doctor his peculiar role. For it would come to the same thing whether he or a colleague gave injections, etc., if he were merely practicing the arts of medicine, merely using the tricks of the trade. Only when he goes beyond the limits of purely profes~ional service, beyond the tricks of the trade, does he begin that truly personal work which alone is fulfilling. s. r 96 
And, in general, concerning any occupation, Frankl comments: 
The job at which one works is not what counts, but rather the manner in which one docs the work. It does not lie with the occupation, but always with us, whether those elements of the personal and the specific which constitute the uniqueness of our existence are expressed in the work and thus make life meaningfuJ.5. p. 95 
It is through the investment of the human ingredient that any worker is unique and thus irreplaceable, and infused with a sense of meaning and purpose which does not allow for the burnout pattern to evolve. 
There are obviously many factors -extraneous, situational, intrinsic, and subjective, as well as combinations of these factors -which contribute to burnout. Each individual situation is unique and should not be explained away through nonspecific generalities, but it would appear that logotherapeutic philosophy and technique can be useful tools in tackling this twentieth-century phenomenon. 
Through the eight categories presented here -philosophy of work, dereflection, experiential values, self-detachment, facing the unavoidable, appreciating finiteness, self-transcendence toward meaning, and the human ingredient in work -logotherapy offers a wide range of possible approaches to each burnout situation. Logotherapy can serve as a mid-course corrective for burnout and as prevention. It is up to the counselor to ferret out the factors causing the burnout, and thus decide which particular aspect of logotherapy to apply in the given situation. 
Burnout may be seen as the condition in which the fire, the spark which ignites the individual, peters out. The fire has gone out because there is no more wood to burn. Frankl's system provides the lugs, in the form of log-o-therapy, to feed the flame of the human spirit. 
REUVEN P. BULKA is Rahhi of Congregation Machzikei Hadas, Ottawa, editor ofthe Journal of Psychology and Judaism, and author ufmany articles on various.facets oflogotherapy. 
REFERENCES 
I. Bulka, R. The Quest.for Ultimate Meaninf(.' Principles and Applicatwns of Logotherapr. !','ew York, Philosophical Library, 1979. 
2. 
Czikszentmikalyi, M. Beyond Boredom and Anxietr: The Experience of P/11_1· in Work and Games. San Francisco, Jossey-Bass, 1975. 

3. 
Frankl, V. E. "The Search.for Meaning." Saturdai· Review Sept. 13, 1958, 20. 

4. 
___ Man '.I-Searchfi,r Meaninf{: An Introduction to Logotherapr. New York. Washington Square Press, 1963. 


5. 
____ lhe Donor and1he Soul: From ATclw1h<'raf'_I" 10 /.01;01her11pr :\ew Yllrk. Han tam Books. 1967. 

6. 
____ Archo1herafi., and Exisrentia/i.1111: Sele,ted P11per.1 on ru1;01hem;n. '.\c\\ Yor,. Simon & Schuster, 1968. 

7. 
____ 77,e Will to Afellni111;: Foundllrions llnd Afil,lirnuon.1 of l./lf;Ulhera;1r. \"ew York. World Publishing Company. 1969. 

8. 
Freudenberger. H. "The Staff Burn-out Syndrome in Alternative Institutions." Ps.-cl101hem;n: Theorr. Resellrch and Prwtice, 1975. I.?( I). 73-82. 

9. 
Freudenberger. H. and G. Richelson. BurnoW: How w Belli the Hi1;h Cull of Sucu·11. :\e\\ York. Bantam Boob, I 981. 


10. Pines, A .. E. Aronson. and D. Kafry. Burnoul: J-i·um Tedium to Per.1<mlll (ir(})vfh. '.\:c\\ York. Free Press, 1981. 
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Logophilosophy for Israeli's Retirees in the Helping Professions 
David Guttmann 

What are the differences in life styles and personal characteristics among retired physicians, nurses and social workers? What is the influence of work prior to retirement on life satisfaction? What is the relationship between the retirees' perceived economic security, health, achievement of life goals and a sense ofself-actualization? What contributions do retired professionals make to society years after retirement? How do they relate to their chosen professions once their professional obligations are no longer so mandatory? 
An investigation of the daily lives of 136 older Israeli professionals --35 social workers, 55 physicians, and 46 nurses -~ permitted a peek at a generation that will soon be vanishing: Former pioneers who conquered uncharted territories, fought battles, suffered many hardships, vanquished enemies, and who by right could now rest on their long-deserved laurels of victory. Who are these people? Among them there are physicians who rode on donkeys, for miles, to render assistance to hundreds of women during childbirth; nurses and social workers who walked long distances on foot to bring food, clothing, medicines, and incidentals to new immigrants who flooded the country immediately after the State of Israel was established in 1948; those that battled red tape and administrative procedures for their clients. These people came to a barren land and in their small ways performed deeds which, from the perspective of the computer age, seem almost heroic but were viewed as daily business routine. In a world in which home visits by helping professionals are outdated, it is reassuring to see an 80-year-old physician carrying his black bag on his way to a house-bound patient; or to notice a retired nurse or social worker on her customary round. What are their lives like in the dusk ofthe twentieth century? What are their sources of happiness? How do they use their spiritual resources? Can they exist in a closed system, or do they attest to Frankl's assumption that self-actualization is a by-product to our reaching out for meanings to fulfill and other human beings to encounter? 
Theoretical Considerations 
The present research examined the applicability of three major approaches to adjustment in retirement: Continuity Theory;3, 4 Development Theory; 16 and Disengagement Theory.6 All three approaches suggest that individuals can choose among different life-styles that may lead to personal satisfaction and a sense of self-actualization after retirement. 
Continuity Theory claims that older people as a whole continue to have social and psychological needs similar to those they had when middle-aged, and that successful aging requires remaining socially involved and maintaining their previous life style. Habits and activity patterns continue into the post-retirement years. This theory suggests the "maintainer "life approach in retirement --older people will continue their work or work-related activities, although retirement provides opportunities to disengage from their occupations. 
Development Theory argues that there are role changes and transitions over the life span which may be perceived either as crisis or opportunity for personal growth and experimentation with new roles. 18 This theory supports the alternate life style of the "transformer" -individuals who take charge of their lives and experiences, and develop new activities. 
Disengagement Theory contends that older people become less involved in the organized structures of society, reduce their interactions and roles, and thus withdraw from social life. This theory proposes the "disengaged"life style after retirement. 
Researchers have identified a number of satisfying life styles among retirees. 
Maas and Kuypers 13 in a longitudinal study covering forty years of adult life, 
found that men and women of different occupational backgrounds developed 
different life styles after retirement. High-occupational-status men became 
volunteers in community and political organizations, while blue-collar males 
tended to become hobbyists. Dominant-type women invested themselves in 
community work, while working women expanded employment into late-life 
careers. 
Snow and Havighurst20 examined the life-style patterns of retired male college presidents. They distinguished two major life-style subgroups: The maintainers held on to professional activity, pursuing part-time assignments and supplementing this with other activities. They tended to maintain this level ofactivity up to the age of 74 years. The transformers changed their life style by reducing professional activity and finding a new and enjoyable life style, typically in a non-professional area (e.g., hobbies, community affairs, arts and crafts, travel, and other active leisure pursuits). 
In Israel, Amir and Ushpis2 examined factors influencing life satisfaction of 
retirees in academic professions (e.g., engineers, lawyers, teachers, physicians). 
Two-thirds of the formally retired academicians continued to work part-time 
and participated in a number of meaningful activities. The more frequent the 
activity, the higher satisfaction with life was reported. 
Kramer and Harpaz12 found that among low-occupational-status industrial 
and service workers in the Haifa Metropolitan area, life styles and leisure 
patterns continued almost unchanged into retirement. A "spill-over" effect was 
discerned: Workers whose routine tasks had induced apathy, carried over this 
experience to their nonwork sphere. Passive leisure activities dominated this 
sample of workers. Guttmann and Levey9 compared the leisure patterns and 
satisfaction with retirement among former employees ofthe Hadassah Medical 
Organization: medical staff, managerial/clerical, and maintenance workers. 
They found that the higher the occupational status, the more frequently the 
retiree engaged in diversified activities: work, volunteering, study and recrea
tion. Low-occupational-status retirees reported more dissatisfaction with 
retirement and less activities than high-status retirees. 
A Tentative :vlodel 
Retirement refers to the mandatory retirement age determined by an organization or law. In Israel, persons beyond the mandatory retirement age (65 for males, 60 for females), frequently continue to be employed on a part-time or full-time basis by their former or another employer under a special contract. Members ofthe health professions tend to continue employment. In the helping professions, a number of agencies recruit trained social workers for paid or volunteer work. Nationwide in I980, 27. 9 % of males and 6.6 % of females beyond the age of 65 continued to be employed. 7 
Theory and research suggest the sociological categories that may be empirically assessed so a typology of retirement life styles may be developed. Our research proposes a tentative model of retirement that provides a strategy to compare, describe, and test hypotheses related to life styles in retirement. 
Demographic Characteristics of the Sample 
Cross tabulations comparing social workers, nurses, and physicians revealed a number of similarities and differences in their demographic characteristics: 
Sex: All social workers and nurses were females, but only a third of the physicians were women. 
Marital Status: Most social workers were unmarried, either widowed or divorced/ never married. Among nurses, close to a third were widowed. Most physicians were married. 
Children: Almost one-third of the social workers were childless. Most nurses and physicians had children. The majority of retired professionals had one or two children and none had more than three. 
Age: More than halfofthe physicians were 75 years or older (52%), compared to 18% of social workers and 15% of nurses. 
Continent of origin: Almost all retired professionals were born in Europe or America (96%). Two-thirds of the social workers and nurses and half of the physicians arrived in Palestine before the Second World War, and the remainder have resided in Israel between 16 and 40 years. 
Education: Most social workers (77%) and nurses (91 %) were certified, but only 17% of social workers had academic degrees. Among the physicians, 20% had Ph.Os. 
Hebrew: 9% of the retirees had difficulty in speaking Hebrew, 16% had difficulty in reading Hebrew, and 20% in writing Hebrew. 
Life Before Retirement 
The major tasks of the retired professionals before retirement were closely related to their former work place. Most social workers were employed by municipal councils or in government. and almost half the nurses by the Workers' Sick Funds or in hospitals. This was also true for the physicians who, in addition, had (or still have) their private practices. More than half of the retirees were practicing in the occupations they had hcforc emigrating to Israel. In Israel. 459i of the professionals rose to higher positions as supervisors and counselors to students. More than two-thirds of the physicians had hccn active in their profession for more than 40 years. 
The majority of the retired professionals expressed satisfaction with their former places of employment and with work in general. Important sources of satisfaction were the sense of helping clients; the variety and success in professional work (including opportunities to engage in interdisciplinary work); and the responsibilities they carried. Among physicians dissatisfied with their work the most frequently cited reason was lack of cooperation of their supervisors. For social workers and nurses it was case over-load, the amount of paper work, and meager resources. 
Physicians saw their main work as leaders in the field and research, lectures and publications. Nurses and social workers were more oriented to developing new services and skills. Both of these professions are relatively new in Israel\ academia. Thus, for example, the first Bachelor of Social Work program started in 1958. Hence the need for greater participation hy members of these professions in activities aimed at strengthening the "professionalization" of social work and nursing. 
Only 57 ofthe 136 retired professionals studied had made some plans for life after retirement. Few of them had attended formal courses on preparations for retirement. A third of the retirees opposed the idea of leaving their jobs at the age ofmandatory retirement. This was true especially among physicians, 45% of whom retired at age 70, one-third continued to be employed after 70, and even so considered retirement as too early. Social workers and nurses felt that they retired at the "right age"for them -usually around 60 years -and perhaps for this reason almost half of them did not continue work hcyond retirement. In making decisions about continuing work or retirement, the majority of professionals turned to their families, friends, colleagues and professional organizations for encouragement and support. 
Retired physicians, nurses, and social workers may be regarded as a relatively 
healthy group of elderly people. Compared to other Israeli people in their age 
111 19
groups, professionals tend to self-evaluate their health higher than others.5-Only 6% among our sample reported poor health. Although close to half of the retirees reported some chronic condition or illness, only a few could not perform the tasks of daily living. On the whole, despite some impairment in mohility, sight. and hearing, most felt fit for life and went ahout their husiness as vigorously as ever. 
Retirement Roles and Volunteer Activities 
One of the major developmental tasks after retirement is to engage in meaningful roles and activities. According to Havighurst. 11 work is a source of i ncomc: a use of time: a source of personal status and identity: a framework for social interaction: and a source of meaning and creativity. Transition to retirement requires a realignment and redirection to the psychosocial goals around which individuals integrate their lives. Some retirees wish to hold on to their present achievements by continuing those roles which in the past afforded them security and satisfaction. Others consider retirement an opportunity to grow and develop ouhide interests such as these: 
Goud interpersonal relations --84Si: of the sample. especially those 75 years and older: 
Professional development and occupational achievements -59% of the sample. expecially males (i.e .. physicians). and former leaders in their professions: 
Selfacruali::ation and personal development --soc;c of the sample. especially those who were employed in the social services: 
Philosophical, social, and religious xoals --46(\-of the retirees. especially those who made significant contributions to the development of new services: and 

General saris/action and pleasure in life -23% of the sample. especially the older retirees (75 and older). 
Health is a major factor in assessing one's overall achievement and selfactualization. Physically limited retirees reported less interest in occupational goals and in maintaining good interpersonal relations than did the healthy subjects. Economic security. personal conveniences. and pleasure were ranked the least important among the personal goals of these retired professionals. Perhaps their strong identification with the ideals of the pioneers those of hard work, total dedication to one's profession and occupation. and the determination to serve society -prevented them from considering themselves entitled to some well-deserved pleasures. including the right to seek personal happiness outside of their work. 
General Satisfaction with Life 
Answers to the question ofwhat constitutes for retired professionals a general sense of satisfaction were sought by employing the 13-statement Life Satisfaction Index Z (LSIZ) developed by Neugarten et al. 14 and revised by Adams. 1 This instrument was specifically designed to measure psychological adaptation to aging and the respondents' morale. Of the 79 subjects in the sample who responded to all 13 statements in the index, seven out of ten were generally satisfied with their lives, 30% were dissatisfied. 
Health is considered a major factor in perceiving one's present life as satisfying in old age. In our study, 59% of the sample reported good or very good health. a finding similar to that of Shanas'17 study of old people in three industrial societies. but much higher than the 19% reported by Weihl el a/22 in their nationwide survey of Israeli urban elderly of 65 and older. Statistically significant relationships (p=.003) were found between health and life satisfaction. Compared to retirees reporting fair or poor health. retirees in good health responded much more positively to these statements: 
-My present activities arc as interesting as ever: 
--i have gotten more breaks out of life than most people I know: and 
-These are the hest years of my life. 
Age was another factor in life satisfaction of retired professionals. In general we found that the older the retirees the lower their score on the LSIZ. Also ,coring higher were retirees who developed new methods of service: those who held managerial and leadership positions during their work careers: and those who guided students for years in their professional development. 
Profiles of Types 
For the final analysis we developed a profile for each type of retired professional according to their life styles in later years. There were no recreationalists among the sample, as none of the respondents indicated much interest in active leisure outside of the home. This finding is corroborated by the low proportion of retirees who seek conveniences and pleasures as major life goals. 
Maintainers are the modal life-style type for this sample. Over four-fifths (83o/cJ of the physicians and ahout half of the nurses and social workers continued their professional work long into retirement. The physicians, unlike the nurses and social workers, did not tend to engage in volunteer activities and studies unrelated to their profession. They have a strong tendency to invest themselves in their professional work even while retired. These maintainers were no older than their non-maintainer peers. While they enjoyed somewhat better health, the major factor in their life style was a strong sense ofsatisfaction in the work place. "Work! No social club, no hobby or study groups,"exclaimed one of them. "Only work! Nobody should prevent the retired doctor from fulfilling his professional obligations as long as he is capable of performing his job!"ts 
According to the disengagement theory," those who retire voluntarily from their social roles --of work and family responsibilities --arc supposed to he contented with the new phase in their lives. However, the nine physicians in the sample who neither worked, studied, nor volunteered, and were labeled disengaged, saw their present life style less than desirable. Perhaps this was so because these physicians had a relatively high degree of disability due to poor health and economic difficulties. 
The transformer life style emphasizes study, volunteer work. and employment outside of the retirees' former professional area. Whereas half the social workers and some 44% ofthe nurses participated in study or volunteer activities unrelated to their former profession, no one in the sample hegan employment in a new occupation after formal retirement. And although the nurses had ventured into some new areas, their participation was low. and they showed no other indications of transformation in life style. 
On the other hand, social \vorkers, who tended to retire earlier than their peers in nursing and medicine (at an average age of 63) were generally satisfied with their work and tried new responsibilities as volunteers. 
Thus the concept of transformer as a commitment to a new life style appeared to apply to only two of the retired social workers. one of whom hccame a student and the other immersed herself in seven different volunteer task, ouhide her profession. 
Conclusion 
The modal life style for retired physicians. nurses. and social workers in this sample is the maintainer. There is no significant support for the transformer life style among the retirees, which would re4uire much ego strength to aid the individual in the transition. 
The findings support the continuity theory of adaptation in old age in which individuals maintain middle-age commitments, and variations in life style arc closely related to former ha bits and values. The psychological disposition of individuals to seek congruity with their identity and continuity with their personal history, predisposes them to maintain former life styles in retirement. Professionals, in particular, perceive their occupation as a vocation having intrinsic value and interest; hence the constraints on new roles they arc willing to risk in retirement. 
Several explanations may be uni4uc to the Israeli situation. There are structural constraints such as the six-day week, case overload, strict observance of the Sabbath, lack of public transportation on that day, the comparatively low incomes for salaried professionals which seriously limit outdoor leisure activities. In addition, all males between 18 and 54 have to serve a month or longer in reserve army duties, and then usually make great efforts to catch up on work and salary. 
The findings attest to the fact that Israelis in the helping professions perceive their occupation as an avocation providing rewards through a continuous demand of self-reflection and self-transcendence. 
It seems that the self-actualizing meaning that shaped the character and self-image of these retirees was the ideological context within which they regarded themselves as builders of a new land and a new society based on physical work, hardships, and self-sacrifice. They saw work as "a search for daily meaning as well as daily bread; for recognition as well as pay; for astonishment rather than torpor; in short, for a sort of life, rather than a Monday-through-Friday sort of dying. Perhaps immortality too is part of the quest. "21 
The maintainers phenomenologically confirm the Franklian thesis that self-transcendence and the awareness of fulfilling a personal mission, a pervasive sense of a life task to which one is called, are prere4uisites to a meaningful life and a sustained sense of human dignity. x_ P-117 
DA V!D GUTTMANN, D.S. W., is director ofthe Center for Study of Preretirement and Aging, Catholic University of America, Washington, D. C., and head c~f the Richard Crossman Chair of Social Policy, Universitr of Haifa School of Social Work, Haifa, Israel. 
REFERE:\CES 
L Adams. D. L "An /\nalysis of a Lite-Satisfact1on Index." .Journal of Gerontologv .:4(4): 4 70-476. I 969. 
2. 
A:nir. J_ and V. llshpis. "Factors Influencing Adjustment of Retirees in Academic Profrss1ons. Gerontologr (Hebrew) 11(3): 11-38. 1977-78. 

3. 
Atchley, M. J. Julius, and E. Wasser. Serving r/11! Aging. New York. Community Scnice Society of N.Y., Inst. of Welfare Research, 1964. 

4. 
Atehl~v. R. C. The Social Forces m later li/i'. Belmont. CA, Wadsworth Puhl. Co.. 1972. 

5. 
Cibuls.ki. I. Social Supporr .Vetwork.1 ofthe ilder/r. Doctoral Dissertation. Tel A,iv University, 1982. 


6. Cummings, E. M. and W. E. Henry. Growing Old: 7he Process o(Disengagement. !'.ew York, Basic Books, 1961. 
7. 
Davies, M .. J. l.ockardt. and Y. Kop. Aging in Israel: A Clwnhook. Jerusalem, Joint Israel and Brookdale Institute, 1982. 

8. 
Frankl, V. E. The Doctor and the Soul. New York, Vintage Books, 1973. 

9. 
Guttmann, E. and S. Levey. Adjwtment to Retirement. Jerusalem, Applied Research Institute. 


1970. 
IO. Harpa7, H. Characteristics, A11irudes, and Needs of Old People in Tel Aviv-Yajfo. Iel Aviv, Israel Gerontological Society, 1978. 
11. Havighurst, R. J. Human Development and Education. New York. David MacKay Co., I953. 
12. 
Kramer, Y. and I.. Harpa7. "Leisure Patterns Among Retired Workers." Journal o( Vocational Behavior, 21: 183-195, 1982. 

13. 
Maas, H. S. and J. A. Kuypers. From Thirty to Seventy: A Fonr-Year longitudinal Stwlr o( Adult Lile Str/es and Personality. San Francisco, Josscy-Bass, 1974. 

14. 
Neugartcn, B., R. J. Havighurst, and S.S. Tobin. "The Measurement of Life Satisfaction." Journal of Gerontology, 16: 134-143, 1964. 

15. 
Physician's Bulletin, December 1979, p. 59. 


16. Pincus, A. "Toward a Developmental View of Aging for Social Work." Such;/ Work, 3:33-46. 
1967. 
17. Shanas, E., P. Townsend, D. Wcddcrhurn, H. Friis. P. Milhoj, and J. Stchouvcr. Old People in Three Industrial Societies. New York, Atherton Press, 1968. 
18. 
Sheehy. G. Pathfinders: Overcoming the Crisis ofAdult Li(e. New York, Bantam Books, ]982. 

19. 
Shuval, J. T., R. Fleishman. and A. Shmucli. Jnformal Support.fi!r the Elderfr: Social lVerwork in" Jerusalem Neighhorhood. Jerusalem, Joint Israel and Brookdale Inst.. 1982. 


20. 
Snow, R. B. and R. J. Havighurst. "Life Styles an<l Patterns of Retirement of Educatnr,." The Gerontologist, / 7(6):545-552, 1977. 

21. 
Terkel, S. Working. New York. Pantheon, 1979. 


22. Weihl, H., T. Nathan, and N. Getter. An Investigation ofthe Family Life, Living Conditions, and Needs ofthe Non-Institutionalized Urhan Jewish Aged /i5+ in Israel. Jerusalem, Min. of Social Welfare, 1970. 
Responsibility and Meaning in Treatment of Schizophrenics 
James E. Lantz 

Schizophrenia has been called a physical disease, a dysfunctional style of living, a logical method of existing in an insane world, and a unique psychosocial reaction to stress. 5 In recent years many authorities 1, 5, 6 have concluded that schizophrenia is both a basic biochemical illness and a reaction to stress. In this view it is' assumed that the schizophrenic client has a core perceptual and integrative deficit which results in an increased vulnerability to emotional and external stress. 1, 6 This core deficit is considered to result from a physicalbiochemical disturbance within the receptor sites of the central nervous system. 1, 5 Treatment of the schizophrenic client is generally most effective when two treatment components are present: Medication to help control the biochemical disturbance, 1 5 and supportive psychotherapy to help minimize the occurrence of too much stress and to maximize the client's skill in reacting effectively to such stress. 1, 5, 6 The author believes that a third component, seldom discussed in the literature, should also be included --the logos (spiritual) component. 
The Pain in Schizophrenia 
The schizophrenic client often suffers from intense symptoms which can be part of the disease: loose associations, confusion, illusions, hallucinations, delusions, impaired reality testing, body image distortions, paranoid feelings, and the experience of intense anxiety reactive to the normal tasks of daily living.5 Although such symptoms can be controlled to some extent through medication and supportive psychotherapy, there is scant evidence that schizophrenia can be permanently cured.4• 5 The schizophrenic person is forced to live with and suffer from an ongoing, painful disease that is not yet completely understood, and for which a consistent, permanent cure has not yet been found.S. 6 
Schizophrenic clients are forced through the reality of the disease to suffer from the disease and to accept the responsibility for their own reaction to it. Although they should not be blamed for having the disease, they are responsible for developing a healthy and effective response toward it. Logotherapeutic interventions can be of particular value within these two areas (responsibility and suffering). 
Responsibility 
It is generally assumed that schizophrenic clients cannot prevent, or recover completely from, the disease. 1, 5 They can, however, control their attitudes relating to it. 4 This existential option is always available to every person.2 The 
clients have the choice to respond to the illness with an attitude of resignation or an attitude of responsible defiance.1 The following clinical illustration demonstrates how a female schizophrenic client was able to use logotherapy to develop a responsible and defiant attitude toward her disease. 
Joan, 25, had her first schizophrenic episode at the age of 22. During the next two years, she had five psychiatric hospitalizations for exacerbations of her ongoing illness. At the age of 24 she was released from her fifth psychiatric hospitalization having developed the awareness that she did have an ongoing illness, that she would need to continue taking anti-psychotic medication. and that she would need ongoing supportive psychotherapy at a community mental health center. 
The client's first contact with the author occurred in a community mental health setting after she was released from her fifth hospitalization. At that time her symptoms were well controlled by medication. She was not hallucinating, was not experiencing persecutory delusions, and did not complain of overwhelming anxiety. She stated that "medication is doing the job" but expressed disappointment that she was "stuck with this disease." She stated that it had taken her five "trips to the nut house" to realize that she was a schizophrenic and that she might need treatment and medications for the rest of her life. The author suspected this last statement as possibly indicating that she was considering suicide and asked her about this possibility. Joan stated that 'Tm thinking about it but I haven't made up my mind." 
At this point the client and the therapist talked about the different attitudes which she could take toward her disease. The therapist provided the client with a fairly detailed description of how a person might implement an attitude of "positive defiance" about the illness. The client was asked to give it some thought and a second outpatient appointment was scheduled. 
In subsequent visits the therapist and the client talked in Socratic dialogues about the difference between "finding a cure for the illness" and "rising above the illness." The client eventually decided that it might be possible "to use my illness in a way that helps others -to show people that schizophrenia doesn't have to ruin your life." 
Joan still suffers from schizophrenia. She still takes medication and she is still in ongoing outpatient psychotherapy. She has read most of Frankl\ books. she believes that she is able to control her illness by using a defiant attitude toward it, and that she has raised herself above the "disease." She works full time. is an active member of a self-help group organized and operated by former mental patients, and is a "big sister" to a troubled adolescent. She has remained outside the state hospital for more than five years. She has changed her opinion about herself. She believes that she is a person who "happens to have schi10phrenia" rather than being "a schizophrenic." 
Suffering 
Although suffering is a part of life. the length and intensity of the schizophrenic clients' suffering appears to he extreme. This intense and continuous suffering can be minimized by effective treatment yet it can seldom be eliminated. The schiwphrenic client. like other human beings, benefits greatly by finding meaning in suffering. The following case illustrates the henefits which can occur when a schirnphrenic client is ahle to find meaning in his or her rnffering. 
Jack. 37, is dirnrced with one child. He has heen separated from his family for ten years. He has had at least 15 hospitalizations during the past 10 years and has hecn diagnosed as a chronic schizophrenic. undifferentiated type. Jack was referred to the author's aftercare support group to help .Jack improve his sociali1ation skills. 
In the first few meetings .lack did not participate in the group's interactions. Jack's use of this isolating relationship style was accepted by both the therapist and the other members of the group. After two months Jack started to talk in the group. He told about his many hospitalizations, his feelings of inferiority, and how he had decided to "just get by." He reported that he had given up trying to work and that he did everything he could to minimize "stress and suffering." After all, he stated, "there is no real reason to try." When questioned about this decision he replied: "What can you expect ---I'm a schirnphrenic, I've lost my mind, my wife. and my son." 
Another group member asked Jack about losing his family. Jack reported that his wife had divorced him and that he had been in the hospital so much that he had lost contact with his son. 
A third group member became angry at Jack and told him that "my father was schizophrenic but at least he tried." This group member told Jack that "when I was young I knew my father was sick, but I could always count on him to see me when he wasn't in the hospital. I always admired him because even though he suffered, he never ran out on me." 
Jack missed a number of group meetings after this confrontation. When he returned he told the other group members that he had gotten real upset after his last meeting but "it made me think." He wondered if he had tried hard enough. The therapist suggested to Jack that he had stopped trying to "avoid suffering" and that if he could "find a good reason for suffering it might be easier to try." 
Jack is now working part-time and visits his son weekly. Jack reports that the group helped him find a "good reason for trying" and that "it is easier for me now that I see my son." His part-time work brings extra money so that he can help support his son. During the past three years Jack has had only one readmission to a psychiatric hospital. 
JAMES E. LANTZ, Ph.D., is a clinical social irnrker at Harding Hospital, Worthiniton, Ohio. 
REFEREl\CES 
I. Anderson. C., Ci. Hogarty. and D. Reis. "Family Treatment of Adult Schizorhrcnic Patients: A 
Psycho-Educational Arrroach," Schico11hrenia Bu//erin, 1980, 6. 490-50j_ 2 Frankl. V. The Will ru Meaning. :".ew York. World Publishing Co., 1%9. .l I .ant1. J. Famill' {lt1d .14(/ril{l/ lherarn. 1\icw York. Arrleton-Ccntu,,-Croft. 1978. 
4. ---· "Deretlcction in Family Iherary with Schi1ophrenic Clients.·· J/ze !nrernmional For;m1 f,;r Lu1;urherap1·. I982. 5(2). 119-122. 
5. 
Liet .J. and A. Slalw. !111e1;rared Psl'chiarric Treatmem. Hagerstown. llarpcr and Row. 1975. 

6. 
Snyder. S. Biulu1;icai A \/>eels of Mem11/ Disorder.,. 1\e\\ York. Oxlord Uni\crsity Press, J9f;0. 


Logotherapy and The Book of Job Alan J. Atlas 
All people at some time in their lives are forced to suffer innocently. This undeserved agony is older than the Book of Joh and will exist as long as humanity itself. The phenomenon of suffering and reflection on its cruelty have destroyed the faith of many, and yet preserved that of others. 
As Job cries out to God for an answer to his agony, so do all people seek a possible meaning to their individual misfortunes. Innocent suffering seems to go against God's law, against the natural universe itself. All people hope life will go well and are willing to accept minor setbacks. It is almost impossible, however, for us to accept having our hearts broken. Job, in seeking his answer, indicts God and forces Him to show His face. All sensitive and thinking individuals, whether religious or not, have addressed the problem of innocent suffering. The questions are endless: How can God allow it? How can humans allow it? Would it be crueler of God to stop human actions, even if they be cruel? Is suffering the ultimate absurdity, denying any meaning in life? Or, rather, is it a challenge through which people may discover life's meaning? 
Answering the last question in the affirmative, Viktor Frankl directs the forces of logotherapy to the search for meaning. This existential school believes that the supreme conscious human longing is the commandment to find meaning and purpose in one's existence. A life with meaning, logotherapy has found, can survive any odds, hardships, or misfortunes, while a meaningless existence lacks even the attractiveness of its own survival. 
As a neurologist and a psychologist, Frankl is willing to admit that instincts, somatic influences, and environmental factors can determine some aspects of a person's behavior. But as a survivor of the Nazi death camps, he is convinced that the human spirit can overcome all obstacles.4-pp. 16-17 Only humans can transcend their suffering, through their innate freedom to decide about their attitude to that suffering; animals must merely exist in agony. 
Likewise, God only speaks to human beings. Animals never cry out to Him in love, supplication, or loneliness. Therefore, God's relationship to the lower creatures is merely one of satisfying their needs, rather than longings. 
Can an ape that is being used to develop poliomyelitis serum, and for this reason being punctured again and again, be able to grasp the meaning of its suffering'!1-r 187 
Only human beings have been given the opportunity, and hence the obligation, to speak to God and see if He can provide some meaning for our ordeal. When people cannot get any meaning out of their pain, they feel as if they have sunk to the level of the ape in the experiment or, like Job, have been attacked by God's "poisoned arrows." When a man finds that it is his destiny to suffer, he must accept suffering as a unique task. He must acknowledge the fact that even in suffering he is unique and alone in the universe. No one can relieve him of his suffering or suffer in his place. His unique opportunity lies in the way he bears his burden_ 1. PP 12.1-24 
This passage, coming from the wisdom of the heart. as wdl as from the knowledge of the mind, is a valuable synthesis of Frankl\ understanding of suffering. Human "destiny" is the state in which a person cannot remove personal angui~h. Only unalterable suffering must he borne, or else it becomes neurotic masochism. Although responsibility must never be shirked, one shouldn't take on more than one can handle. If destiny commands that we assume a task, we have no other choice. This is similar to the Jews' unconditional faith and trust in an unconditional God who gives Israel tasks, commandments and obligations which are to be followed. Evasion of our task violates God's law (or, existentially, life's objective) and breaks our Covenant with Him (or, similarly, violates our own system of values). Job, forced to suffer innocently, obligates himself to indict God because he knows that he is innocent and He will prove himself so. No one else can. 
In line with Frankl's logotherapy, Job realizes his uniqueness and singularity in the universe. In his ordeal he can turn to no one; not even to God, or so it seems at first. When individuals are forced to confront the ultimate, eternal and often terrible truths of human existence, they do so alone. Others may clarify and explain, but the sufferer is forced into total self-reliance. Job's three friends are unable to answer his agony; the answer must come only from within, if it comes at all. Although Elihu tells Joh essentially the same message as the Voice in the Whirlwind, Job must hear the latter to reconcile himself to his fate. 
No one can suffer for another. Commiseration really only affects the bearer, not the object. The three friends sympathize with Job, but cannot agonize with, or for, him. In fact, in their philosophical confusion about his alleged guilt, they cannot even understand his very innocence. Having been earlier able to live in his conventional beliefs, Job is finally given an opportunity to confront -and either confirm, modify, or reject --these ideas, as he sees fit. In logotherapy, every innocent sufferer is given the opportunity to see behind the structure of one's normal, peaceful world and glimpse the outlines ofan ultimate meaning in existence. And also, the chance to derive meaning from the dignified attitude one takes while "bearing one's cross." 
An essential characteristic of the religious man is that he interprets his existence not only as a responsibilityfor fulfilling certain tasks, but to the particular taskmaster. To the religious man, God's will is "decided" on Earth. The unique achievement of Mosaic monotheism may well consist in its conveying to the human race the permanent consciousness of a divine authority.2. rr SR-59 
Life Task 
A task is something that a person assumes: whether or not it is particularly desirable: it must he fulfilled. Frankl once pointed out that the late Rahhi Leo Baeck translated "Torah" as "life task. "4. r 141 As God demands that humanity follow His laws, so must we also follow an existential imperative. Awareness of the ta~kmastcr (God, the imperative to exist meaningfully, or hope for a better life) makes the task worthv.'hile and even ennobling. .Joh rcali1cs that God is inflicting these sufferings on him, and this knowledge makes Job trust strongly enough in the taskmaster to indict Him. The figure of the Satan becomes merely an agent for the working of Providence. 
Job never questions the existence of God;j ust the hiding of His face. "Why," he asks, "am I being tortured? What have I done?" Job reali1es that God needs humans to carry out His will on Earth and is able to rely on this mutual Covenant with the Master of the Universe as the basis of the indictment. The suffering strengthens, rather than weakens the relationship with God because it puts it to its most difficult test. And by maintaining his trust in God, even when it is de.1pite God, Job is "deciding" His will on Earth. 
For Frankl, confronting his fellow prisoners during the war, as well as his patients since then, as for Job, suffering itself is not as painful as the feeling that it is of no purpose: 
With special regard to suffering ... I would say that patients never really despair of any suffering in itself. Instead, their despair stems in each instance from a doubt as to whether suffering is meaningful. Man is ready and willing to shoulder any suffering as soon and as long as he can see a meaning in it.3-r-56. 
This can be considered empirical proof that all people are aware of their responsibilities in life. "I've got a job to do and I'll do it," is the attitude most people will take in difficult circumstances. During adult life, evasion of one's responsibilities is considered, at best, laziness, and at worst, moral cowardice. 
To the religious person, suffering is seen as another of God's tasks to be endured as well as possi hie. But to the secularist, or even atheist, the image of the taskmaster is absent, even inconceivable. Logotherapy shows that life itself is a task. Challenges are given and must be met. If possible, they should be overcome; if not, the act of putting up a good fight is its own recompense. "The rules ofthe game of life do not require us to win at all costs, but they do demand that we never give up the fight."2.p. 107 
Through the right attitude, unavoidable suffering is transmitted into a heroic and victorious achievement. That is why one's life does not lack a meaning until the last breath, until one's death. Even through death life does not lose its meaning; for this meaning does not consist in preserving anything for the future (which is impossible), but rather storing it in the past. Therein it is stored forever.3-rr. 83-84 
Man can fight vainly but heroically~ and die heroically but not vainly. c r 107 
The Strengthening Power of Suffering 
This pervading sense of the existential imperative, similar to Job's trust in God ("My Redeemer Liveth"), displays the eternity of meaning. A person will die, but their actions always li,e on, stored in time. As Hemingway says of human beings in 771e Ole/ Man and the Sea. we "can be destroyed but not defeated." No circumstances, or tortures of the figure of Satan, can deprive a person of the search for meaning. Even one's own death cannot erase the fact that one had lived life to the fullest possible measure. In fact, as the pressure in 
life is increased, the energy used in extracting purpose increases proportionately. The right kind of suffering -facing your fate without flinching -is the highest achievement granted to man. "2-p. ,ii, As long as suffering doesn't destroy us, we are able to build up our life again stronger and wiser than before, because we realize that we are not as vulnerable as before. Everyone has the capacity, and therefore the commitment, to learn from experience. 
In suffering from a misfortune, we move inwardly away from it, we establish 
a distance between our personality and this misfortune. 2-r 107 
As Job\ agony and loneliness increase, he comes closer to God. even if he has to drag Him into court. Job is not concerned with the figure of Satan: He wants and expects God Himself to answer for his lamentations. As an innocent sufferer, a person is cleansed ipso facto. In Judaism, innocent martyrs, especially the children, are said to have died Al kiddush ha-Shem; i.e., for the "Sanctification of God's Name," and worthy ofthe highest place in heaven. Job, as are all sufferers, is brought closer to God by His mercy. Existentially, one in agony is able to see the full range of human achievement and despair. "Suffering," writes Frankl, "establishes a fruitful. almost revolutionary tension in that it makes for emotional awareness of what ought not to he. "2• r 108 
Job, as the conventional believer in the book's first two chapters, is unaware of any alternative existences. He takes for granted the unconditional mercy of God and has trust that his righteousness will bring furthr:r blessings from heaven. In turmoil, Job finally realizes the existence of evil and suffering in the world. As seen in logotherapy, "Suffering is intended to guard man from apathy, from psychic rigor mortis. As long as we suffer we r::main psychically 
alive. "2. p. 10s Suffering makes us sensitive and perceptive to the surrounding world. The existence of agony challenges us to find meaning in it, if only in the attitude we take to the suffering. Job, after his ordeal, has a stronger and more valid trust in God than ever before. And it is certainly more concrete than that of the three friends, who are content merely to voice their established religious platitudes. 
Logotherapy recognizes the meaning of suffering and installs it in a place of honor in life. Suffering and trouble belong to life as much as fate and death. None of these can be subtracted from life without destroying its meaning. Only under the hammerblows of fate, in the white heat of suffering, does life gain shape and form.2, r 111 
The destiny a person suffers therefore has a two-fold meaning: to be shaped 
where possible, and to be endured where necessary.2• p. 111 
As opposed to Freudianism, which has as its goal the elimination, or at least the alleviation, of all psychological and spiritual tensions and stresses, Frankl's Existenzana(J'se accepts and welcomes the pressures of life. Peace of mind, in logotherapy, will come when we have successfully reconciled ourselves to the unfortunate, as well as happy, experiences in life. 
"Death and suffering belong to the human condition. The more one tries to deny them, the more one gets tangled up in them."3. p. 88 Job's torment is only ended after the Whirlwind convinces him that he can't know everything, learn everything, and do everything, therefore he must accept his fate. Although ostensibly submission, the acceptance transforms Job's action into transcendence. And acceptance is the first step in realizing existential meaning in a situation. By heeding the Voice in the Whirlwind in the midst of his despair, Job is redeemed through an increase in the consciousness of his role in the ultimate drama. 
"There are," writes Frankl, "no tragic or negative aspects which can not, by the stand one takes on them, be transmuted into positive accomplishments. "4. r. 73 
Buber felt all actions and relationships could be sanctified if only the person desired it. Frankl suggested the same idea in logotherapy, in terms of finding meaning in these actions and relationships. Job was incapable ofending Satan's 
tortures, but he had the ability, and hence the obligation, to summon God to his defense. It is, all at once, a plea for help as well as an accusation. Likewise, all people are able to realize the existential imperative under all conditions. Tragically, not all do so, for they are afraid ofthe responsibility required in acting and the irrevocability of all action. 
The most poignant question for the Auschwitz prisoner wasn't just that of survival.3-r 103 Rather the question is: 
Is this life meaningful --in which case its meaning does not depend on its duration --or else it is meaningless, in which case it would be pointless to prolong it.4-r 76 
In the third century A.O. Rabbi Yannai said: "It is not in our power to explain why the wicked are secure, or why the righteous suffer" (Sayings ofthe Fathers, IV:19). Frankl, like all people before and since Yannai, will not give a facile solution to the eternal problem of undeserved suffering. But in this state of apparent hopelessness and despair, "Religion provides man with a spiritual anchor, with a feeling of security such as he can find nowhere else. "4-p. 144 
Frankl's writings have given inspiration to countless readers. Logotherapy and existential analysis are not merely examples of one person's courage and personality, but challenges to make one's own life as meaningful as possible. No other modern philosopher has so vividly described what has here been referred to as the "existential imperative." Like Job, the logotherapeutic patients are educated to realize that their problem may not be answered, and perhaps, need not be answered. Frankl and Job teach the patient and student respectively to have unconditional trust in a very conditional life. 
A LAN J. ATLAS is a doctoral candidate in the School ofEducation, Boston University. 
REFERENCES 
I. Frankl. V. D. :'\fan's search.for meanin[<: An inrroduction to logotherapr New Ynrk: Washington Square Press. 1962. 
2. 
___ The doc/or and the soul: From psl'chot/l('rap\' 10 logo1her11pr 'Jew York: Allred A Knopf Inc., 1965. 

3. 
___ P1rch01herap_1· andexistenrialism: Selected{'aperson log01hera1>r. :\cw York: Snnon & Schuster. 1967. 

4. 
___ The 1\'i/110 meaning: Foundations and ap/>licmions o(logmhern1>\'. Ne\\ York: World Publishing Company. 1969. 


Odysseus: His Myth and Meaning for Logotherapy 
Ruth Hablas 
Logotherapy is a relatively new member of the contemporary therapeutic community, yet its basic tenets2 are reflected in classical mythology. Ancient Greek stories of gods: heroes and mortals of lesser character arc replete with instances of an individual's relentless search for the meaning of life in specific events and situations. Responsibility appears as an important measure of the difference between hero and ordinary citizen as they pursue their goals through actions and relationships. Human faith in and submission to the will of the gods allows for the unfolding of meaning beyond the ken of mortals. In being challenged to transcend the limits of their understanding these individuals respond with varying degrees of enthusiasm. 
Myths portray human experience which is transformed through openness to higher meanings. As penetrative studies focused on the meaning of human existence, these myths throw light through the ages reaching our contemporary era and illuminating our efforts at self-understanding. For these reasons, myths have relevance for logotherapy in its ongoing efforts to clarify the foundational issues of human life. They can play a supplemental role in the work of logotherapists in this era of frustration and despair, deepening the sense of solidarity between client and therapist as they join forces in the search for meaning. 
Homer's Odyssey1 expresses both implicitly and explicitly many principles stressed by logotherapy in its recommendations for the contemporary world. This is the tale of Odysseus, a leader of the Greek army which has just been victorious in its siege of Troy, and the success of life-threatening disasters he experienced in his attempt to bring himself and his men home. If he were depicted only as a conquering soldier, it might be difficult to demonstrate a meaningful relationship between him and the mass of contemporary humanity, particularly those suffering from noogenic neurosis or existential frustration. However, Odysseus is also a wayfarer, suppliant, husband, father, friend, and confidant, and thus far more than military in his meaning for our generation. 
It is particularly his role as a wanderer, homesick and vulnerable to the unexpected, dependent and yet responsible for his men, that makes his story meaningful for persons experiencing the shock of being uprooted. Such individuals are out of touch with values and convictions which had previously provided security, or are exposed to sometimes shocking or bewildering situations which demand decision as the price of survival. 1 n his suffering, this hero speaks to all whose plans for life have gone awry. 
In spite of his vulnerability, Odysseus is not a person one would expect to appear in a therapist's office. A hero is universally acclaimed to be successful in achieving life meaning beyond the ordinary. A hero is, however, still mortal. Precisely because he successfully negotiates great and precarious enterprises in a manner marked by mortal limitations, Odyssrns embodies those characteristics an effective therapist will have in mind when dealing with clients. The mythic hero, in particular, obliges us to ponder human events imbued with divine or higher meaning and questions the foundations of our values and goals as we contend with the exigencies of our personal odyssey. A mythic hero speaks to both therapist and client, serving as exemplar and critic of contemporary human endeavors. 
This paper will not give an exhaustive analysis of each phase of Odysseus' journey home. I simply wish to suggest possibilities for further reflection. For this purpose, l will focus primarily on only two of his many adventures: his dread trip to the land of Hades, and his terrifying sail through the straits separating Scylla and Charybdis. 
It should be kept in mind that every stage of the voyage was perceived by Odysseus as decreed by the gods. Given his own choice, he would have sailed directly to his home in Ithaca. As his plans went awry, it became clear to him that he was caught up in events with meanings beyond his own. Openness to such more-than-mortal meanings and the flexibility to incorporate them into the situation at hand are dominant characteristics of mythic heroes and key factors in the ultimate success of their enterprises. They are, thercfore, crucial to the ultimate meaning myths hear for our era. Whether one chooses to acknowledge a specifically divine intervention or simply bow to an unnamed meaning beyond one's own, myths serve warning that life inevitably contains some confrontations which force one beyond the ordinary limits of personal intention. 
The Trip to Hades 
The Odyssey is a variegated journey, highlighted hy critical events and situations. From the goddess Circe, Odysseus learned that his adventures must include seeking enlightenment from the blind prophet Teiresius in the land of the dead. The conquering hero of Troy was so dismayed at receiving this mandate that he wept "and would gladly have lived no longer to see the light of the sun.''1· r 129 No other part of his journey was perceived by Odysseus to be so disastrous as this descent into the dark realm of Hades. Death itself seemed better to him than facing the dead while yet alive. He and his confreres were well aware that although the gates of Hades yielded easy access, no living person ever returned through them. 
This episode serves as a lesson for us that life should be illumined by death. that light should he found in darkness. The seer Teiresius is blind. His guidance comes only through an experience of death. Odysseus' distress was not at the prospect of being counseled by someone eise. He was, quite simply. terrified to approach death at such close quarters. According to the plan of the gods. however, it was essential to the success of his enterpri~e that he experience the darkness of Hades: in this realm the prophet Teiresius alone possesses understanding, "but the other ghosts 11it about aimlessly."1.11 129 
Because no one can imrrove uron Frankl\" de~crirtion of what it is like for the living to sustain a dialogue with death. I shall make no attemrt to meditate uron that theme here. Such unique and profound suffering as prelude to extraordinary success in human enterrrises is a theme of ancient mythology. Odysseus preferred death to the task of facing death without dying. suggesting that suffering of the spirit is more rrofound and terrifying than that ofthe flesh. Yet precisely that agony of spirit is essential to the molding of a hero and prelude to the successful realization of a major human endeavor. 
Odysseus was a man who embodied his values in action. He was also a man whose attitude toward life was flexible enough to discover in a deathly experience an essential source of renewal. Mortals had no authority in Hades. Passing through a situation where all his native subtlety and ingenuity were useless. Odysseus emerged with strength and certainty regarding the rest of his voyage. Circe herself greeted him on his return with a revealing exclamation: "'You have done a bold thing in going down alive to the house of Hades, and you will have died twice, to other people's once. "1. P-148 
Odysseus is not alone as an exemplar ofspiritual dying issuing in renewed life. The name of Jonah has stood for centuries as a representative of one who died without dying. Listen to his cry: 
Out of my distress I cried to Yahweh 
and he answered me 
from the belly of Sheol I cried 
and you have heard my voice. 
You cast me into the abyss, into the heart of the sea, 
and the flood surrounded me. 
All your waves, your billows, 
washed over me. 
And I said: I am cast out 
from your sight. 
How shall I ever look again 
on your holy Temple? 
The waters surrounded me right to my throat, 
the abyss was all around me. 
The seaweed was wrapped round my head 
at the roots of the mountains. 
I went down to the countries underneath the earth, 
to the peoples of the past. (Jonah, 2:3-7)3 
A fellow prophet, Jeremiah. lamented: 
I am the man familiar with misery 
under the rod of his anger: 
I am the one he has driven and forced to walk 
in darkness, and without any light. 
Against me alone he turns his hand. 
again and again all day long. 
He has wasted my flesh and skin away, 
has broken my bones. 
He has made a yoke for me. 
has encircled my head with weariness. 
He has forced me to dwell in darkness 
with the dead of long ago, (l.amentations, 3: 1-6)3 
Such suffering is more than simply a prelude to future success. Surviving so devastating an experience of mortality represents a fully human response that is an accomplishment in itself. 
Yet we must recall that Odysseus'time in Hades was not all pain and anguish. It also offered insight. Our hero was eventually greeted hy the ghost of his comrade Achilles. In once again confronting the greatest hero of the Argives. Odysseus wasted no time in reminding him that "no one was ever yet so fortunate as you have been, nor ever will be, for you were adored by all us Argives as long as you were alive, and now that you are here you are a great prince among the dead. "J. P· 142 Achilles, however, would have none of it. "Say not a word ... in death's favor. 1would rather he a paid servant in a poor man's house and be above ground than king of kings among the dead. "I. r 14:> The hero whose insistence on his dignity while alive almost lost the Trojan war for his army, manifested quite another perspective in the house of Hades. The value of life. he had learned, transcends the varying events and situations that comprise it. To live is the essential thing, whether as prince or pauper. To he king of aimless, unsubstantial ghosts is nothing. Only on losing everything in death did Achilles learn that meaning can he found in any situation on earth. The lesson surely was not lost on Odysseus, for light is perceived most clearly in darkness. 
Odysseus learned much more than the details of his voyage during his visit to Hades, and this emphasis on education is not incidental to the story. At every major turning point there is someone, divine or mortal. who unfolds for the hero the next stage of his journey, or interprets for him the hidden meaning of what has already occurred. The hero·s destiny may overshadow him from birth. but it is realized in genuinely human fashion. There is a slow, plodding progression as each phase of this journey unfolds. Odysseus never has the benefit of a total overview, for that is a prerogative of the gods. Mortals view events from limited perspectives and thus are always in need ofsupplementary information. The Odyssey is a journey but it is also an education as the hero is led heyond the limits of his own understanding. The visit to Hades is a critical point in this pedagogical journey of Odysseus. 
Scylla and Charybdis 
Crucial as this experience in Hades was, an encounter with death of another kind awaited our hero. The education of this man was as yet incomplete and Circe, again, served as mentor. She pointed out to him that he must sail the straits between Scylla and Charybdis and could not do so without the loss of either all or some of his men. Odysseus· sense of responsibility for his men prompted him to object that surely there must be some other way ofcompleting his voyage. There was no human reason for participating in a situation which guaranteed such grave loss to thme under his care. Circe retoned. "You daredevil ... you are always wanting to fight somebody or something; you will not let yourself be beaten even by the immortals."1. P-150 Beaten he must he. however. as the journey proved. 
However. Odysseus would not allow his men to be harmed without at least an attempt at intervention. Against Circe's instructions. he put on his armor and ~tationed himself on the ship's bow. While he and his men stared in terror at the sucking pool of Charybdis. not far from one side ofthe ship. the monster Scylla swooped down from the other side: 
While we were taken up with this, and were expecting each moment to be our 
last, Scylla pounced down suddenly upon us and snatched up my six best 
men. I ,...-as looking at once after both ship and men. and in a moment I saw 
their hands and feet ever so high a hove me, struggling in the air as Scylla was 
carrying them off, ,~nd I heard them call out my name in one last despairing 
cry.1. r 153 
Helpless and hopeless in regard to these men, Odysseus could only muse in awe on the overriding power of the gods. His will to safeguard the lives of his men was thwarted by a more powerful will whose disastrous manifestations he accepted without comprehending. Although he had done what he could to fulfill his obligations to all his men, he nonetheless had been faced with a choice implying loss in both alternatives for action. 
One could see in this incident simply a black commentary on the futility of freedom in human responsibility. There is more. however, for those who find themselves afloat on those forbidding straits and implicitly challenged to successfully negotiate them. Physical disability compounded by economic or marital stress, business advantage compromised by ethical convictions, peer pressure confronting personal integrity -~ these are some of the ways we face potential loss regardless of what decision we make. Yet every decision, no matter how insignificant, implies loss. What we choose is always countered by what we let go. Every decision cuts us offfrom something or someone. Loss is a fundamental p~rt of every free decision. We sail the straits between Scylla and Charybdis even in ordinary endeavors. But in crucial moments, when the stakes are particularly high, we experience more profoundly the terror of expectation and the agony of loss. At such moments we become keenly aware ofthe burden of human responsibility, a burden we shoulder lightly during the less crucial portions of our Odyssey. Freedom is not negated in such an experience, but rather is brought from the ideal to the real. 
It might be asked how Odysseus would have responded if his wife, who served as the guiding motive of his journey home, should have proven unfaithful. Agamemnon, after all, returned home safely from the Trojan war only to be murdered through the conniving of his wife and her lover. We may answer this question on the basis of the evidence presented by Odysseus himself. We have seen him at all times sufficiently flexible to make the most ofan unexpected turn ofevents, even though it might entail great personal suffering and loss. His faith in the overarching meanings of the gods is essential for understanding him. Strong willed as he was, he submitted to actual conditions and incorporated the unexpected into his plans. Reading the myth carefully, we see that each devastation and detainment served as a stepping stone toward the ultimate completion of his enterprise because Odysseus was always clear as to his priorities. It can he assumed, then, that the hero would deal with marital betrayal as he would with any other disaster which befell him. 
Although Odysseus' voyage centered on one goal, there is nothing to suggest that this goal subsumed the whole of his possibilities for life. Surely the sad specter of Achilles served as a haunting reminder of the relativity of earthly status compared to the gift of life itself. The education of this man included a questioning of his values and priorities at their most fundamental level. 
The Link to Logotherapeutic Principles 
This has been a brief glance at two of Odysseus' many adventures during his return from Troy. This myth provides ample opportunity for reflecting on the major principles of logotherapy. The writers of classical mythology have bequeathed to us the fruit of their efforts to come to terms with the complexity of human existence. The more genuinely human an approach to therapy claims to be, the more its major tenets will be found rooted in previous generations. Surely those principles will flow from the human community as a whole, rather than belonging to one unique system of human thought. 
Myths are stories for everyone. Not all of us have a Troy to conquer, but most of us know the loneliness and frustration inherent in a journey from one goal to another. Who knows how many of us refuse to embark on such an undertaking precisely because ofthe possible terrors involved? Odysseus stands out through the centuries as a human being seeking to fulfill a goal, sensitive to the responsibilities in each specific moment, submissive to higher meanings and open to suffering which defied justification on human terms. He appears as a person whose reputation for heroism was purchased at a great, but genuinely human, price. It may be that through such literature persons suffering from loss of meaning and courage in life may be inspired to and gifted with renewed enthusiasm for realizing the potential oftheir existence. Ifthis is so, then myths have meaning for logotherapy. 
RUTH HABLAS, Ph.D., is a clinical psychologist in Warwick, R.J. 
REFERENCES 
I. Butler, S. (Trans.) The Odyssey by Homer. New York, Walter J. Black, Inc., 1944. 
2. Frankl, V. E. Mans Searchfor Meaning: An Introduction to Logotheray. Boston, Beacon Press, 1968. 
3. The Jerusalem Bible. London, Darton, Longman & Todd, 1966. 
Logoanalysis for Alcoholics 
Robert R. Hutzell 
The previous issue of the Forum outlined the specific procedures ()f Logoanalysis applied to more than 200 inpmient alcohol-treatment patients. This article reports the results ofthis procedure. 
Crumbaugh and Carr4 assessed the effectiveness of Logoanalysis with patients receiving a Jellinek-type program on a Veterans Administration Alcohol Treatment Unit. Patients were selected who met basic Logoanalysis referral criteria, i.e., staff persons' clinical judgment that the patient experienced existential vacuum, had motivation to change the existential vacuum, was at least of normal intelligence, and was free of more than minimal cerebral damage. 1-.1 They compared Purpose-in-Life (Pl L) test scores obtained at the beginning and the conclusion of Logoanalysis for those patients randomly assigned to Logoanalysis groups and for those patients randomly assigned to not attend Logoanalysis groups. Patients with initial PIL scores less than 92.5 showed significantly greater increases in PIL scores when they had attended closed-ended Logoanalysis groups than patients who had participated in the same treatment program without receiving Logoanalysis. Thus, the data from Crumbaugh and Carr4 suggest that the addition of Logoanalysis to alcohol treatment can result in an increase in the patients' sense of meaning/ purpose/ direction in life. 
This paper presents two types of studies. Both are designed to extend the results of Crumbaugh and Carr,4 using Logoanalysis as outlined in a previous article.6 The first study uses test results other than the PIL so the subjects would not be sensitized to the purpose of the test materials. The second study assesses behaviors beyond the test scores --behavior changes that staff persons collected after completion of an alcohol-treatment program similar to that of Crumbaugh (i.e., Jellinek-type approach, disease-model conceptualization of alcoholism, Alcoholics Anonymous emphasis). 
Study I 
Study I was designed to assess the overall sense of life meaning/purpose/ direction of patients who had completed the Alcohol Dependency Treatment Program (ADTP) including the Logoanalysis group as compared to patients who had completed ADTP but had not participated in the Logoanalysis group. The study used data from a large battery of tests given for clinical purposes unrelated to the Logoanalysis group. It is highly unlikely that the subjects associated the test questions with having attended or not attended the Logoanalysis group. 
Suhiects. Included were individuals who had just completed the six-week ADTP and had been accepted into a ten-week Extended Assessment and Rehabilitation Program (EARP). EARP was a ten-bed clinical and vocational rehabilitation program for selected graduates of the 51-bcd ADTP. Usually the participants had demonstrated poor vocational histories and had few job prospects before entering the program. EARP used a patient-participatory multidisciplinary team approach and was a residential logotherapy program with particular emphasis upon quality sobriety and vocational/ behavioral effectiveness. Most persons starting in this ten-week program were acutely aware of the vocational training aspects of the program but, when entering the program, were not well aware of its logotherapy philosophy. Within the first nine months of the EARP program, 30 patients met the following criteria: 
(I) they had participated in seven to ten Logoanalysis sessions while on ADTP (Logoanalysis group); OR had not participated in Logoanalys1s while on ADTP (control group), and (2) within the first week of entering EARP had completed a battery of psychological tests (footnote I). 
Procedure. Because those patients who had participated in the Logoanalysis group also had responded to both the PIL and the LPQ, and might have been sensitized to these two tests, we used data from an early version of the Existential Depression (ExD) Subscale ofthe MMPI, 7 whose relation to Logoanalysis had not been discussed with the patients. The ExD was developed as a screening device with wide applicability because a majority of patients entering our medical center receive the MM Pl as a part of their initial evaluation. Previous assessments of the correlation between the ExD and the PIL with different alcoholic patients had yielded the following: r =.661 (N = 32 alcoholic patients, mean age = 40.1, PIL administered within 24 hours after ExD). 
ExD scores were extracted from the MMPI data of subjects who met the criteria described above. The scores of the two groups were compared using a nonparametric statistical test. the Mann Whitney U Test. 
Results and Conclusions. The ages of the two groups did not differ significantly (footnote 2). The results of the U Test suggested that scores of the Logoanalysis group were significantly higher than the scores of the control group (footnote 3). The differences between the two groups were more obvious when modal scores were observed than when means or medians were observed -Logoanalysis group modal score was 13 while the control group modal score was 8. 
The results suggested that individuals who had completed Logoanalysis scored higher on feelings oflife meaning/ purpose than did persons who had not completed Logoanalysis. These differences existed in ,pite of matching the subjects on their appropriateness for inclusion in a residential logotherapy program and in spite of test materials to which they could not have been sensitized previously (footnote 4). 
Our study used psychometric test data as did the Crurnbaugh investigations, and expanded his results because we used test results to which the subjects could not have been sensiti1cd through previous testings and discussions. 
Stud) II 
The true value of Logoanalysis training within an alcohol treatment program will be seen if Logoanalysis produces changes in the participants' behaviors associated with alcohol abuse, rather than changes in test scores associated with feelings of meaning/ purpose in life. Such is the purpose of the second study. 
Follow-up data for most alcohol treatment programs are difficult to obtain and inconsistently available. Our alcohol treatment program using Logoanalysis is no exception. Still. several sources of information dealing with behavior changes showing the effectiveness of alcohol treatment are available. Follow-up lJUestionnaires were distributed by the Alcohol Treatment Unit Outpatient Team. by the unit Coordinator, and by Counseling Psychology Service. These were completed by the patient or by other individuals overseeing the follow-up treatment of the patient. For purposes of our study, the data collected as follow-up to the alcohol treatment program were utilized. Because of the relatively small amounts of data available from any one source, the data were pooled and weighted as described below. 
Suhjects. Included were three groups of persons who completed the alcohol treatment program within a five-month period. The first group (Logoanalysis Group) consisted of 23 individuals selected from those who might benefit from Logoanalysis and who completed the analysis missing two or fewer sessions. The second group (Control Group I) consisted of 23 individuals who also were assigned to Logoanalysis group but attended two or fewer sessions. The third group (Control Group II) consisted of 23 individuals who had not participated in Logoanalysis. Patients in this third group were individually matched with persons in the Logoanalysis Group on the following criteria: ( I) type ofdestination at discharge, (2) age, (3) date of discharge. 
Procedure. Data were collected from all available sources and the results were scored as _either positive or negative points. From a follow-up questionnaire which was distributed to the patients just before discharge and returned a few days to several weeks after discharge, each patient received I point if the questionnaire was returned,± I point for indicating attendance/ nonattendance of Alcoholics Anonymous meetings,± I point for indicating consumption/nonconsumption ofalcoholic beverages after discharge, and± 1 point for indicating employment/unemployment. For persons discharged to half-way houses, a questionnaire was sent to the half-way house administrators shortly after the patient's discharge, and the patients were given± 1point depending on whether or not they had been attending scheduled aftercare appointments. A counseling psychology questionnaire was mailed to selected patients one month after discharge; the patients were assigned I point if they returned the questionnaire, ± I one point if they indicated they were/weren't employed ( or in school). and ± I point depending upon the patient's indications of compliance/noncompliance with aftercare plans. Finally, some additional information sources were available, such as telephone calls to the patient (or significant others) or telephone calls from the patient ( or significant others). and this information was scored as+ I point if it suggested that the patient was complying with aftercare 
and was not drinking alcohol, or I point if aftercare plans were being ignored 
or the individual was again abusing alcohol. 
Higher total scores indicate behavior changes that most alcohol treatment counselors would regard as positive signs of change toward an alcoholindependent life. Lower scores, conversely, indicate fewer changes necessary for an alcohol-independent life. If the Logoanalysis treatment had a positive effect upon these behaviors of the patients, then the total scores of the I.ogoanalysis Group should be greater than the total scores of either of the control groups. 
Results and Conclusions. The mean ages ofthe Logoanalysis Group, Control Group I, and Control Group II were 46.6, 45.3, and 44.2 years respectively (footnote 5). The range ofscores for the Logoanalysis Group was from -2 to +6 with a median total score of+ l. The range ofscores for Control Group I was 4 to +4 with a median total score of I, and the range ofscores for Control Group II was from -2 to +4 with a median score of -1 (footnote 6). 
These results suggest that after discharge from the alcohol treatment program patients who participated in Logoanalysis were more likely than nonparticipants to display behavior change toward future quality sobriety. 
Discussion 
The results of Crumbaugh and Carr4 suggested greater changes in PIL test scores by Logoanalysis participants than by randomly selected nonparticipants. Our study suggests similar differences in changes in scores of tests not previously associated with Logoanalysis as well as similar changes in other life behaviors. Patients who participated in a Logoanalysis group were more likely to show behavior change toward future quality sobriety than those patients who did not participate in such a group. 
One disadvantage of our investigation was that the participants could not be randomly selected to participate or not participate in Logoanalysis. Thus it is possible that the results may be confounded by motivation or other relevant variables. Note though that patients often were referred to the group specifically because they appeared to lack motivation. In a number of cases, they were referred to the group because they had been through this and other alcohol treatment programs many times and thus were referred to Logoanalysis on a basis of"Let's give it a try, nothing else has seemed to work." A better controlled investigation would not use archival and largely self-report data as did our study but rather would preplan data gathering and would randomize to control for potentially relevant variables such as motivation. Such an investigation would be substantially more time consuming and expensive than was our study, but our positive results can serve as justification for conducting the more accurate but more expensive investigation. 
In spite of the confounding, our results suggest that those individuals who participated in Logoanalysis did demonstrate more of the hypothesi1ed appropriate behaviors following discharge than did those patients who did not participate in Logoanalysis, even though we cannot state at this point the exact contribution of Logoanalysis per se versus the exact contribution of other potentially relevant variables upon the outcome. Thus. Logoanalysis i~ pre
sented regularly on a VA alcohol treatment program with the following sugges
tion to the participants: 
"If you can determine what is really important to your life ---that sense of direction that really fits your values and not someone else's values ---then the next time that you have the opportunity to take a drink. you will say to yourselL '\:o. I am not going to let alcohol mess up what I am really after."' 
Logoanalysis has been used in groups with a wide variety of participants other than alcoholics. It has been found effective with geriatric. neuropsychiatric patients; though the presentations must be more concrete, the presentor must take more ofa leadership role. more sessions are required. and we have not been successful in getting most of the geriatric. neuropsychiatric patients to complete homework assignments outside of the actual group meetings. Hospital staff members. psychology graduate student classes. and other groups with generally higher intellectual functioning have also participated in Logoanalysis following the same general outline. We have found that the level of interaction can be more sophisticated with these latter groups. and the amount of homework that is completed is typically greater. 
In all, our results support Crumbaugh's contention that Logoanalysis can be useful in changing the feelings of life meaning/purpose/direction of a wide variety of individuals. While typical Logotherapy success stories are anecdotal and uncontrolled scientifically, the present paper was written to demonstrate some of the first stages of a research program designed to validate the effectiveness of Logoanalysis in changing individuals' lives. 
ROBERT R. HUTZELL. Ph.D., is a senior level Clinical Psychulugist at the Veterans Administration Medical Center, Knoxville, IA 50138. The data presented in this article are/om clinical sources and research proiects supported in part by the Veterans Administration Western Research and Development Office, Livermore, CA. 
FOOTNOTES 
I. Patients entering EARP were routinely a,sessed with the following tests: Minnesota Multiphasic Personality Inventory (MMPI). Purpose-in-Lite (PIL) Te,t. Life Purpose Questionnaire (LPQ), Wechsler Adult Intelligence Scale-Form R (WAIS-R). Fundamental Interpersonal Relations Orientation-Behavior (FIRO-H), Shipley Institute of Living Scale. Army-Beta Examination, Edwards Personal Preference Scale. and Alcohol Lise Inventory. The tests were usually administered individually during several days at a rate determined hy the patient. 
2. 
Ages --Logoanalysis group: X = 33.4, SD= 9.5. N = 13: control group X =37.5. SD= 8.8. N = 17; I (28) = 1.22, p = .23. 

3. 
L' = 67.: = 1.84. p (I-tailed)< .05. 

4. 
:'\ote that this early version of the ExD consisted of 23 items emhedded in a 400 item trueI false test which was only a part ofa large hattcry of intelligence and personality tests administered for clinical assessment and feedback purposes. 

5. 
Standard De\iations were 13.7. I 1.0. and 13.5, respectively. 

6. 
A Kruskal-Wallis One-Way Analysis of Vanance indicated statistically significant differences among the groups. H (2) = 12.25. I'<. .01. Subsequent '\1ann-Whittncy C Tests demonstrated the Logoanalysis Group scores to be higher than those of the two Control Groups: /; = .145.5. p (I-tailed)< .05; (I= 343. 5, p (I-tailed)< .05. No significant difference was demonstrated hetw,:en the two control groups. U = 222.0. p = .33. 


REFERENCES 
I. Crumhaugh. J.C. "Change, in Frankl\ Fxi.stcntial Vacuum as a Measure of Therapeutic Outcome. .Vewsle11erfi,r Re.search in Psrchologr, 1972, 14, J5-J7. 
2. 
____ Everythin1s to Gain: A Guide to Self:Fulfi//111enr 7hmugh Logoanah11.1. Chicago !\elson-Hall, 1973. 

3. 
____ "Logotherapy: New Help for Prohlcm Drinkers." The !nterna1iu11al Furu111.f,,r Lugo1herapr, 1981. 4( I), 29-34. 


4. 
____ and G. L. Carr. "Treatment of Alcoholic, with Logothcrapv." The lnlemarional Journal of the Addictions, 1979, 14, 847-853. 

5. 
____ W. M. Wood, and W. C. Wood. Logotherap_1·: .Ve11· He/11 .f,1r Prohlem Drinkers. Chicago. Nebon-Ha!L 1980. Hut?ell. R. R. "Practical Steps in Logoanalysis." 1he International f,,rum.f,n rogotherarn, li(2). 74-83. 


7. ____and T J. Peterson. Development ofan MMPl Existen1ial Depre.1.,iun Srnle. In preparation. 
Finding Meaning Through Existential Guilt 
Philip J. Sternig 

A client came to me with the complaint that she was depressed and couldn't do anything with enthusiasm. She felt a gnawing restlessness and dissatisfaction with her life. She said she was happily married, enjoyed her children, and attended adequately to her work as a housekeeper, wife, and mother. Yet, she was dissatisfied and wanted to find out why her life seemed so empty and meaningless. 
As we worked together she discovered that she was experiencing the effects of a human phenomenon called existential guilt. What she began to realize was that she was falling short of her own personal potentials and was settling for being far less than she could be as a person. Before marrying, she had dreams of finishing college and of becoming a teacher of handicapped children. She also had hoped to develop her talent for painting. Then she fell in love, left college, married, and began to raise a family, abandoning her dreams and interests in the process. During the years her children were growing up she became caught up in being a "dutiful spouse," attending to "her responsibilities" as a homemaker and serving the needs of her family. At the time she came to see me she felt totally resigned to this task. 
Yet beneath her resignation something within her kept her unhappy with this "fate." As we worked together she began to recall her former interests and dreams and recognized that nothing in her present situation stood in the way of her attending to those interests and making those dreams become a reality. She realized that an exciting new life could be hers if she took charge and began to reorganize her present reality. Which she did -and her depression, restlessness, and dissatisfaction with life began to change into a new experience ofmeaningful life for her. She had experienced existential guilt and came through it to a fuller experience of life. 
Existential guilt is often confused with guilty feelings or actual guilt. But it has nothing to do with guilty feelings and is only remotely connected with actual guilt. To get a perspective ofexistential guilt it is important to see it in relation to actual guilt. 
Actual Guilt 
Actual guilt is a reality in its own right. It takes three forms -real, neurotic, and existential. Real guilt follows after we do something which we consider to be wrong. This type of guilt is a conscious phenomenon following real action. After committing a wrong action, a person can seek expiation and make restitution, thereby alleviating the guilt. Example: the guilt which can follow premeditated murder or theft. 
Neurotic guilt, on the other hand, can exist without committing any wrong actions. The very intention or desire to do something wrong is enough to cause neurotic guilt. Unlike real guilt, it has its roots deep in the unconscious mind. Also, unlike the person experiencing real guilt, the neurotically guilty person can't get rid of the guilt by the usual methods of atonement. Example: someone secretly wishes that an irritating relative would die. The relative suddenly dies of natural causes. Then, the person wishing the death starts experiencing guilt for having "killed" the relative and becomes obsessed with a sense of being guilty or "guilty-bad." 
Existential guilt is different from both real and neurotic guilt. So different, in fact, that it might be more accurate not to call it guilt. Existential or ontological guilt is not so much "guilt" as it is a suhliminal preoccupation -asort of inner nagging, an inner experience of discomfort, of dissatisfaction, of something being out-of-joint and demanding attention. It is a state of being-in-the-presentmoment-and-compelled-to-act on something. Namely, to act on our need to adequately relate to the world ofreality as it is expressed in three distinct ways: as the world of personal reality or self (Eigenwe/t); as the world of other persons (Mitwelt); as the world of nature as a whole, the cosmos (Umwelt). 3 
We have an ontological responsibility to relate as fully as possible to ourselves, others, and the cosmos. When we act on that responsibility, the result is a sense of well-being, composure, relative serenity, satisfaction, and fulfillment. When we refuse to act on it, we experience existential guilt, which nags at us until we choose to attend to our personal needs, the needs of others, and of the cosmos. 
Three Areas of Existential Guilt 
Existential guilt expresses itself in three areas. The first alerts us to actualize individual potentials. Ifwe refuse to accept responsibility for corporeal, intellectual, spiritual (noetic, fully human), emotional, or psychic needs, there will arise a sense of something being wrong -an experience of existential guilt. For instance, corporeally, we might deliberately be careless about good nutritional habits, or about getting adequate exercise or rest, refusing to recognize this as a lack of responsibility toward ourselves. Intellectually, we might consistently refuse to attend to the improvement of the rational mind. Or, noetically, we might refuse to provide adequate time for reflection or for the development of the creative mind, human sensitivity, or even the cultivation ofa sense of humor. In each of these personal or self-world areas, the existential guilt pushes us to do something about the refusal to be responsible by causing an experience of dissatisfaction with the status quo. 
The second area in which existential guilt ex presses itself relates to the world of others. We have a responsibility to understand one another, to relate positively to one another. To act on that responsibility, we need to put aside our short-sighted biases, our first impressions, our projections, harsh judgments, self-righteousness, disrespect, intolerance, and narrow-mindedness. If we refuse to be open to relating positively to other people, we will experience a deep dissatisfaction. That is existential guilt, prodding us on to do something about 
neglecting our gifts for creative social interaction. 
The third area of existential guilt arises when we refuse to relate to nature as a whole. refuse to relate respectfully to animals. plants. inanimate nature. and the cosmos in general. We possess an innate sense of how we need to relate to the natural world and how the cosmos needs us to relate to it. Yet. in so many ways. we refuse to pay attention to our responsibilities in this regard. As long as we refuse. we will experience the inner nagging of existential guilt. The more we refuse, the more persistently we'll experience the urge to be responsible. 
In any of these three areas. what happens when we obstinately refuse to respond to the urgings of the inner dynamic called existential guilt? If these inner promptings are ignored or repressed. neurotic guilt can develop. Also, a refusal to respond to these inner urgings can usher in depression in the form of existential frustration. with its sense of meaninglessness, floundering, and loss of interest in living. Such a refusal can also set the stage for cynicism, unrestrained anger, and hatred. It would be interesting to conduct research on the possible relationship between the refusal of people to respond to the constructive urgings ofexistential guilt and the high incidence ofsuicide and drug abuse, terrorism, child molesting, spouse beating, and ecological devastation. 
On the other hand, what happens when we do respond to the deep-seated "call" to accept responsibility toward self, others, and the world of nature? We experience purpose, an awareness of tasks to be done, of needs to be met. We begin to live from the center, loving selfand moving outward from selfto others and the world with concern and compassion. Existential guilt is a positive, dynamic element within each of us, the presence of which can provide a reason for living -if we are willing to embrace the responsibilities it invites us to recognize. Existential guilt pushes us to accept and to act upon our responsibilities. 
Viktor Frankl has said that it is a human prerogative to become guilty and it is a human responsibility to overcome guilt. 1 In the case ofreal and neurotic guilt his observatio·n is both astute and pertinent. But where existential guilt is concerned, we do not need to overcome it. Because, when it operates in us it is serving a positive purpose. However, we are responsible for learning to live with and to adopt a positive attitude toward the failures in us which give rise to existential guilt. 
Logothcrapy can help in this learning process. It teaches us to recognize that 
we are multi-dimensional, as Frankl has pointed out.2 In approaching the 
human person as an intellectual-emotional-spiritual-physical being, logother
apy recognizes the individual, social, and cosmoc responsibilities ofeach person 
and assists people in the task of acting upon those responsibilities. The logoth
erapist, in dealing with the effects of existential guilt (confusion. restlessness, 
feelings of emptiness, a sense of meaninglessness) helps clients sort out the 
demands life is making upon them within all the human dimensions and helps 
them rise to the challenge of those demands. 
Existential guilt points out our failures to us and makes it possible for us to 
decide what we'll do about those failures. When we are helped to acknowledge 
our failures to relate fully to ourselves, to others, and to nature as a whole we 
learn to creatively utilize existential guilt. Then. when we act upon the acknowledgement of our failures and embrace our responsibilities toward ourselves, others, and nature, we grow through the experience ofexistential guilt to a fuller experience of being human. 
REFERENCES 
I. Frankl. Viktor E. 1he Unheard Crrfor Meaninf?. New York, Simon and Schuster. 1978, pg. 51. 
2. 
___ 1he Will to Meanin[?. New York. New American Library, 1970. pp. 22-28. 

3. 
May, Rollo. Existence. New York. Simon and Schuster, 1958, pp. 52-55. 


PHILIPJ. STERNIG, M.A., isacertijied/ogotherapistanda Ph.D. candidate in transpersonal psychology. 
A Progress Report on Three Patients 
Guido Korfgen 
In my pratice as a psychotherapist, I often incorporate logotherapy in my treatments. I shall present three such cases. 
A Case of Inner ConAict 
The first case, a 29-year-old woman, married, without children, stated as her main problem that she believed she was unable to do any work. She had been employed in some shops and factories, but always left her work after a short time, feeling weak and weary, although she was physically in good health. When her husband returned home in the evening, his wife had not attended to her domestic duties and the husband had to cook and wash the dishes. Several medical treatments, some of which had taken place in hospitals, had been broken off without any success. 
In her childhood she had been spoiled by her father and had learned to live without any duties and responsibilities. No work, no duties, no responsibilities; only amenities and convenience were the "guidelines" of her life. She defended these by a great resistance to therapy. She expressed repeated objections and doubts concerning my therapeutic endeavors. 
I fought fruitlessly against this wall of resistance until I differentiated her mind into two actresses: Katherine, which was her Christian name, and Katinka, a derivative name reflective of her infantile behavior. I explained to my patient the foll-owing: "In the house of your mind there are two inhabitants: In the upper flat is Katherine, the willing and reasonable person, and in the lower flat Katinka, who wants to remain a pampered child without any duties and to go on living her paradisical life." All her troubles resulted from the conflict between Katherine and Katinka in the one mind, while she, and especially her husband, suffered from the effects of this conflict. "Your task and aim as Katherine are," I explained, "to help Katinka to grow up into an adult person and to make peace between you both. You alone are responsible for Katinka and therefore also responsible for yourself. I can only show you the way and tell you what is to be done. The solution lies entirely in your hands. One day Katinka will be a great help and source of energy for you, because Katherine and Katinka are a unity and one person." 
Whenever my patient expressed her resistance and her objections, such as "the therapy is pointless, I have already had many treatments and been in a lot of clinics without any success; the best thing is to commit suicide," I replied in an energetic voice: "Stop! Who is speaking now, Katherine or Katinka?" My patient learned quickly to distinguish between the two activities in her mind. Subsequently Katherine had to answer Katinka and to disprove her opinion and objections. Besides that. Katherine had to describe to Katinka her behavior and her aspirations in detail. Sometimes the roles were reversed. so that my patient fir~t had to speak and operate as Katinka and then as Katherine. 
Whenever the patient entered my consulting room. I asked. "How about Katinka? What is she thinking today?" Then I addressed Katherine asking. "and what is your opinion and answer?"' By this method of self-distancing and confrontation I succeeded in breaking down her mental resistance and helped her accept reality. I was delighted when she phoned one day and declared "Katinka now wants to learn something and to do some work." Some weeks later she phoned again saying. "At last I want to be an adult person and no longer a little doll.·• I replied each time, "This is an important step forward. you must note it in your diary and underline it in green." 
I ask every patient to keep a diary: it is important that the positive events in it be noted and underlined in green for emphasis. 
Because my patient avoided disagreeable jobs as far as possible. I induced her to note daily the disagreeable and also the agreeable duties she encountered. together with the corresponding feelings. To eliminate the inactivity habit. she had to fulfill special and disagreeable tasks, beginning with easy ones, then gradually increasing the degree of difficulty. After some initial problems, she finally succeeded in doing so. Now we are trying to discover the meaning of her actions and her life. Meanwhile her husband reported that his wife had made some progress in pursuing her domestic duties. 
One day my patient told me that her left hand was mostly cold and the right one warm. Since mind and body are interdependent and consequently mental diseases can also be treated by the body, I explained to her the following: "Your right hand represents Katherine and the left one Katinka ..."In daily concentration exercises my patient had to feel the contact of the fingertips by placing them together. Later on, when she succeeded in doing so, she had to feel the fingertips melting into one another. I explained that this was an additional means of integrating Katherine and Katinka in a unity of getting rid of the pathological conflict. This represents our progress to the present day. 
Learning to Deal with Grief 
The second case is that of a 57-year-old widow who was still suffering great sadness after the death of her husband six years before. She had been happily married and coddled by her husband. She had been a good wife and had cared about her husband. The only meaningful aspects of her life had revolved around the love and care of her husband and two children. Thus she had a pyramidal orientation of values according to the designation of Stanislav Kratochvil 1 where one value is dominant. When the husband died. the children were grown and out of the house on their own. Thus my patient had lost the remaining source of meaning in her life. 
When she came to me, sad and grieving. I suggested that she go and visit old and sick persons living nearby in a very primitive home. and hring them flowers or some other gifts. In my experience compassion. serving others, is the hest method of self-tramcendence. In this way I was encouraging an effort toward self-distancing and self-transcendence by helping her to recognize that people exist whose situation was much more deplorable than her own. In addition, I suggested a contact with another widow who also had been happily married and who had overcome her grief. All these and other efforb had been in vain at the beginning. 
With Fritz Kunkel I believe that there are persons who crave a crown. either of gold or of thorns. in order to be admired or to be pitied. Otherwise they have no self-image at all. My patient was one of these people, and for this reason her basic mental attitude had to be altered before any progress could be made. That attitude consisted in endeavoring to be a certain kind of person, either admired or else pitied. Later she agreed that it was better that her husband had died before her, otherwise he would have been helpless and unhappy. She understood that she had mqde a meaningful sacrifice by now accepting the role of survivor. Gradually she learned to be a person who stopped seeking either admiration or pity, but had value simply as a human being. 
Eventually she acted on my suggestion to attend sick and old people as a means to new meaning in life. She also made new friends after having been lonely for so long. The treatment was difficult but when I saw her two weeks ago, she was content and no longer sad. 
Feelings of Inferiority, Fears, and Obsessions 
The third case concerns a timid and polite young man of 27 who had suffered from an inferiority complex, feelings of fear, and obsessions. Whenever something was demanded of him, he felt inhibited because of his fear of failure and ridicule. He experienced this fear for the first time at school when he had to perform a difficult class exercise while being observed by a strict teacher. Suddenly he did not know how to go on and he promptly felt a headache while perspiring heavily. The real origin of his trouble, however, was the influence of, and the strict discipline by his father, who was rigorous, unpredictable, and often unjust in. administering punishment. In our initial interview the young man told me that he always had lived in fear of his father. These negative impressions had been reinforced by his teacher. Because of his inferiority complex my patient avoided every gathering because he then felt unsure and ill. Of great importance were his thoughts, fantasies, and monologues, as the following examples demonstrate: 
While employed as a massage apprentice the patient had fantasies of being derided and criticized whenever he did or said anything. While studying for school he thought "I shall forget everything I have learned." In the school of nonmedical practitioners, while the teacher was dealing with shock, he was afraid of succumbing to shock. The consequence was nausea, vertigo, and perspiration. This last example demonstrates the significance of anticipatory anxiety. 
His main obsession was a fear ofdriving his car full speed while on a collision course. The diagnostic phase established three interconnected symptoms that needed to be treated: the fears. his feeling of inferiority, and the obsessive tendencies. As to his fears, the patient learned to use progressive relaxation, became fear and relaxation cannot co-exist. As mentioned before, his fear and insecurity were hased on negative thoughts and fantasies. For example, he imagined his teacher asking him a question to which he could not supply an answer. When this occurred again and again, it resulted in a vicious circle of anticipatory anxiety and fear. The goal of therapy was to substitute positive thoughts for the negative ones. 
Since the lack of self-awareness and self-confidence came from the humiliations and d'?privations imposed by the patient's father. I pointed out that, as the descendant of his father he himself personified the father, with all his powers and rights. These powers and rights were symholi7ed hy the handing over of a scepter. In the hypnotic conditions of autogenic training the patient was instructed to actively imagine the handing over of the scepter several times. Later on, when he was in difficulties, he recalled the scepter in his hand as a symbol that he was now able to rule his own life. This helped him overcome most of the difficulties with regard to feelings ofinferiority. Besides the use of guided imagery, paradoxical intention proved effective when I gave the patient the suggestion that he intentionally do something wrong and give incorrect answers, therehy risking the appearance of ridiculousness and earning a rebuke. After some resistance, he finally succeeded in doing this, and so gradually overcame his fears. Additionally he learned to put into practice self-assurance and self-reliance training according to the method of Andrew Salter. By degrees the young man acquired more self-awareness and self-confidence, and the fear finally disappeared. 
Freeing him from obsessions was the third therapeutic task. 
Similar to the case of Katherine, I instructed him to differentiate hetween himself and the voice of an imp inside him, asking him to drive his car into another car or to jump out of the window. He soon learned to disregard the imp, saying "I don't care about your ridiculous and stupid demands. I choose to do what makes sense to me." Eventually he was able to ignore all ohsessive demands. 
As a precautionary method, paradoxical intention was available in suggestion form: "l have already hit other cars so often, why should I not do it today as well!" 
At first I was afraid my young man would really do it, but thanks to Dr. Lukas, who encouraged me, the method worked. Finally, I was able to discharge the young man from my care without any disturbing symptoms. The control session, some months later, confirmed the results. 
Conclusions 
Logotherapy offers additional therapeutical possibilities. To overcome hyperreOection, which increases mental duress through self-ohservation and anticipatory fear, deretlection aims at eliminating symptoms by directing attention away from them. Ignoring a trouble is helpful but often difficult to achieve. Therefore, another ohject and focus of concentration must be found. Concentration on a symhol -a circle. or a scepter, as in the example of our third case -may be useful. Other possihilitics include concentration on a loved one, a hobby, a cause, or any ohject of significance for the patient. 
Another modification ofdereflection is the distancing from. and the devaluation oL organic troubles. When. for instance, someone is suffering from heart palpitations. they may tell the heart. "Do what you want, beat rapidly. beat slm\ly. beat regularly or irregularly, I don't care," and the heart disturbance will generally vanish. 
Besides using the resources cf the human spirit. the lngotherapist finds that concentration on the solar plexus or the heart is effective. It is all the more helpful when such focusing is combined with any of the repetitive autosuggestivc formulas. All these methods must be learned and practiced in advance by using the imagination in the hypnotic state of autogenic training. 
In "classic" psychotherapy the importance of will power is mostly neglected or even denied. Howe_vcr, it is our strength of mind which enables us to replace enjoyment and benefits with perseverance and renunciation. Only thus is the freedom of mind secured. 
The will represents a reservoir of mental energy. It is comparable to a battery which must be recharged from time to time. To recharge the power of the will many valuable exercises exist: Not taking medicine immediately for the slightest pain. stopping a meal just when it tastes good, fasting, giving up a pleasure. Such exercises may enable the patient to realize meanings and attain goals with new-found ease. The energy of will can then be applied toward a positive goal. Otherwise it may act chaotically, as an aggression. Directing will power into positive channels can help people, especially youngsters. find meaning in constructive activities and avoid destructive aggressions. 
Logotherapy can be helpful. But often people who see a meaning which is worth living, working, and suffering for. still are not able to actualize it because they lack the necessary motivation and will power. In such cases the goal must be attractive and approached step-by-step. 
In my practice, I have found that it is possible to combine logotherapy with many other methods, depending on the type of problem. Logotherapy may be a supplementary, but always is an important part of psychotherapy. 
GUIDO KORFGEN, M.D., is a practicing psychotherapist in Schwahisch Gmund, West Germany. 
REFERENCES 
I. Kratochvil. S. "K psychoterapii existencialni frustrate." Ceskoslovenska psychiatria. 57: 186. 1961. 
This is explained by the psychologist, and she dramatized the game to show the boy what he could do to stay awake if he felt sleepy, to walk, to play, to wash his face, and so on. 
This this suggestion is explained to his parents who find it funny but are willing to cooperate in the game, in an amused way, not really convinced about a successful outcome. 
They are asked to create a favorable environment for this experience but not to change their usual behavior pattern. That night, before Maurice and his parents go to bed, they get everything ready. They put pillows on his bed to make him comfortable, the child's toys and the things he may wish to have near him. A red light is left on in order not to disturb anybody else because it is made explicit to him that he must not wake up his parents to play with them. 
He enjoys all the arrangements very much, especially when he secs his bed filled with "the things for not falling asleep," as he calls them. 
When everything is ready and his parents are ready to leave, Maurice, before getting into bed tells his father: "Daddy, you know that I don't want Mr. Sleep to touch me, and each time when I feel sleepy I will wash my face." 
After the house is silent, Maurice starts to play and after fifteen minutes he is peacefully asleep, to the astonishment of all. 
The boy takes this as a game and next day he tells everybody that Mr. Sleep has been the winner that night but that he will go on with the game until it is his turn to be the winner of the game, and that he would then pass one night without sleeping. 
He tries to stay awake for two or three nights more, without success. 
His parents are astonished because of the accomplished change and comment that they have tried all the methods they could think of, but never thought of asking him not to fall asleep. 
The logical outcome of this is that things start to change --the boy's behavior with his companions and his achievements, too. 
In subsequent interviews with his parents some behavior patterns of the boy are discussed which show him as too dependent, and an orientation is given about how to help him grow up and be independent. 
After two months following treatment Maurice does not show any more sleeping difficulties. 
JOVITA RIVEROS de CARBONE is a licensed psychologist and a memherof the Grupo de Logoterapia de Mendoza (Argentina). 
Maurice and Mr. Sleep 
Jovita Riveros de Carbone 

Maurice, 7, attends the first psychological counseling session accompanied by both his parents. "The problem is that he can't sleep at night," explains his mother. "He gets so upset when we tell him that it is time for him to go to bed that it seems we are sending him to prison. He fears that moment, he is frightened that he won't be able to fall asleep." 
When the preparations for getting to bed begin he gets nervous, he comes and goes to avoid lying down, sometimes he weeps, or he asks to turn on the television, but when it is turned off he wakes up. "We have used different ways to help him fall asleep," says his father, "counting to one hundred, watching TV, taking him to his mother's bed; he seems overwhelmed, his eyes turn glassy, he shivers, he goes to the bathroom, he drinks water, he is restless. 
"It is not fear of the darkness or of being alone, but fear of not being able to fall asleep. He worries about being tired the next day in school. 
"As a consequence, he does not want to go to school, showing a great nervousness and tension. In spite of the fact that he is a child with a high intellectual coefficient, he has low grades at school, with ups and downs in his achievements, and problems relating to his friends." 
At the time of the consultation, this problem has existed for one and one-half months, affecting the shole family. After fifteen days of work applying psychodiagnosis techniques which show symptoms of an obsessive condition, a maturation age according to his chronological age, and after having achieved an optimal level of communication and effective contact, the decision is made to use the logotherapeutic technique of paradoxical intention. An effort is made to develop a game, with attention to all the details called for. 
At the next counseling appointment, the boy is led into the counseling room, and after allowing him to work freely with pencils, coloring box and plasticine, and while he talks a bout his favorite games and his toys Maurice is told: "Here is a new game, Maurice. Let's play it tonight instead of sleeping. What do you think of that?" 
"Well, let's play, as long as I can't sleep anyway." 
"The game consists of playing touch-last with Mr. Sleep. He will try to touch you, but you must not let him succeed. You have all night to do whatever you wish: you may leave the light on, take along to bed your toy cars, coloring box, paper to write, draw, paint, travel in your imagination wherever you want. The only thing you cannot do is to fall asleep because then Mr. Sleep will touch you and be the winner ofthe game. Remember, Maurice, that this is a game, and that Mr. Sleep will try to succeed in touching you by all means, but you must not let him." 
The International Forum for 
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