Volume 12, Number 1 Spring 1989 
CONTENTS 
World Congress VII: The Pursuit of Meaning Road to Self-Esteem. . . . . . . . . . . . . . . . . . . . . . . . . . 
2 Vera Lieban-Kalmar 
Meaningful Education . . . . . . . . . . . . . . . . . . . . . . . . 5 Elisabeth Lukas 
Logotherapy in Schools . . . . . . . . . . . . . . . . . . . . . . . . 1 2 Hans-Norbert Hoppe 
Logotherapeutic Approaches to Crisis Situations 
I. Intervention with Suicidals . . . . . . . . . . . . . . . . . . 1 7 
2. Work with the Grieving ...................... 2 0 Uwe Boschemeyer 
A Logotherapeutic Support Group for Mothers of Special Children . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3 Mary Harris Pegram 
Meaning and Intimacy .......................... 2 8 James D. Yoder 
Psychopathology and Life Purpose . . . . . . . . . . . . . 4 0 George B. Kish and David R. Moody 
Logotherapy in Behavioral Sex Counseling with the Developmentally Handicapped . . . . . . . . . . . . . . . 4 6 Dave Hingsburger 
The Existential Vacuum in Bergman's 'Scenes from a Marriage' . . . . . . . . . . . . . . . . . . . . . . . 5 7 Jim Lantz 
The Use of Meaning with the Elderly .. . ....... 5 9 Melvin A. Kimble and James W. Ellor 
Book Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 2 
VIKTOR FRANKL INSTITUTE OF LOGOTHERAPY P.O.Box 156 • Berkeley, CA 94704 • (415) 845-2522 

Caring: The Ethical Imperative of the Healing Arts and Sciences 
Hans W. Uffelmann 
A volume of the journal Daedalus bore the timely title, "American Health: Doing Better, Feeling Worse."2 This is indeed an accurate description of the status of American health care today. We have conquered diseases that threatened to wipe out entire civilizations through plague and pestilence, the current threat of AIDS notwithstanding. The list of accomplishments ranges from the discovery and application of effective methods of anesthesia and antibiotics to artificial hearts, in-vitro fertilization, and fetal transplants that hold the promise of arresting the natural disease process of Parkinson's and other fatal illnesses. The account is lengthy, impressive, and undeniable. It is an imposing testament to our cerebral and manipulative capacities, and those achievements are matched in the fields of physics, cybernetics, and nuclear technology. However, in the midst of this euphoria we must remember that only one decade is left to bring to fruition the work of others that would allow us to call this 20th century "The Age of Meaning." I am speaking particularly of the humanistic thinkers who are engaged in Man's Search for Meaning and in the incessant Pursuit of Meaning, upon whose thoughts many of us have built applications of logotherapy. Despite and because of our successes in science and technology we find ourselves increasingly in the grips of an "existential crisis" that needs urgent attention because it threatens to leave us technologically enriched while humanly empty. What meaning does a world offer which is composed of scientific and technological riches but void of those features which make us uniquely human? It certainly does not enable us to meet the challenges of the future, assuming that we survive those of the present. A world dominated by nihilism, pandeterminism, and many types of reductionism is a world without meaning because it lacks the necessary freedomresponsibility diad that adds values to a mere knowledge of facts. Such a world would be devoid of wisdom, the trademark of meaningful existence. The features of our existential crisis were described in Fabry's "Dilemmas of Today -Logotherapy Proposals."1 He points to a shift of world views from a vertical to a horizontal society in which our decisions are not given from above (kings, 
priests, teachers, parents) but must be made increasingly by our own conscience. He calls attention to the unsettling consequences of such traumatic readjustments and prescribes the three major axioms of Frankl's logotherapy -the universality of meaning, the centrality of "will to meaning," and the realization that meaning is disclosed by actualizing our capacity for freedom which is essentially tied to responsibility. 
Proceeding on the Socratic assumption that meaning is found within ourselves and taught by Socratic midwifery, the therapist-teacher, employing a "horizontalist educational approach,"2 becomes a facilitator rather than an authoritarian vessel and conduit of facts. This fundamental reorientation offers a meaning-disclosing resolution to the prevailing existential dilemmas. 
Lazar transposes Fabry's general analysis into the realm of health care. In Lazar's essay, "Logomedicine: A DoctorPatient Partnership,''3 he redirects medicine's fragmented and reductionist toward a more holistic logotherapeutic approach. 
I shall extend this general theme further and explore the relationship of caring and meaning in the context of health care. Following a phenomenological-existential approach. I shall briefly describe the status quo in the health sciences, focusing on the "caring" (or lack of it), then discuss medical ethics, its fundamental role in the human capacity to find meaning, and conclude with some practical implications of caring as the primary ethical imperative of medicine. 
The Status Quo 
The dehumanization of the medical arts and sciences is particularly disturbing because this is the area of maximal opportunities for complementing and integrating the arts (humanities) and the sciences, namely, in medical practice and research. One of our most outstanding medical educators and humanists calls "medicine the most humane of the sciences, it is also the most scientific of the humanities."5 
The list of contributory factors to the many uncaring practices in today's medicine could not even approach an exhaustive account in a "Future Shock" world already overtaken by the "Third Wave."6 
Such accounts must include the pressures and intrusions as well as opportunities provided by the Promethean gifts of modern medical technology and increasing medicalization of our lives. We seek a medical remedy for every irritation and, if we do not receive total satisfaction, we tum to litigation. Additional factors include our abusive life style despite warnings and occasional fads which give the appearance that people are becoming more mindful of the abuses of their bodies, minds, and spirit. Moreover, the virtues of moderation and good sense concerning life styles are subverted by a distorted understanding of the meaning of individual freedom which, for many Americans, flies in the face of assuming even partial responsibility for one's own well-being. 
Spiraling health-care costs dramatically intrude into the practice of medicine. They influence medical and ethical decision-making on all levels of health-care allocation. Our answer to the question whether health care is a right or a privilege, is clearly that it is a right for those able to pay and a privilege for those who can't. Private hospitals "dump" patients into public institutions; a "wallet biopsy" has become a standard admission criterion in most private institutions. "Social Darwinism" will become the norm unless current trends are radically reversed through a fundamental change in our philosophy of medicine. 
Changes in the philosophy of medicine are not unprecedented. From the Hyppocratic to the socio-economic philosophy of the past four centuries to the present "ecologicalholistic" philosophy of medicine is a step of about 2,500 years. The changes were necessitated by demands arising primarily from outside the profession. This may have to be the case again because present conditions cannot prevail and the establishment does not move rapidly enough to avert an impending catastrophe. Our current means of reform consist of education and consumerism (Naderism). Though effective in their own ways, the former is inherently slow, the latter is confrontational tending to prevent the best therapeutic relationship. 
Medical Ethics 
Nowhere is the existential cns1s in medicine more manifest than in doctor-patient relationships. Here the pressures become acute and counterproductive to the purposes of medicine. The medical ethicist, Robert Veatch,lists three models of the doctor-patient relationship:8 
•The 
traditional "priestly" model in which the physician is in total charge of the patients' care and makes all medical, including valuational, decisions for them. This model is often criticized for "playing God"--sometimes a justifiable critique but also frequently misplaced when society demands this role of the physician. 

•The 
engineering model in which the physician presents patients with the facts only and leaves it entirely to them to evaluate available treatments. 

•The 
contractual model which assumes that physicians and patients meet as equals and divide their unique responsibilities, fulfilling their respective roles. It is a utopian model because our health care system is designed to treat the acutely and chronically ill, and to claim that both parties meet on an equal basis is naive, to say the least. 


Clinical experience shows that it is not a matter of healthcare providers to commit themselves to one or the other model once and for all. Each model can be used in favor or against patient care. To use Fabry's terminology, the inherent tendencies for a vertical relationship is most obvious in the priestly model but may appear in the others as well. For example, a physician in the engineering model may present a patient with a factual overload that renders the patient unable to choose among the many alternatives. On the other hand, the patient may make unrealistic demands on the provider. The contractual model may be subject to legalistic interpretations by either party or -most likely in our climate of health care "corporationalization" by third-party providers -preempted unilaterally by a party outside the doctor-patient interaction. 
The objective of medical intervention may be misconceived and thereby dehumanized when the physician and patient suffer from misconceptions about the goals of the therapeutic relationship. For instance, both frequently see the "cure" as a proper objective of medicine. However, in Oliver Wendell Holmes' paraphrased words, " ... a good physician cures never, heals seldom, but cares always". This statement rings even more true today, considering the types of diseases currently plaguing humankind. 
Thus, lack of caring is a troublesome feature of the existential crisis in the healing arts and sciences.It is neither accidental nor as benign as some of our technocrats wish us to believe. They point out, with the help of statistical evidence, that we are now better off than ever before. They point to the extension of life span, the eradication of many diseases, and the benefits of modern medicine, including in-office surgery, noninvasive diagnostic and therapeutic tests instead of the more dangerous invasive procedures of the past. They point with pride to a selective and carefully chosen improved mortality and morbidity rate for certain diseases, including cancer. Why not accept the purported benefits of cure and healing over the laborious and time-consuming, often hopeless, efforts of caring? 
Of course, curing and healing are only two among an array of caring activities and it is possible that curing and healing may be effected without caring. For instance, an accidental or even erroneously administered medication may bring about an occasional cure, while many wounds heal without caring attention. The relationship between caring and other medical approaches can be seen in terms of necesary and sufficient conditions. Proper caring is the neded prerequisite for a humane approach to medical treatment and a meaningful doctor-patient relationship. Considered in this more fundamental sense, caring inserts the ethical quality into interpersonal ties. 
The reason for this central part of caring in medicine becomes obvious the moment one recognizes and accepts caring as a primary means of relating to the world. Some existentialist philosophers regard this uniquely human feature as the sole means by which we are a being-in-the-world.7,P-39 Thus, one can say that fundamentally the human being is not isolated from others, nor is it inextricably merged into others. It is the human being who isolates (or alienates), fuses, or unifies itself with or from others; it does this in terms of its various modes of care (or failing to care) which is also an action...The specific ways in which human beings act with one another is solicitude . which is also a mode of care ( or concern). The notion of solicitude encompasses various modalities since it is possible that one may 'care for another' in various ways. 7, p.50 
By caring we relate to others who can reciprocate in similar ways. Though we cannot but relate to others, it is not the caring itself that is important in medical ethics but the quality of caring because it entails the ethical import of our actions and our very being. It is never a question that we relate but how we relate in caring for others. 
Practical Implications 
Medical ethics is concerned with moral issues arising within the health-care arts and sciences, including medical practice and research. An ethical issue results from a conflict of principles presenting a "tragic choice." A real clinical problem in medical ethics forces a choice among several undesirable outcomes, and must do it so the humanity of the participants remains intact and, if possible, is enhanced. Among other secondary and tertiary effects, such a choice and its resolution must be meaningful.. One may talk about many conflicts that arise in medical situations, including confidentiality, truthtelling, refusal of treatment, allocation of scarce resources, and others. However, in my experience those conflicts can be reduced to three primary conflict situations of competing ethical p1inciples from which all others can be deduced. 
The first is the principle of autonomy, the patients' right for self-determination and the exercise of freedom of will, giving rise to the principles of truth-telling, privacy, refusal of treatment, informed consent, and similar values. Autonomy is most frequently challenged by such forms of paternalism or maternalism as lying to patients, restraining someone to treat patients without their informed consent, and many ways in which the patient's autonomy may be overridden. 
The second major principle of medical ethics is beneficence -doing only what is in the patients' best interest, proceeding according to the traditional principle of the physician's code of ethics, primum non nocere (first, do no harm). Also, the principles of surrogate decision-making are guided by the notion of beneficence (e.g., best interest, proxy decision-making, and the so-called "weakest party principle"). The most frequent challenges to the principle of b~neficence come from its contrary -malfeasance in the legal sense. 
The third major principle of medical ethics is justice, interpreted in the wider sense of "fairness" and not confined to legalistic connotation. The notion of distributive justice is derived from this principle--that everyone should share equally in the benefits of available resources. This is "life boat" ethics. Also, the duty not to discriminate follows from the ethical principle of justice as does the notion of an equitable prioritizing of available resources (e.g., for organ transplants). The ethics of justice is opposed by the many kinds of injustices and unfair health-care practices that permeate our health-care system and dehumanize it, rendering it meaningless. 
The fundamental element of caring provides the humanizing quality of ethical decision-making and applies all these principles to specific situations. 
The function of caring is all-pervasive, it provides meaning to our actions and interpersonal relations. It is the truly human factor in an otherwise existentially threatening atmosphere in which life and death are often not looked upon as integral parts of "being human" but as separate, adversaries engaged in a meaningless struggle for domination. 
Caring is the ethical imperative of medicine because it provides meaning even in the face of seemingly insurmountable odds that tend to reduce human relationships to mere biological, physical, psychological, or meaningless spiritual routines, engaged in by robots. 
Mayerhoff provides an excellent analysis of caring: "I experience the other as an extension of myself and also as independent and with the need to grow; I experience the other's development as bound up with my own sense of well-being; and I feel needed by it for that growing. I respond affirmatively and with devotion to the other's need, guided by the direction of its growth."4,P-6 He stresses the necessity of my being-there which implies devotion in a holistic sense rather than in the reductionist sense often found in medical care-giving. 
There is also a reciprocity in this relatedness: "I grow by becoming more self-determining by choosing my own values and ideals grounded in my own experience, instead of either simply conforming to the prevailing values or compulsively rejecting them."4,p.6 
The centrality of caring in the doctor-patient relationship reveals caring as the ethical imperative of medicine that underlies all other values to be actualized. This notion of caring represents a truly logotherapeutic worldview implied in Fabry' s "horizontal" axis of being, and is meaning-disclosing and meaning-giving. It reminds me of the definition of a friend as someone who leaves you with all your freedom intact, but who obliges you to be fully what you are. Thus, I try to teach my students the wisdom of the inscription on the entrance of the University of Missouri-Kansas City School of Medicine attributed to Elizabeth P. Peabody: "After you leave a patient's room the patient should feel better; otherwise, why visit? 
HANS W. UFFELMANN, Ph.D. is professor of Philosophy and Medicine, University ofMissouri-Kansas City. 
REFERENCES 
1. 
Fabry, J. "Dilemma of Today -Logotherapy Proposals," International Forum for Logotherapy 11(1), 1988. 

2. 
"Health Care in the United States," Daedelus, Winter 1977 

3. 
Lazar, E. "Logomedicine: A Doctor-Patient Partnership." International Forum for Logotherapy 11(1), 1988. 

4. 
Mayerhoff, M. On Caring. New York, Harper & Row. 1971. 

5. 
Pelcgrino, E.D. "Some Notes on the Flirtations of Minerva and Aesculapius, Medicine and Philosophy, Philadelphia, Society for Health and Human Values, 1974. 

6. 
Tomer, A. The Third Wave, New York, Morrow Publ., 1980. 

7. 
Uffelman, H. "Toward an Ontology of Social Relations," unpubl. dissertation. 

8. 
Veatch, R.M. "Models for Ethical Medicine in a Revolutionary Age," Cambridge, MA, HCR 2., 1972. 


Quotes from World Congress VII: 
"We are not only responsible fnr ourselves, but as part of the world we bear a global responsibility. This means we respond to the meaning of the moment--not merely in seeking self-actualization but in actualizing a future worthy of humans. We obey the demand of the situation, not to benefit ourselves, but for a good cause. We ourselves benefit in a humanly decent world in which good causes prevail. 
"To be ready and able to exercise this global responsibility calls for expansion of three sensitivities: the feeling for the Sacred, for the Necessary, and for Otherliness. The feeling for the Sacred teaches us reverence for life, the most effective protection against destrnction of the environment, one of our profoundest problems. The feeling for the Necessary teaches us self-limitation, an effective shield against uncontrolled population explosion, another challenging world problem. The feeling for Otherliness teaches us love for those close to us, as well as for those far from us. Love is the best protective shield against war and violence, a still unresolved world problem." 
Elisabeth Lukas, "From Self-Actualization to Global Responsibility." 
There always will be differences between East and West, {but] Takashima and Frankl, representing these two traditions, show that there can be agreement on what are the essentials in the dimensions of the self: a holistic view (mind, body, and spirit), recognizing the spirit as the key to meaning; a balance of purpose and awareness; thankfulness as well as reflection; and an affirmation of a life of meaning for the future as well as the present. 
William Blair Gould, "The Dimensions of the Self in Frankl and Takashima." 
The point on which Frankl and the other approaches seem to diverge concerns Frankl's postulate that the capacity for self-transcendence constitutes an essential aspect of human living and forms the basis for the effective use of the paradox in therapy. 
Robert F. Massey, "Therapeutic Paradox in Family Systems." 
Logotherapy As Homecoming 
James D. Yoder 
Our deepest and most universal longing is expressed by Ulysses in The Odyssey: "Nothing is harder for a man than restless longing." Our need for roots and "at homeness" is clarified by Frankl. He identifies the causes of uprootedness as loss of traditions, reification of the human being, idolization of nation states, and the mass pursuit of pleasure.5 
This article reviews the current state of homelessness and loss of meaning, and discusses the clinical applications of logotherapy that lead to a sense of foundation, the experience of meaning, and what might be described as "homecoming." It concludes with a case, demonstrating logotherapy counseling methods with a client experiencing symptoms of lostness. 
The Experience of Lostness 
Walter Lippman draws attention to the unmooring experienced by so many persons in our twentieth century: No mariner ever enters upon a more uncharted sea than does the average human being born in the twentieth century. Our ancestors thought they knew their way from birth to eternity; we are puzzled about the day after tomorrow.2,p.96 
Nietzsche prophesied the age of "mass man," of such spiritual and psychological unmooring experienced by the humans that it is as if the world were "unhooked from its sun." 
Who gave us the sponge to wipe away the entire horizon?What did we do when we unchained this earth from its sun? Whither is it moving now? Whither are we moving now?... Are we not plunging continually? Backward, sideward, forward, in all directions? Is there any up or down left? Are we not straying as through an infinite nothing?6,p.105 
Pascal in the seventeenth century wrote of this condition, the search for something steadfast: 
We sail on a vast expanse, ever uncertain, ever drifting, 
hurried from one to the other goal. If we think to attach 
ourselves firmly to any point, it totters and fails us, if we 
follow, it eludes our grasp and flies us, vanishing forever. 
Nothing stays for us. This is our natural condition... we 
burn with desire to find a steadfast place and an ultimate 
fixed basis whereon we may build a tower to reach the 
infinite. But our whole foundation breaks up, and earth 
opens to the abyss. l,p.345 
Simone Weil develops this theme in The Needfor Roots. 
We feel ourselves to be outsiders, uprooted, in exile here below. We are like Ulysses who had been carried away during his sleep by sailors and woke in a strange land, longing for Ithaca. In the same way every man who longs indefatigably for his country, who is directed from his desire neither by Calypso nor by the Sirens, will one day suddenly find that he is there.9,p.484 
The Sirens and the Calypso represent the meaningless pursuit of pleasure, the one-dimensional view of persons that lead to disruption and spiritual poverty, and to Ulysses' tragic statement. 
Logotherapy taps the resources of the spiritual dimension and enables us to rise above the life-denying snares of the Sirens and the cataclysmic Calypso of materialism. 
Our Deepest Longing 
Man's Search for Meaning describes what the deep yearning of a young Jewish psychiatrist lost in the maze, despair and horror of being transported from one Nazi concentration camp to another. The themes of "home" kept prisoners alive, by reliving precious memories or by renewing hope for reunions with loved ones. 
Transported from Auschwitz to Dachau with hundreds of other prisoners, the train passed through Frankl' s cherished home city, Vienna. The track actually led past the street where he was born and lived during his early years. Crowded in the car, prisoners took turns looking through the barred peepholes to what lay beyond. Thinking that he was on the way to death, one last glimpse of his home street and city offered an opportunity for supreme experiential and even spiritual value. In great urgency Frankl pleaded. 
I began to beg them, to entreat them, to let me stand in front for one moment only. I tried to explain how much a look through that window meant to me just then. My request was refused with rudeness and cynicism: 'You lived here all those years? Well, then you have seen quite enough.' 3,P-52 
How tragic to be denied the opportunity to re-experience the meanings retroactively provided by a glimpse of one's hometown and streets! How even more tragic to find oneself in a world where one can no longer name a spot of land, a river, a tree, or reflect upon an image that brings the experience of "home." 
Clinical Applications 
Logotherapy helps clients develop a centeredness, a sense of foundation, an "at homeness," and provides them with tools, outlooks and methods to "be at home" more comfortably, productively and meaningfully in today's world. The methods: 
1. 
Self-distancing: Helps clients step away from the. "problem, "2,P122 

2. 
Modification ofAttitudes: Demonstrates the noetic power to change from an unhealthy attitude to a healthy one.4,p.129 

3. 
Orientation to Meaning: Clarifies the grounding of the person who wills-toward-meaning. Meaning (of-themoment or ultimate) is primary in the experience of being grounded and"at home."8,p.148 

4. 
Se lf-Transce nde nee: Elucidates our spiritual nature, wherein we abandon our focus on body and psyche to experience that deeper rootedness, the stability of centeredness.4,P-61 


The following clinical applications of logotherapy help clients drop absurd beliefs, depression/lostness, gaining what is deep, foundational, life sustaining logos 
Socratic dialogue: Brings to surface those "particles of home" and wisdom which exist preconsciously, breaking through into consciousness. Clients are enabled to comprehend the personal wisdom of their own past and present which is at their disposal.10,p.69 
Dereflection: Demonstrates such noetic strength as the freedom to choose another look--toward what has been achieved, to those small treasures of "at homeness" that are repressed and forgotton.5,p.101 
Paradoxical Intention: Leads us toward a happy breakthrough by laughing--stepping away from what binds us, what limits progress and growth. 8,p.27 
A Case: Better Grain 
Glenn, a despairing and, at one time, suicidal client gives dramatic evidence of a modification of attitudes toward wholeness and meaning possibilities. He teaches English and brought two Teasedale poems which represent where he is emotionally, psychologically and spiritually in his struggle. 
Client: I want to share this poem with you: 
ATSEA 
In the pull of the wind I stand, lonely, 
On the deck of a ship, rising, falling, 
Wild night around, wild water under me 
Whipped by the storm, screaming, calling. 
Earth is hostile and t11c sea hostile, 
Why do I look for a place to rest? 
I must fight always and die fighting 
With fear an unhealing wound in my breast. 
(Silence.) The reason I picked it is, I guess, I feel that sense of continual struggle--getting beat up and having to exert maximum effort just to stay even. 
Counselor: Sisyphus and the stone. 
Client: Yes. Sisyphus and the stone. 
Counselor: I want to tell you that I'm pleased you shared that poem with me. It certainly is not about giving up, though you may have some unanswered questions and unresolved feelings about life and yourself, things you want to search for. The poem expresses courage in the face of shaking foundations. 
Client: On water,--no foundation. Counselor: And storms can be fascinating. Did you ever go out in the yard and watch an approaching thunderstorm? 
Client: Well, I think that's part of it. I enjoy the storm. I like to sail, and the bigger the wind the more I like it. I'd rather sail in a strong wind. 
Counselor: It excites you, challenges you. 
Client: Exhilaration. There is something else I want to read. 
THE BROKEN FIELD 
My soul is a dark ploughed field in the cold rain; 
My soul is a broken field ploughed by pain. 
Where grass and bending flowers were growing, 
The field lies broken now for another sowing. 
Great Sower when you tread my field again, 
Scatter the furrows there with better grain. 
Client: I feel that life is a lot to go through --for what? I'm cynical at times. It's ironic. 
Counselor: Should life be more than this? 
Client: Yes. 
Here the client in the safety of the shared encounter bares his great pain and open wound. The poem describes by word and mood what he experiences existentially. He shows me honestly how fatigued he is, and his searing doubt about the worthwhileness of his efforts. In affirmation, I let him know I hear him, and try to clarify what is positive from the sad and heavy poem. "The poem expresses courage in the face of shaking foundations." For there is great wisdom in what this client had discovered about himself and his world as he reaches out with faith. It is the same discovery made by Pascal when he described the human situation. We burn with desire to find a firm footing, an ultimate, lasting base on which to build a tower rising up to infinity, but our whole foundation cracks and the earth opens up into the depth of the abyss. l ,p.345 
We search for a "logoanchor," a beam of light, something from his struggle that gives evidence, even slightly, to directional movement and hope for the future. We continue: 
Counselor: A feeling of loss. Though there is hope the seed is sown, seasons go by and there is a harvest, but there is also some disappointment. So, next day, next season I'm open to the potential in newer and creative seeds. 
Client: I'd like to get a little more bushels to the acre. Counselor: I'm wondering if that's possible right now? Get more per acre now? 
Here I decide to look for concreteness. The imagery he presents is of wild water, storm driven, and a person seeking footing and some sense of homecoming, rest from exertions and labors. I must point to what is solid now. What footstone or, in logotherapy, noetic strength, is present now? Where is the meaning now? 
Client: Well, I've been thinking about a couple of things. (Discusses one difficult and uncooperative class he was teaching, then three classes of creative activity.) I hit it three out of four today. We also had a panel about death following a paper I assigned. It worked out beautifully, the students sparkled. I enjoyed it and it meant something to them. The subject was facing death, their own limited powers . I guess I'm learning to accept the good things that do happen,take time to experience them, and don't discount them because something discouraging happens. 
Counselor: What did you learn about death? 
Client: I guess I'm changing the way I look at things. I'm not just looking to the future but what I have of my life now; death can't rob me of that. 
Counselor: This very day I reap the harvest. I saw your eyes brighten, your smile reflected a joy. 
Here my risk of holding before him the immediate meaning content of moments of that very day proves therapeutic. Through stormy, wild water and shaking foundations (physical and psychological) he knows he has found some meaning stepping stones. 
Client: Yes. I have, I do! I did reap the harvest of the dav did. At times I feel I'm not ready to give up life. L's surprising--more and more I feel life is what's to be experienced each day and not a far-off goal to attain. Which is quite a change in two weeks. 
Counselor: Your attitude is changing. 
Client: Well yes, and I seem to be fairly comfortable with it.I had something really good happen to me last Sunday.(Narrates how he got together with an old friend, a lawyer in an important position, and shared a talk.) I was really touched that he would feel comfortable sharing so deeply with me, especially when I tend to put myself down, not as successful financially as he is, but it was kind of a revelation to me and a gift of grace through this man that I would be the person to share his pain, that he would turn to me, seriously talk about his difficulties of living, sharing his pain. I received a tremendous gift through that. 
Counselor: I wonder what he saw in you, experienced in you? 
Client: Well, I used to think that he saw in me a person with a ready smile, gentle, not a shark or a tiger, though there is that aspect of me. But this time, after our encounter, I believe he sees in me a person who accepts people as they are, doesn't feel the need to pretend to be tough, a person who shares his values. He is a person who values service. 
Counselor: You experienced his affirmations, and found them healing. It's important for you to serve others. 
Client: Yes. 
Counselor: He recognized that part of you that cares and ministers. It's part of being a faithful teacher and a friend. Client: Seeing the value of compassion--seeing others' needs and attempting to meet them, not merely aggrandizing myself. 
Counselor: You have understood that experience of great value to you is like rich treasure stored in the granaries of time.No one can ever take it away from you. It was a beautiful experience and an affirmation of you. You both were enriched. I also want to affirm you. I like it when you say " I want to live in the now, concentrate on life in the present; we think of the future, but it isn't here yet. The present is important." 
Client: I said last week I seem to live with a quest, but the quest is in the past, like the light at the end of the dock, reaching back to fill the emptiness, for experiencing approval and a caring safe place where I can grow. Without having to do this or that. 
Though he still feels a portion of the emptiness of childhood neglect, he has opened a door that reveals something precious and infinitely more, his treasures stored, day by day, through self-transcending actions, his caring and ministery to others, his faithfulness as a loyal friend. Already he is overcoming the emptiness and lack of love in his childhood which he cannot go back and fill. The backward look in selfpity is counterproductive for mental health. It is my task to present him with the meaning possibilities of his future and the real meanings he has stored by his authentic giving of himself. 
Summary 
Logotherapeutic philosophy and techniques which aided this client toward grounding, at-homeness, and meaning include: 
l. Self-distancing from some of his problems. He experienced some distance between his reflective inner spirit and the objective facts of limited horizons put there by fear and diminishing hope. 
2. 
He brought poetry demonstrating in encounter where growth is possible, something shared--a changing world view filled with pain, but also a view that he and his pain are separate. He is genuine in allowing me to hear his pain. 

3. 
The pain is acknowledged but we move beyond it to the truth contained within it. "It certainly is not about giving up ... the poem expresses courage in the face of changing foundations." 

4. 
Dereflection continues as together we look at the fascinating possibilities for growth, or experience "within a storm." He even says "I'd rather be in a strong wind." Poetry and metaphor move us forward as if together we are being sustained by healing waters. 

5. 
"It excites you, challenges you." He responds, "exhilaration." Energy is present, focused toward positive change. This is a directional movement, "noodynamics"--a healthy tension. 

6. 
The deeply moving spiritual insights revealed by "My soul is a dark ploughed field" reveal that the pain has been put to good use, to prepare him for what was always hoped for-meaning fulfillment. He reveals his openness toward meaning. It becomes a beautiful prayer--"Scatter the furrows there with better grain." 

7. 
The dereflection toward this positive look is continually affirmed, supported by Socratic dialogue: "I'm wondering if it's possible (to reap a little more per acre) right now?" 

8. 
Meaning components from his storehouse are shared: accomplishments in deeper understandings, discussing death with his students. Socratic questioning: "What did you learn?" thus making experientially concrete the meanings of his day (newly sown field). 

9. 
Modification ofattitudes ensue: "I'm changing the way I look at things ... What I have of life is now and death can't rob 


me of that." From great despair and the open wound to such existential spiritual insight! I am amazed and enriched myself . 
10. The personal Socratic questioning rivets the focus upon his uniqueness, his spiritual qualities and resources affirmed by others but forgotten in his despair. "I wonder what it was that he saw in you?" 
He finds the answers--etemally preserved "givens" in his experience, "a person with a ready smile, ... gentle ... a person who accepts people ... one who doesn't feel the need for pretension ... one who values service to others." 
These "givens," experientally grounded through his own life, self-transcendence and commitments in the world, all form pieces in his picture puzzle called "home." Though the puzzle may never be complete because of human finiteness, he gives evidence th~t already he has experienced sufficient foundations and has the courage to fill his rooms full of meaning and build an attractive landscape around himself and those he loves. 
JAMES D. YODER, PhD., is regional director for the Viktor Frankl Institute ofLogotherapy and a licensed psychologist in private practice in Kansas City, Missouri. 
REFERENCES 
1. 
Beck, R. Perspectives in Philosophy. New York, Holt, Rinehart and Winston, 1961. 

2. 
Fabry, J. The Pursuit ofMeaning. S.F., Harper and Row, 1980. 

3. 
Frankl, V. Man's Search for Meaning. New York, Washington Square Press, 1963. 

4. 
__, Psychotherapy and Existentialism. NewYork, Simon and Schuster, 1967. 

5. 
__, The Will to Meaning. New York, New American Library, 1969. 

6. 
Kauffman, W. Existentialism from Dostoevsky to Sartre. New York, World Publishing Company, 1956. 

7. 
Lukas, E. Meaningful Living. Berkeley, Institute. of Logotherapy Press, 1984. 

8. 
__, Meaning in Suffering. Berkeley, Institute ofLogotherapy Press, 1986. 

9. 
Panichas, G. The Simone Weil Reader. N.Y., Moyer Bell Ltd., 1977. 

10. 
Welter, P. Counseling and the Seaarchfor Meaning. Waco, Texas, Word Books, 1987. 


81 
Finding Meaning in Suffering A Personal Account 
Robert C. Barnes 
Logotherapy maintains that, when we see meaning in life, we are able to endure any suffering. The logotherapeutic counselor tries to relate the experience of suffering to a meaning the counselee can accept. This article is a personal account of how I have witnessed and applied Frankl's wisdom in my professional and private life. 
One of my clients, Anthony, was a 34-year-old petroleum engineer who loved his wife and his two children. He worked hard, provided well for his family, was devoted to religious concepts, and brought up his children according to the principles of his faith. 
Unbeknownst to him, his wife had an affair with a close friend of the family. When she was ready to make the break, she was not interested in counseling to reconcile her marriage. Her mind was made up. There was nothing Anthony could do to dissuade her. He dealt with the grief and was able to cope with his feelings of rejection by considering the greater tragedy that his six-year-old son and eight-year-old daughter were experiencing. Through a self-transcending change of attitudes, he was able to transmute his unavoidable suffering into a victorious achievement. His faith gave him strength to face his fate instead of being destroyed by it. Through self-distancing, he exercised the human capacity to step away from himself and think objectively how--with the same set of values--he would advise someone else in a similar predicament. Through selftranscendence he reached beyond himself to those he loved and to values in which he believed. He fought for custody of his children. After two weeks of a bitter trial-by-jury, Anthony won their custody. As a man in his mid-thirties, he was a daddy with a broken heart but a triumphant spirit. 
Two years later the children's mother took Anthony back to court for a second emotionally draining custody battle. She had convinced the children they would be coming to her and had promised them ·everything from trips to Disneyland to maid service. When the judge read the jury's verdict, after a week in court, that his children would remain in his custody, he collapsed in exhaustion. He told me, "I've got to go home and tell the children. Their mother has already instructed them by long-distance telephone to have their bags packed. I don't know how much longer I can handle this." I looked at him reassuringly and said, "You have a task in which you believe with every fiber of your being. You are determined that your children will be brought up in a loving home, where they are taught values that are eternal. Knowing that your children need you, you will never have to wonder if you will have the strength to fulfill your task." 
Logotherapy teaches us that in the dimension of the human spirit we can become the master of our fate, not the victim, even in the face of any limitation. Suffering gives us the opportunity to bear witness to the human potential at its best, which is to turn tragedy into triumph. But logotherapy emphasizes the potential meaning of unavoidable suffering. Unnecessary suffering is masochism. 5,P· 126 
"Whenever one is confronted with an inescapable situation, whenever one has to face an unchangeable fate, e.g., an incurable disease, just then is one given a last chance to actualize the highest value, to fulfill the deepest meaning, the true meaning of suffering"2,P-178 " ... Suffering ceases to be suffering at the moment it finds a meaning"3,p.129 
Several years ago, my wife Dorothy was diagnosed as having cancer. It broke my heart to realize her pain. Someone said to her, "Why you, Dorothy, with all the good you have done and can do with your life?" Her response was, "Why me? Why not me?" She was aware that appropriate handling of suffering is a dimension of serving. Both of us believe that God enables us to use our own pain not only to enrich ourselves, but also to strengthen others. 
Lukas gives two eloquent personal examples of such self-transcendence. She tells of her mother's tragic bout with cancer and the triumphant spirit with which she faced it. "She acted with courage, not to overcome her own suffering, but to alleviate ours."9,p.138 
Lukas also tells of her own interaction with Dr. Frankl when he suffered a severe heart attack in 1979 during a visit in Munich. She reached him by telephone in the intensive-care unit of the hospital. In her own words, "I wanted to say so much to help, comfort and thank him, but I couldn't find words. Here, like Mother at her sick bed, was a person who had more strength than the people around him, and he set an example. He spoke calmly. To die held no terrors for him. He accepted any decision of fate because it was beyond his responsibility ... Thus, he tried to comfort me who myself could not find words. He wanted to tell me, 'Remain calm, too, when you'll face death some day...' 
This was his legacy, a lesson from the hospital bed. He did not think of heart failure--he thought of me!9,p.139 
One of my students, a master gymnast and an accomplished athlete, is struggling with cancer right now. In class this spring, her head was completely bald because of massive doses of chemotherapy. Not long ago she thrilled crowds with her athletic prowess. Now, in spite of her limp caused by surgery, she inspires us as never before with her inner radiance. She told me, "Cancer is the best thing that ever happened to me. It has given me a sense of myself I didn't have before." It reminded me of the words of Nietzsche who said, "That which does not kill me makes me stronger." 
Paul Tournier wrote, "There is no life exempt from suffering. There is no life which, from birth, does not already have to carry the weight of hereditary weaknesses, no life which does not suffer emotional shocks in childhood, which does not suffer daily mJustices, hindrances, rnJuries, and disappointments. To all this pain must be added sickness, material difficulties, bereavement, old age, worry about loved ones, and accidents. In the lives of even the most privileged there is something that is hard to accept."13,p.I43 
Janet, a former student whom I had known to be outgoing, charming, and always helpful to host social events on campus or receptions at her church, came to my office, terrified. Slanderous accusations had been made against her about her professional responsibilities of administering a nursing home. She was frightened about losing her administrator's license, afraid people would believe the accusations, couldn't eat or sleep, thought this was the end of her world, and was potentially suicidal. Believing in her innocence and the strength of her character, I told her that in listing the accusations against her, she was describing someone I didn't know. I reminded her of the many good things I knew about her when she was a student, the widely-known evidence of her good character, and the loving things she had done for people of all ages. The accusations came from an individual who was jealous, but had so much influence that a hearing was scheduled before the state licensing board. I attempted to get Janet back in touch with her true self. I told her she was allowing her accuser to control her life, and that she had temporarily allowed herself to lose control of her own circumstances. Then I employed logodrama and a form of paradoxical intention. Together we imagined and wanted her fears to become reality. We set the stage in our mind. It was her "day in court." Her accuser was there and people who didn't really know her but testified against her. The more Janet regained touch with her true self, the more she hoped the trial would go on for hours because she realized that those who accused her would really be making fools of themselves. Finally I told her, "You are a beautiful, good, and loving person. You have nothing to fear." Suddenly Janet began laughing. "What amuses me," she said, "is a picture that came to my mind. After the trial, I was picturing hosting a reception there in the courtroom for my accusers." And I said, "Your sense of humor has helped you again distance from yourself and see yourself as you really are:' 
Jerry, one of my students, has a story in his family that would merit being made into a movie. When his parents were in their early thirties and had three little boys, Jerry's father had a tragic automobile accident that left him paralyzed from the waist down. Following the accident he went on to become a brilliant executive in the oil field supply business. Later he suffered a massive stroke that left him as a quadruplegic. The only feeling he had in his body was in one side of his face. He controlled no bodily function nor motion. Still he kept on building his business empire into a greater legacy for his family and those he loved. For years as an adult, Jerry went to his father's home three and four times each night to turn him in bed to prevent bed sores. In the morning, Jerry lowered his father into the tub to bathe him, then groomed and dressed him, fed him breakfast, and drove him to his office. Once there, his father was every bit as much in charge as the most physically fit business executive. Nobody in Texas remembers him as a handicapped man, but as a phenomenally successful businessman. It would be understandable if a person in such circumstances longed for death. When Jerry was asked what had been his father's biggest disappointment in life, Jerry responded, "My father loved life and lived only to his early seventies. His greatest disappointment was that he didn't get to live longer." Tragic optimism and the triumphant power of the human spirit combined! 
Recently we lost a good friend, a prominent physician. He had open-heart surgery. This operation has worked for many, but not for him. In the months of his decline, he knew with a physician's insight what was happening. Conscious to the very end, he thought deeply about the preparation for his own death. As a religious person he pondered about how worthy his soul might be for heaven. He recalled the meanings he had actualized during his lifetime--accomplishments death could not void. He brought eight thousand babies into this world. For years, people drove to him for miles, bypassing other medical centers. He was known for being genuinely interested in the whole person. He listened with an educated ear and a caring heart. He established the mental health center in our city. When patients couldn't pay for their medical care, they received the same high-quality treatment as those who paid. 
A related example of what Frankl calls "tragic optimism" is seen in the courageous attitude of his widow. Someone said to her, "We had hoped you could have many more beautiful years together. It almost seems you were cheated." She responded, "Cheated? Oh, my no! Many women live a lifetime and never know the love of such a man. What we shared far surpasses what other couples know whose marriage lasted many more years. Cheated?" she asked once again. "No, I was significantly blessed." 
I have long believed in the concept of the wounded healer: those who show an undefeated spirit in desperate circumstances can do something for us which others can't. 
Several years ago I heard Rollo May who was 75 at that time. During the question period a woman asked, "Dr. May, you have talked about the wounded healer, but have you known any suffering in your own life? You're an internationally famous psychologist, a widely recognized author. Did you experience any suffering that helped you become the sensitive therapist you are known to be? How might the concept of the wounded healer apply to you?" 
May responded, "I am the second child born to a schizophrenic mother. My older sister is schizophrenic and has been confined for years in a mental hospital. As soon as I could walk, I learned to get out of the house. I became a loner, very sensitive. My father abandoned us when I was a pre-schooler. I have had heart problems ever since I was four. I fought malaria and was hardly ever without fever from the time I was 20 until I was nearly 30. I suffered from tuberculosis. From my academic training I gained knowledge to help others, but from my experiences I gained the ability to help them." 
A Personal Account 
My own mother died when I was three weeks old. Her younger sister came to take care of my brother and me. Later she married my father. When I was five, my new mother gave birth to my brother Richard. While she loved all of us, Richard was very special to her. At 18, a drunk driver killed him on his first trip home from college. The week after his funeral, Mother redecorated the nurseries in our church and volunteered as "nursery home visitor." She took religious teachings about spiritual aspects of parenthood to expectant mothers in the church. She visited their homes, not to tell about her sorro\v, but to help them more meaningfully anticipate their joy. 
My wife and I anticipated for years the challenge of being parents. By reasonable standards, we much from which we could nurture a child. We know the importance of love in a child's life. We could teach our child about our faith. We both have doctoral-level psychological training which gives us insights in child rearing, and the means to provide whatever level of education our child may have wished to pursue. 
The child who came to be ours was nearly 16 years old, from a background of severe child abuse. Handsome and intelligent, he had remarkable potential for growth and many capacities sto help others. For a while his spirit flourished, he was active in his church youth group and outstanding in school and community plays. But then came heavy drinking, substance abuse, promiscuity, hot checks, school failures, lies, and the loss of more than twenty part-time jobs after finishing high school. Only now and then would his beautiful spirit shine through the maze of negative choices. We loved him, and he loved us in return--at least the best he knew how. After wasted years, the pattern was obvious that he chose to stagnate instead of grow. He was fixated on the concept that the world owed everything to him because he had a difficult childhood. The lining of his existential vacuum is made from his consistent lifestyle of using people. 
We have never given up hope that his spirit would work its way through his twisted thoughts. Tragic optimism helps us hold onto that hope. Self-transcendence helps us value what we have learned from these experiences with our son, and use this insight to help other parents in many ways we would otherwise not have been able to do. 
In my own case, I live within a body that has major limitations because I had polio when I was thirteen, two years before the polio vaccine was available. My body is crippled, but I as a person am not. I was long ago healed even during the onslaught of paralysis. For me, healing was in the spirit. Healing came, in part, through the acceptance that my body had limitations, but my life need not be shaped by those limitations. Healing came also, in part, by realizing that I am a whole person, that the Creator has purpose for my life, and that no disease took away anything I needed to fulfill that purpose. can truly say that, because of the opportunities I have had to serve and help others, my life is extraordinarily rich in meaning. 
Is there meaning in suffering? Let me leave you with this thought: Those who have gone down into the depths of life are most certain of its heights. The veterans of life with the most scars have found the greatest dimensions of meaning, and believe the struggle most worthwhile! 
ROBERT C. BARNES, Ph.D. is professor and chairman, Department of Counseling and Human Development, HardinSimmons University, Abilene, Texas. 
REFERENCES 
1. 
Frankl, Viktor. The Doctor and the Soul. New York, Vintage Books, 1973. 

2. 
__. Man's Search for Meaning. New York, Washington Square Press, 1965. 

3. 
__. The Unconscious God. New York, Simon and Schuster, 1975. 

4. 
Lukas, Elisabeth. Meaning in Suffering .. Berkeley, CA, Institute of Logotherapy Press, 1986. 

5. 
Tournier, Paul. The Healing of Persons. New York, Harper and Row, 1965. 


Quotes from World Congress VII: 
"If education is only training for the job market, the system deserves the scathing indictments of those who realize that a good public educational system is far more than money and jobs. It is the heart of a nation, and in today's world it may be the very heart of life on this planet. 
"What can be done? We need to put some key ideas into our educational system. We need to teach young people that life has meaning under all conditions. We need to teach a structure for the individual students so they can find personal meaning in their lives. We need to demonstrate the interconnectedness to everyone living on this planet. We share this blue marble in space and without cooperative efforts of all peoples the planet we call home will become an uninhabitable place for human life. There is nothing more sad than to see a brilliant student, who has excelled in the academic disciplines, stumbling in life because he lacks any significant understanding of his purpose on this globe or his reason for existence. Some of our very best minds, the young people who should be our future leaders are tuned out, drugged out, or in despair. No one should ever graduate from school without experiencing a solid curriculum that emphasizes the importance of human life, the importance of each individual being." 
Willis C. Finck: "From.Classroom to World Arena." 
Exposing Prisoners to Logotherapy Mignon Eisenberg 

In the Spring of 1988 I held regular group meetings with felons in the top security prison of Israel,using the concepts of logotherapy. I met with a small group of convicts once or twice a week in the prison library. The meetings were interrupted in June 1988 when I left for the United States and resumed in February 1989 until June, 1989. Each group session lasted for two to three hours. 
The group consisted of nine males, ages 26 to 49. Seven were Jewish, two Arabs. All were from different origins: Bukhary, Egypt, Iraq, Jordan, Morocco, Iran, Tunisia, Turkey, and Yemen. Two were bachelors, five married with one to four children, two divorced with child.One was a youth leader, one a locksmith, one a vegetable vendor, two were mechanics, and four had no specific profession. 
I did not inquire about their crimes. Only in response to the request by the Congress Academic Review Board did I find that my group participants were imprisoned for offenses ranging from drug use to burglary, manslaughter, and murder. Seven were imprisoned for the first time, one for the fourth, and one for the fifth time. Prison terms ranged from 40 months (drug use) to life.(murder). "Life" means about 18 years. Most of the convicts had previously undergone psychotherapy. 
The objectives of the group meetings were: 
•To 
improve communication skills. 

•To 
make members aware of their intrinsic value as worthwhile, spiritual, unique human beings, enhancing their self-image, self-confidence, and self-esteem. 

•To 
turn guilt and despair into catalysts for the refinement of personal conscience, activating social restitution. 


To promote these goals, in keeping with Carl Rogers' and Viktor Frankl's theories of personality, I displayed a basic attitude of unconditional caring, regard, and acceptance. 
Methods 
One method used was consciousness-raising through meditation, relaxation and will-training exercises, Yoga breathing, autogenic training, free phantasies projecting into the future. Participants reported a lowering of psychic tension, increased vitality, openness, a general feeling of wellbeing, discarding social masks, feeling in touch with their inner, childlike core, eager to grow. 
A second method was conscious-ra1smg through informal lectures as guideposts to successful living, and logotherapeutic approaches for crises intervention, coping, and survival. Lectures were supplemented by discussions that included the following insights: 
•No 
situation in life is void of meanings and alternatives. Even blows of fate lose their sting by offering opportunities to choose new responses, develop different attitudes, change. 

•The 
greatest triumph is to rise from the ashes: to delve into the bountiful resources of the defiant power of the human spirit, to define and redefine ourselves in response to the questions life puts to us. 

•Physical 
and psycho-social limitations do not detract from the meaning of life. They can even provide incentives to find authentic worthwhile meanings, turn victim into victor. 

•The 
door to meaning opens to the outside, reaching out for people to love and causes to serve. 

•
Decide to 'straighten yourself out,' ( the inner self is the true source of all 'outer' conflicts): be congruent in thought, speech, and action. Say what you mean and do as you say. 

•
Material success, saturation, and hedonism can lead to despair and boredom that characterize the existential vacuum. To derive new energies, to live meaningfully, one must become aware that failure and deprivation can be turned into a challenge. 

•Only 
a neurotic person argues: This is the way I am, I cannot change. Only with the awareness of being able to change can successful living be accomplished. It is never too late. 

•Place 
one thing above everything else: to master life under all circumstances. This foremost self-transcending endeavor immunizes against despair. By forgetting yourself, by transcending yourself, you become truly human. 

•No 
one can be deprived of the inalienable spiritual resources, of which freedom is the most powerful: the freedom to take a stand, make decisions, and commitments and carry them through, and -if needed -rebuild their lives and become a model for others. 


A third method used was application of these concepts through 'games,' verbal and nonverbal exercises, role playing, alternative lists, logodrama, Gestalt and other approaches. 
Drawing life maps with color crayons provided a valuable vehicle for self-discovery and consciousness-raising. The traumatic event that brought the convicts to prison was often shown as a multi-colored explosion, similar to that which, according to Kubler-Ross, dyi11g children draw their confrontation with approaching death. 
Another valuable tool was the 'acceptance game' in which every participant, in turn, told each group member how he perceived him. The person addressed was not allowed to talk back, just listen until it was his turn The game provided an opportunity to check out how they came across to others and how they responded to compliments and criticism. The game opened communication channels. The week after, members were asked to relate their feelings during praise or criticism, and how they perceived themselves. 
The games and exercises provided opportunities to 
•talk 
to others, improve communication, 

•trust 
their own and others' ability to make decisions, 

•plan 
ahead for a better future, and 

•act 
cognitively by synthesizing personal meanings discovered during the group experience, for personal implemenation. 


Cases 
E., 38, sentenced to life for robbery and murder, born in Tunisia, married, four children, no profession, an habitual gambler, cynical, aloof. He had been in prison for 18 years and was ready for parole.He stated that he wanted to stay in prison because, once outside, he would resort to his old habits. He smiled arrogantly when he told me, "Don't believe a word these guys say. All we do here is manipulate. We try to flatter you and tell you things you like to hear." I reminded him that he had told me of one good deed he had done in prison, so he couldn't be all bad: his cellmate, like most prisoners, "solved" his prison problems with "five grams of coke." When the addict's wife told him she would divorce him if he kept this up. E. threatened to withdraw his friendship and support unless Y stopped using drugs. They shook hands and made a pact which the other kept. "So you have a friend forever," I told him. After Y. (see next case) made his suicide confession, I paired E. and Y to discuss their 'likes' and 'dislikes' and dwell on characteristics they would like to change. At the next meeting Y. told me that they too made a pact, for E. to abandon his gambling habit, for the sake of their budding friendship. 
At the February, 1989, reunion with the group. E. appeared in jeans and shirt sleeves. "Until I became part of the group," he said, "I was scared to leave prison because I thought I was a helpless victim of my gambling. I was like a small boat in a stormy ocean. I had no North. Logotherapy provided North for me." 
Y., 29, sentenced to six years for robbery. Father from Iraq, mother Yemenite. married, three children. Used to be youth leader and artist. Effeminate, introvert. When the group started he had been almost three years in jail. The turning point came with the acceptance game preceded by group discussion about the concept of freedom, followed by an informal lecture. 
Y. who had been quiet in previous meetings spoke at length about his problems with prisoners who thought him a weakling. I remarked that it took a real man to permit himself to act softly in this crowd. He then spoke of his repeated suicide attempts in jail which had been frustrated by guards. He didn't want to die, he confided, just was testing his limits. When I asked him why he didn't want to die he replied he had a mother whom he loved. (Someone to live for; therefore, according to Frankl's suicide test, not in immediate danger.) Since this meeting, Y. 's mood changed. He made friends with E. (see case above), had his paintings exhibited in a national show with a section of art by prisoners .. At the parting meeting in June 1988 he gave me a gift-wrapped art work -a hand-written poem decorated with dried leaves dipped in lacquer, neatly bordered with white shoe lace, framed in black wood, under glass. It was his thanks for "a significant contribution to enrich our souls and for the chance to work on ourselves, to mend, improve, and utilize all the help you were ready to give us, for a better, safer future." He also enclosed a letter to his fellow convicts: "It is good to be together and observe group ham1ony, respect, and mutuality .I know everyone of us carries in his heart his entire world and his pain. Yet, we have the strength to turn our pain into personal meanings by transforming it into new beginnings. Pain and suffering are not separate parts of our life journey. They are what lends purpose and meaning to life and represent our hold on our reality. Come what may, we are determined to overcome the obstacles." 
S. 26, sentenced to life for murder. Bukhary, married, one child; locksmith, tall, dark-skinned, sullen, reminiscent of Lennie in Steinbeck's OfMice and Men. In the acceptance game I told him it wasn't fair that he obviously enjoyed listening to what everyone said to him but when his turn came hardly opened his mouth. It was impossible to know what he was thinking or feeling, I said, yet I was convinced that he had a lot to say. He looked at me with a deep, penetrating look. His black eyes seemed to clear up, like a veil lifting. and he said: "These meetings are the best thing that happened to me in prison. They bring back the good times and permit me to have new hope.I read Man's Search a long time ago and had forgotten. Now it comes back in full force. and at the right time, when I am more mature. What you say lift s my spirits, makes me feel human again and I realize I still can change. I sense you are trying to impart something good to us, that you trust us and believe we can do it. You are treating us like equals. I want to justify this trust. I feel a new freedom in my veins." 
A week later he was re-reading Man's Search and felt as if he, S., had written that book, so strongly did he identify with its thoughts and feelings. He said it made him feel less lonely and gave him the strength to see that it was possible to change in spite of everything. 
These cases opened doors for other opportunities. One of my University students, T., was employed as a social worker in the same prison in which I held my groups. For six months she had tried to help X., a 33-year-old prisoner, married, father of three, sentenced to two years. Because of several suicide attempts he spent several months in the psychiatric wing. He was constantly depressed, spoke about his despair and helplessness, missing his daughters and wife. He took drugs, was self-centered, refused to work or study. 
For six months T. tried to help him. He said he did not want help nor could he be helped. He wanted to terminate treatment, once even walked out on her. She told him she would be here for him every week at the same time. 
We decided T. should change her tactics and try a variant of paradoxical intention. She told him there was no progress in his treatment. He maintained he could not change. She replied that there is no 'cannot,' only a 'don't want to.' And she reiterated that if there was no change within the next two or three weeks, she would interrupt treatment for some time. He expressed anxiety: "Don't you want to try another approach?" "No," she said,."the ideal situation may be, as you suggested, to do nothing, therefore there is no sense in going on." He showed bewilderment and he asked what she wanted him to do. This was the first time he expressed interest in cooperating with treatment. She suggested part-time work, even if he didn't feel like it, just to please her, for one week. To her surprise he called out to her several days later when she passed the diamond factory site located on prison grounds: "Look here, I am working!" When she made an appointment again, he told her, radiantly, that he was working full-time and loved it. He saw himself with new eyes. He had lived in a bubble, he said, and used most of his energy to fight her well-meant advice. T. said to me that she now realized that trying too hard to help someone change, reinforces negative behavior. She continued paradoxical approaches, cautiously and with quiet determination, every time she noticed a pattern of despair and hopelessness in this client. 
Since the logogroup started, social workers at the prison have adopted logotherapeutic techniques in group meetings before prisoners are discharged: Socratic dialogue, list making, life maps, unguided fantasies, emphasis on responsibleness, self-transcendence, and the defiant power of the spirit. The new supervisor of the prison took an introductory seminar at the Viktor Frankl Institute and plans special logotherapy training programs for the drug program in Israeli prisons. 
The group I described was not a research project but an experiment to verify Frankl's contention that humans are indeed spiritual beings in search for meaning, no matter what their ethnic, educational, social, or economic background was. 
MIGNON EISENBERG, Ph.D. is director of the Viktor Frankl Institute ofIsrael and regional director ofthe Berkeley Institute .. She spends halfa year in Israel and halfa year in Chicago. 
Quotes from World Congress VII: 
"The logochart views the Self as the sum of automatic and authentic self. The automatic self represents the person's automatic reaction to situations and is the result of physiology, heritage, genetics, past, environment, and the gut feelings of emotional response. In Frankl' s terms, the automatic self is not what I am but what I have. 
"The authentic self is what I really am: my essence, uniqueness, my responsible decision-making, meaning-oriented self. The chart lists three parameters; attitudes, meanings, and response (responsibility). Attitudes refers to the way we filter incoming information through our subjective values and belief systems. Meaning refers to our conscious and unconscious search for meaning which differentiates the human from all other animals. Response refers to what we actually do in response to what we think and what meaning we see in a situation. Patients are asked to separate their automatic and authentic reactions and sort them into three categories: Attitudes, Meaning, and Response-behavior. The automatic reaction lists automatic thinking, meaning, and behavior in particular situations. All the phenomena in the authentic-self column -thinking, meaning, and response -come from the noetic dimension. The authenticself column contains much of what Frankl sees as the person's power to take a stand against physical, psychological and environmental influences." 
Manoochehr Khatami: "From Depression to Self-Esteem." 
Logotherapy for Former Prisoners Rosemary Henrion 

This article reports clinical logotherapeutic approaches with former prisoners at the VA Medical Center at Biloxi, MS. 
Mr. A, a veteran having served time for armed robbery and murder was admitted to our Center for readjustment to society.The treatment team referred him to the logoanalysis program to search for new purpose and meaning in life. He was experiencing an existential vacuum with no sense of direction for his future. He was quiet, cautious, and shared thoughts and feelings only at a superficial level. In the therapy group he did not initiate any communication with his peers unless invited to do so. I did not try to persuade him until he felt comfortable enough to develop trust with the group. After four weeks he began to talk about his time in prison, and also shared some traumatic experiences during adolescence, when he felt that to get anywhere in life and "to be somebody," he would have to take what he needed at any cost. When he was 17 he joined the Army and spent three years in the infantry. He became bored with military service, received an honorable discharge, and returned to his home in Florida .. He worked for a local clothes manufacturer but lost his job during the 1980 recession. Recurring bad feelings made him think of his getting what he needed at any cost. He held up a merchant and killed him when he feared that the merchant might identify him to the police. 
Logotherapy helped Mr. A develop a heightened awareness by changing his attitude from seeing himself as victim to seeing himself as survivor despite the blows of fate dealt him.When he chose to release his anger and victim role, his behavior changed. He demonstrated more initiative in complying with the treatment plan he had developed, and began to creatively think of ways to solve his problems by integrating some of the logotherapeutic concepts he learned in class. He continued to struggle with the choice between what he would have to do to attain a meaningful life and his temptation to take the path of least resistance and revert to armed robbery, risking a life sentence. The logotherapy support group provided him with a positive attitude and motivated him to find his mission in life. 
Another veteran, Mr. D was referred to our Center with a history of alcohol and drug abuse. He saw no real meaning and no reason to continue to live. He had been released from prison for "snorting coke" and selling the drug to support his habit. His chemical and alcohol abuse prevented him from being able to maintain any stability. He, too, had traumatic experiences, and in order to avoid responsibility for his life, he medicated himself with illegal drugs and alcohol. The psychological addiction became overwhelming at times, but he saw himself as a "weakling" if he requested assistance. His father had always told him that a macho man can take care of himself and to receive help denotes inadequacy. The father had been strict and the son could never live up to his expectations. The father had told Mr. D that "he would be a nobody all his life." 
At first, Mr. D felt it was too simple, that "anybody can do that." But he became aware that he could never live up to his father's expectations, that he had a value conflict between responsibility (outer guidelines from parents, etc.) and responsibleness (inner guidelines from his conscience).Even though he intellectually knew that he had to do what was best for him on a spiritual level, he was unable to accept this discovery emotionally. When asked how long he had felt trapped, he responded that he had felt that way for years. The logotherapist informed him that people in emotional pain wish for someone to eradicate the pain immediately. To avoid despair, he needed to reach out beyond himself and select daily goals, and live each day as meaningfully and productively as possible. 
In his logotherapy support group Mr. D shared with peers problems that he faced at the fast-focx:i restaurant where he worked. He validated similar problems experienced by his peers and clarified appropriate choices to avoid future mishaps. Being of service to others at work assisted him to feel that he was making a contribution to society. In turn, he gained personal identity through his employment. He knows he can develop meaningful relationships with others who have similar values, but he is not emotionally ready to apply this knowledge. This is a long-term goal. Mr. D is reminded periodically that he is progressing very well in search for a meaningful life despite his desire to return to drugs when feeling discouraged. He also knows that he is a recovering alcoholic and chemical abuser for the rest of his life, and this intimidates him. But with the continued support of the logotherapy group and one-to-one meetings with the logotherapist whenever he feels the need, he may continue to achieve higher values. 
Other ex-prisoners have been referred to the logotherapy program. They are provided with similar approaches to lay a foundation to search for a meaningful life. at their own pace. 
ROSEMARY IIENRION, MSN, MEd, RN, CMP is psychiatric clinical nurse specialist at the VA Center, Biloxi, MS. This article reflects the author's personal views and in no way represents the official view of the Department of Veterans Affairs or the U.S. Government. 
Logotherapy and Nursing Practice Charlotte Stefanics 

Nurses have a unique opportunity to use logotherapy for patients experiencing major life changes because of terminal or chronic debilitating illness.They assist these patients to cope but more is needed to help patients accept the new challenge and, where possible, recover. 
Nurses use their broad scientific knowledge in the care of patients and their families. But in teaching staff nurses I stress the holistic concept of the human being as an entity of mind, body, and spirit. I teach in small groups because they are conducive to learning, gaining insights, and personal growth. We discuss their spiritual and ethical values and philosophical beliefs about illness, suffering, and death. Also discussed are the logotherapeutic assumptions about the human being: the uniqueness of each person, the innate need to make sense out of the absurdities of life, the freedom to choose and find meaning under all crcumstances (within the limits of heredity and environment), the demand quality of every situation. Nurses see that many patients choose not to respond to life and grow. As health-care professionals they realize that exploring the spiritual aspects can help patients search for meaning in whatever is their situation. 
We discuss the mixed messages we receive in our society, specifically that sickness and suffering are intrusions into our lives and should be eliminated at all costs. We talk about the existential vacuum and the attempts to fill it with alcohol, drugs, sex, and fantasy thinking which leads to existential frustration. Nurses learn to accept their responsibility to assist those in their care to find answers to their "why.me?' or "what have I done to deserve this?" Patients have to be guided away from the belief that bad things happen to bad people, therefore I must be bad and worthless to deserve this suffering. This provides nurses the opportunity to influence patients toward attitudes that will help them find the meanings of the moment and gradually, with encouragement, find meaning through acceptance of the unavoidable. 
Many patients live in the hope that they will be better because they need relief from their painful situation. Nurses can use this hope to assist the patients to live in the present and search for alternatives in how to live with a chronic disability or to accept death -and live as fully as possible in the process of dying. 
Nurses have many opportunities to know their patients as persons, listening to them describe their lives. They help patients take a positive attitude in a deplorable, unchangeable condition. Patients are helped to discover within themselves motivation to search for meaning. They learn acceptance of a situation because they choose curative ways to deal with life and go on despite all odds. Nurses assist patients to accept the responsibility to change the situation where possible, and to change their attitude where not. Patients are encouraged to realize that they are still useful in regard to the tasks they can undertake. To be useful is to feel necessary to someone or something, to self-transcend. 
Attitudes Make the Difference 
It is not an easy task to assist individuals to find meaning in situations that seem meaningless. Mr. C., 60, had to have a permanent colostomy because of a cancerous growth. He had cardiac and pulmonary problems which were stabilized, and he did have a successful ostomy surgery. But he held the rigid belief that having a colostomy was the worst thing that could ever happen to him. His inability to accept change and still be a person despite the ostomy resulted in a deep depression, deterioration of his physical stamina, and he died six months later. Yet Mr. A. who became paralyzed from an accident was able to accept responsibility for his life in a new way when he realized that he had a choice about how he wanted to continue. 
Nurses can help patients, through self-discovery and dereflection, choose an attitude of acceptance of their illness and sufferings, and live a full-quality life despite unavoidable limitations. In this way they may be able to conserve health and control symptoms of their patients' illness. Control of the situation usually emerges through self-discovery. The freedom to choose an attitude toward a changed situation gives patients the strength to deal with life on a day-to-day basis. Nurses who validate patients' personhood, help them to recognize their selfworth and to grow from their life experiences. Patients may have to make dramatic life changes because of debilitating illness and nurses who believe that meaning can be found for these patients will make every effort to assist them in their move to wellness. 
Rewards for the Nurses 
Using logotherapy concepts m nursing practice and teaching staff nurses is rewarding for the nurses themselves. They explore their own personal lives and grow from the feedback in the groups so they are able to give quality holistic nursing care to their patients. 
They develop an understanding of self-transcendence that results from their empathetic relationship with patients. Nurses learn the psychosocial aspects in their education. Logotherapy added to their knowledge gives them an excellent grasp of patients' responses to their life situation. Nurses then can work with patients to say yes to life and to gain the courage to deal with their pain and sufferings. 
Nurses who assist patients to explore their spiritual life will help them find value in their lives and their potential to grow as they choose positive attitudes toward their situation, even through the final experience of dying. Frankl' s ideas have profound meaning to nurses when he maintains that human beings are ready to suffer, on condition that their sufferings have meaning. Whenever one is confronted with an inescapable situation, whenever one has to face a fate that cannot be changed, just then one is given a last chance to actualize the highest value to fulfill the deepest meaning--the meaning of suffering. What matters above all is the attitude we take toward suffering. 
I have found that chronic debilitating illnesses and the process of dying opens patients for intervention. They hope that someone will help, yet want to find a comfortable, peaceful inner self. This gives nurses the opportunity to make every effort to help patients find their own answers to the "Why me" in the painful absurdities of life as it unfolds. Growth is movement toward acceptance and patients come to realize that it all has value and meaning because being human means to have choices. 
Patients with terminal or chronic debilitating illnesses may achieve spiritual assessment of their lives. When they share their thoughts and feelings, dereflection and self-discovery can help them find meaning, even if they never before considered life as valuable and themselves having dignity. 
Logotherapy concepts enhance the ability of the nurses to validate the patients as persons who have value, dignity, and deserve respect because they are unique human beings. The potential to grow is actualized by what happens when two humans (nurse and patient) come together in a special relationship--one who helps and the other who needs that special help. Both become different for having shared in the pursuit to find purpose and meaning in life. 
CHARLOTTE STEFAN/CS, Ed. D., R.N., is a mental health clinical nurse specialist at Seminole, Florida. 
Quotes from World Congress VII: 
"We usually don't know whether or to what extent logotherapy of any other therapy really helps in any given case. What we do get is an overall feeling for our work as a whole. Outcome studies have been ambiguous and contradictory because we usually have little or poor follow-up and conflicting criteria of success.... 
"That is why we must watch for serendipitous indicators of the status of past patients, clients, or counselees, and hope these will keep our spirits going in the noetic dimension to which logotherapy is dedicated. And why we must be constantly sensitive to signs of results we may not like--and must reflect continuously on what we can do better in the future." 
James C. Crumbaugh: "How Do You Know When Logotherapy Really Helps?" 
"Can an individual make a difference? The individual has great power, direct and indirect, deliberate, and as a byproduct of action. Not only do the individuals' actions affect their own perceptions and behaviors but this has a ripple effect on the way others perceive and react to them, on their functioning within a group, on the attitude of teachers, family, and classmates, and on the environment in which they operate. It is the defiant power of the human spirit that makes things happen. The direction in which this happening occurs is dependent upon one's attitude, the will to create a positive environment, and willingness to take responsibility for one's action. Self-esteem then becomes a by-product of meaningful behavior which in tum is a reflection of the interaction of the individual within the group and the group reaction to the individual." 
Bianca Z. Hirsch, "Evoking The Defiant Power In Children." 
Existential Vacuum in Grieving Widows 
Jay I. Levinson 

Little attention has been paid in the literature to the existential factors in bereavement. Perhaps because of social taboos, laypersons and mental health professionals alike seem to lack a clear understanding of the existential aspects of bereavement. Often widows are viewed as suffering from some form of "depression." Yet, if death is a natural part of life, and bereavement the normal response to the death of a loved one, how can we label and treat widows as "depressed," a term denoting clinical psychopathology? The label of "depression" implies that widows are coping with their normal existential grief in an inappropriate way, when indeed their reaction is appropriate given the severity of the stressor (death of a loved one). This study examines the existential components of bereavement as related to Frankl's existential vacuum. Additionally, results of the study are integrated with Frankl's concept of meaning in life and Kubler-Ross's concept of meaning in death into an existential model of bereavement. to assist clinicians in understanding and treating those in mourning. 
There are 12 million widowed people in the United States of which 85%, or 10 million, are women.1,11 Yet they are ignored as a potential treatment population by mental health clinicians unless they are diagnosed as "depressed" (a mental disorder) and most commonly treated for reactive depressions. Yct, as Frankl stated, "grief involves a transitional life state, ... a process of socialization to a new status.''9 
Bereavement is not a mental disorder as some clinicians believc. 12 Rather, it is a psychologically normal process of transition, growth, and the ability to discover new meanings. 
Frankl believes our suffering becomes meaningful as we take a stand toward it--showing our ability to self-transcend, detach ourselves from our predicament and change our attitudes. This way we can accept fate and add deeper meaning to our 1ives. 10 In fact, Frankl reserves the noblest appreciation for those who, "deprived of the opportunity to find meaning in a deed, in a work, or in love, by the very attitude they choose to this predicament, rise above it and grow beyond themselves. What matters is the stand they take--to transmit their predicament into achievement, triumph, and heroism."8,10 
Frankl views our will to meaning as our primary motivational life force. 10 It is the key to resolving the existential 
issues of bereavement. Lopata recognized this when she stated "the overwhelming proportion of widows who recognize or admit changes in their personalities or identities consider themselves fuller and freer people than before the death of their husbands."13 The need for further investigation is clear. The large numbers of widowed in this country, and throughout the world, deserve more attention concerning the relationship between existential vacuum and bereavement. 
Among the v.ariables included in this study were the educational level of the widow, forewarning of her husband's death, employment, age of the widow, her need for a meaning orientation, socially reinforced denial, and previous experience with bereavement. 
Education .Lopata found that more highly educated women more easily adjusted to widowhood. 13 Higher educational levels broaden their socialization experience and help them find meanings outside of the spousal relationship. 
Forewarning . Some researchers3.5,12 found that a forewarning of the husband's death was a mitigating factor in the widow's adjustment. It gave the couple time to psychologically work through the dying process. Others11 reported that forewarning of the husband's death inhibited the grieving process. It gave the widow time to rebuild her defenses, especially those of denial, and inhibited her desire to discuss and work through their feelings. 
Employment and Age .Also ambiguous in the literature is the effect on bereavement of employment and age of the widow. Pihlblad14 stated that employed widows adjusted more easily. Carey4 found that employment was not statistically significant. As to age, Ball3 found that younger widows suffer more severely while Abrahams1 stated that both older and younger widows have unique age-related problems. 
Meaning .The widow's socialized need for meaning orientation is not discussed in the literature. Frankl indicated, however, in private discussions, that meaning is a significant part of the American socialization and would influence test data. 
Socially Reinforced Denial has not been mentioned in the literature. The effects of a widow's individual level of denial are well defined by Kubler-Ross.12 My own experience, however, suggests that denial is complicated by the fears and anxieties of the widow's social environment. 
Previous bereavement was defined in this study as experience of mourning the death of a family member or a close friend, within three years of this study. This was considered 
ample time for resolving the previous bereavement process. Variables not included in this study were socio-economic level and the IQ because available data was vague. 
The living situation of the widow was omitted because previous researchers agreed that, whether a widow lived alone or with others, each situation presented unique problems for her. 
The research approach of this project was that of a descriptive study. Its quasi-experimental design included correlations between scores on the Purpose-in-Life Test (PIL) and specific variables deemed important from the literature. 
The independent variable used was the Purpose-in-Life Test, "an attitude scale designed to measure the degree to which a subject experiences a sense of meaning and purpose in life."7 Additionally, each subject was rated for observable signs of presence or absence of existential vacuum, need for meaning orientation, and social denial. 
The following data-gathering procedures were used: subjects were contacted by phone to establish willingness to participate in the study; the necessary consent forms were signed; PIL was administered while subjects were left alone; demographic data was taken; the widows were interviewed concerning presence or absence of existential vacuum, need for a meaning orientation, and social denial; and were asked for "other relevant information." Subjects were selected by invitation. True random samples were not possible because widows live in a highly private world and are extremely resistant to investigation. Some resisted because of the social stigma associated with widowhood (93% of those interviewed expressed this idea), and because widows are susceptible prey for all kinds of solicitors. Many participants asked to be able to validate our study as legitimate, institutionally authorized research before they agreed to particpate. 
PIL scores were summed, and mean and standard error of the mean determined. Compared were the means of the subjects with the means of Crumbaugh' s patient (m=92) and non-patient (m=l 12) populations, using the t-test method. Crumbaugh and Maholick stated that the "range of raw scores from 92 through 112 ... represents somewhat uncertain definition. Raw scores of 113 or above suggest the presence of definite purpose and meaning in life, while raw scores of 91 or below suggest a lack of clear meaning and purpose."6 
Correlational formulas were performed between the variables examined and PIL scores. Pearson Product Moment scores were derived for the interval data collected on the variables of age, education, and length of bereavement. Point Biserial scores were derived for the dichotomous data collected on the variables of employment status, forewarning of death, previous bereavement experience, social denial, and need for a meaning orientation. Correlations were interpreted at the p<.05 level of confidence, n=30. In addition, criteria were developed to rate data pertaining to the observable presence or absence of existential vacuum, meaning need orientation, and social denial. Each set of data pertaining to these variables from a given subject was rated according to established criteria by this researcher and an independent reader. A reliability coefficient of 1(X)% was determined overall. 
Participating in the study were 30 widows, age 28 to 76, with a mean age of 56.1 years. They were relatively well educated with a mean last-grade completed of 13.23 years. One widow had a doctoral-level degree, three had masters, three bachelors, and several at least some college education. The range of last-grade completed ran from 6 to 21 years; length of bereavement from 3 to 12 months, averaging 7.8 months. 
In regard to nonparametric variables, 46.67% were regularly employed; 43.33% had suffered a previous bereavement within the previous three years; 33.33% had known for more than two weeks that their husbands were suffering from terminal disease; and 93.33% said it was important for them to have well defined meaning in their lives. Only two widows did not feel that meaning was a necessary quality. Feeling external pressure to deny the grief trauma was reported by 93.33% of the widows. This socially reinforced denial took many forms, including feelings of isolation, inadequacy, rejection, and feeling like a burden to others. Many widows reported this social denial as the most painful part of the bereavement experience.Additionally, 80% of the widows manifested clinically observable levels of existential vacuum. 
The mean score of the total sample on the PIL was 
104.5. The standard error of the mean was 4.09. There was a statistically significant difference between the mean score for the widows in our study (104.5) and the mean score for patient 
(92.0) and nonpatient (112.0) populations in Crumbaugh. These differences are significant to the p<.05 level of confidence. 
The variable of education was also significant to the p<.05 level of confidence. However, the variables of age and length of bereavement were not statistically significant. 
Correlations between the nonparametric variables and PIL scores showed that employment status, previous bereavement, and social denial were not statistically significant. 
On the other hand, the variable of forewarning of death was statistically significant to the p<.05 level of confidence. Widows with such forewarning had a significant correlation of r=.533 with their PIL test scores. That is, as PIL scores increased, so did the number of women who had more than two weeks forewarning to prepare for their husband's death. Education was also statistically significant, yielding an r=.376, p<.05. This suggests that widows with more education obtained higher PIL test scores. The socialized need for meaning orientation was also significant at the .05 level of confidence, r=.461, indicating that widows with internalized meaning needs scored higher on the PIL test than those who expressed no such need. 
The significant difference between the mean PIL score for widows (m=104.5) and that for Crumbaugh's patients (m=92) suggested that the widows did not suffer from the same level of existential vacuum as psychiatric patients. On the other hand, the significant difference between the mean score for widows and the nonpatient population (m=112) suggested that the widows did not have a clear sense of meaning in life. Therefore, it can be hypothesized that widows possess a unique level of meaninglessness which is neither normal nor pathological. 
Grief, therefore, must be considered a nonpathological part of the life cycle. This contradicts those mental-health professionals who defined mourners as suffering from "depression."12 The widows obviously experienced existential emptiness from the loss of a loved person. The symptoms that are being mistakenly interpreted as pathological depression, such as crying, sadness, sleeplessness, lack of appetite, and apathy are signs of existential vacuum, as defined by Frankl.8,10 This is perhaps the most significant finding in this study. 
The lack of significant relationship between existential fulfillment and age, employment status, previous bereavement, and length of bereavement is in line with other current research data which is ambiguous. This may be due to the measures currently available on existential traits. Also, poor instrument validity is certainly a contributing factor, as are the resistances manifest within the psychological trauma of widowhood. 
The high correlation of PIL scores with forewarning of death (r=.533, p<.01) suggested that those with time to emotionally resolve their fears, thoughts, and feelings about the dying process found this experience emotionally rewarding. Frankl: "What mattered ...is the stand a patient takes toward his predicament, the attitude he chooses towards his suffering."8 It is for those who can find meaning in suffering that logotherapy reserves its "noblest appreciation."8,10 
The significant correlation of educational levels with PIL scores suggests that educated widows are more able to draw on meanings from resources outside the marital relationship. They experience the world more fully than those less educated, and are not quite as devastated by the loss of one source of meaning. These women are able to see things outside of the marriage relationship as meaningful also. 
The internalized need for a meaning orientation, a statistically significant finding of this study, confirms Frankl's notion that the will to meaning is, indeed, a primary motivational force, even in times of severe emotional trauma. The presence of meaning orientation is the highest value in one's ability to discover meaning. 
Widows with a need for meaning orientation may have taken the first step toward readjustment to bereavement . They have begun to discover the myriad of meanings available to them outside the marriage relationship. Widows with meaning orientation, though still experiencing the emotional traumas of widowhood, were closer to existential satisfaction and normal meaning levels as measured by PIL. 
Another possible interpretation of the need for meaning orientation appears relevant. Because many American women find meaning largely within the marriage relationship, they often rely on fewer and fewer extraneous sources of meaning. With the death of the spouse, meaning discovery from marriage is lost, yet the need for discovery persists. This further complicates the widow's adjustment and probably explains her commonly observed need to do things the way her husband had done them. She suppresses her own needs and feelings and replaces them with intellectualized defenses, which are not existentially satisfying. 
Another finding of interest was the high proportion (93.33%) of widows who felt the pressure of social denial, i.e., the verbal and nonverbal feedback from their social environment to "recover" from the bereavement quickly. The social ostracism these women encounter as those around them become emotionally intolerant of their bereavement, seems to increase their need to suppress. One might hypothesize that this complicates the bereavement process even further because of the existential vacuum created by the gap between socially acceptable behavior and true bereavement feelings This would inhibit the expression of normal bereavement and, therefore, prolong recovery. 
From this study I developed a bereavement model, integrating models previously published on the meaning of life and death. The stages of my model are Denial, Anger, Normalization, Existential Vacuum (Meaninglessness), Acceptance, and Existential Resolution. 
Denial has been expertly defined by Elisabeth KublerRoss12 as a phase of emotionally refusing to believe that death has occurred. Kubler-Ross has pioneered the field of thanatology and her contributions, often quoted here, are extraordinary. As presented in this study, the social reinforcement of denial by nonmourners is a complicating factor. Behavioral examples of denial include asking for confirmation, refusing to deal with funeral arrangements, hearing the dead person's voice, doing things the way the deceased did them, and refusing to dispose of his clothing. Bargaining to exchange places with the dead or for a return to life is also common. Some authors view this as a separate stage12 but it would be another form of denial as one is bargaining for afait-a-compli.. 
Anger, too, has been sufficiently documented by KublerRoss.12 It may be directed toward doctors, hospital staff, friends, God, funeral directors, or oneself (guilt). Though there is often anger toward the deceased, this is suppressed. This anger toward the deceased, which is socially unacceptable, is paradoxically expressed through canonization. Mourners place the deceased on a saintly pedestal of perfection. Since people do not get angry at "saints," the anger gets displaced onto "safer" targets. This may take the form of unconscious anger expressed towards friends and family. The deceased has now been stripped of his human and sometimes imperfect qualities, thus inhibiting the grief process. Canonization can also be tied to psychological denial as manifestation of belief in an afterlife. 
Normalization, the third stage of this model, is discussed by Astin: "Widows have needs to recognize the 'normalcy' of what she is experiencing, which includes her getting the message that she'll make it through the process and that she isn't a failure, crazy, or inadequate in human relationships."2 Normalization is best accomplished by individuals or groups of widows sharing their common, and often painful, experiences. Widows find solace in the shared understanding and support of self-help groups. 
Existential Vacuum, or Meaninglessness, is a unique contribution of this study to the literature on bereavement. Our 
results indicate that feelings of emptiness, sadness, and apathy are reflections of the unique level of existential vacuum found in this study. The natural ending of life and the experiencing of it by the survivor must be seen as a normal part of the life cycle. Therefore "depression," as this stage is often described in the literature, is actually inapplicable because it is a clinical term denoting psychopathology. The statistically significant difference between the widow's level of meaninglessness and that of Crumbaugh's psychiatric patients, further supports this notion of nonpathology. 
Acceptance of the death of a loved one is always difficult. Yet, it is essential in order to move toward resolving the existential crisis. Frankl stated, "we must accept our destiny as we accept the ground on which we stand--the ground which is the springboard for our freedom."8 The acceptance stage as defined by Kubler-Ross is neither happy nor sad.12 It is devoid of feelings, a passive acquiescence to one's "tragic triad of human existence; pain, guilt, and death. "8 
Existential resolution.. If the despair of grief is related to the apparent meaninglessness of bereavement then bereavement is resolved through existential resolution. This is the primary task of logotherapy. According to Frankl, the major role of the logotherapist is to bring the whole spectrum of meanings and values into the despairing person's consciousness.8 Often those suffering from this form of existential vacuum cannot discover the many meanings available to them. 
Frankl tells the story about the doctor who was in despair after the death of his wife. When Frankl pointed out to him that he had spared his wife the kind of suffering that he was experiencing, the doctor immediately had some sense of resolution. He discovered something meaningful within his suffering, and much of the suffering ceased. Other examples of existential resulutions include new relationships, jobs, and the ability to positively view the single-again-woman role as an experience with potentials rather than sufferings. One may conclude that, indeed, the suffering of bereavement can be resolved existentially. 
This study was basically hypothesis forming. Well defined experimental conclusions were impossible because of problems in methodology, sampling, existential psychology, and availability and validity of objective measures. Presented here is our best academic understanding of several difficult areas of study. It is my hope that this study will encourage colleagues to expand on the ideas presented. 
One area that needs further study is that of data gathering. More objective measures with higher validity need to be constructed, in such areas as measuring existential vacuum, socially reinforced denial, the need for meaning orientation as a motivational force, and the relationships of these areas to bereavement. Investigation of widow's resistances to research is also important. Until truly randomized samples can be obtained, data on widowhood will be suspect. 
Other forms of bereavement need to be studied. The death of a child, parent, grandparent, and sibling bring unique kinds of suffering. The role of existential vacuum in these experiences may get clinicians further insights into resolution of these existential traumas. 
JAY I.LEVINSON, Ph.D. is a licensed psychologist in private practice in Baltimore, MD. He has taught at University of Maryland School ofMedicine and the Johns Hopkins University Graduate Education Division. He is the founder ofthe Baltimore Ronald House. 
REFERENCES 
1. 
Abrahams, R.B. "Mutual Help for the Widowed." Social work, 11(5), 1972. 

2. 
Astin, A.L. "Counseling "Single-Again"(Divorced and Widowed) Women". The Counseling Psychologist, 6.(2), 1976. 

3. 
Ball, J.F. "Widow's Grief: The Impact of Age and Mode of Death." Omega: The Journal of Death and Dying, 1(4), 1976-77. 

4. 
Carey, R.G."The Widowed: A Year Later. Journal of Counseling Psychology, 242, 1977. 

5. 
Clayton, P.J., J.A. Halikas, W.C. Maurice, and E.Robins. "Anticipatory Grief and Widowhood," British Journal of Psychiatry 122(566), 1973. 6..Crumbaugh, J.C. and L.T. Maholick. "Manual of Instructions for the Purpose-In-Life Test." Indiana, Psychometric Affiliates, 1969. 


7. 
Durlick, J.A. "Relationship between Individual Attitudes towards Life and Death," Journal of Consulting and Clinical Psychology,~ (3), 1972. 

8. 
Frankl, V.E. Man's Search for Meaning. NY, Simon and Schuster, 1962. 


9. __. Psychotherapy and Existentialism~ NY Simon and Schuster,1967. 
10.__. The Will to Meaning. NY, The New AmericanLibrary, 1969. 
11. 
Glick, 1.0., R.S. Weiss, C.M. Parkes. The First Year of Bereavement. New York, Wiley-Interscience, 1974. 

12. 
Kubler-Ross, E. _On Death and Dying. NY, McMillan Co.,1969. 

13. 
Lopata, H.Z. "Self-Identity in Marriage and Widowhood." Sociological Quarterly, 14(3), 1973. 

14. 
Pihlblad, C.T., D.L. Adams, and H.A. Rosencrans. "Socio-Economic Adjustment to Widowhood." Omega, J(4), 1972. 


Moral Judgment and Meaning in Life 
Moshe Addad and A vraham Leslau 
Our study examines the relationship between Frankl's concept of meaning in life and moral judgment. Frankl's9,10,11 basic assumption is that the human being is an entity comprising body, soul, and spirit. The spirit includes everything unique to humans -existential meaning, freedom of choice, conscience beyond superego, moral obligations, ideas and visions, creativity, imagination, love above the physical, sense of humor, and faith. 8,14 According to Frankl, it is through conscience that we conceive the meaning of a situation. We find meaning and purpose when our moral behavior is guided by conscience rather than by selfishness or learned norms. 
In contrast to the cognitive-structural approach, which stresses logic and reasoning in reaching a moral judgment, we hypothized that moral judgment is affected by the development, conditioning, and imitation of the individual.1,2 Further, that conscience (in Frankl's sense) is undermined when the egoistic or normative dimension is most salient, and is reinforced when the human dimension prevails. Thus, the moral act gains meaning when moral judgment is freely governed by intuitive choice of human obligations. We contend that the degree to which humans find meaning is related to the prevalence of the human (noetic) dimension in their moral judgment. 
In constructing a personal profile of moral judgment dimensions, we followed Baruk's2,3 distinction between the following five categories: 
•Self-interest 
judgment representing egocentric judgment based on calculation by one's own needs. To achieve goals, all means are perceived as fair. This class of judgment parallels Kohlberg's13 preconventional stage and the heteronomous level described by Bull4 in which fear leads to obedience. 

• 
Normative judgment , dictated by the individual's needs and directed by society's immediate "commands." The individual guided by such a thought process firmly believes that moral judgment is primarily expressed by the needs and demands of society (e.g. social norms).This represents a socially based egotism, in contrast to the personal egotism which directs judgment motivated by self-interest. This class of judgment parallels Kohlberg's conventional stage and Bull's socionomous level.13.4 

• 
Humane judgment , based on the view that humans are the center of group existence and that justice is superior to all other values. Baruk claims that this type of judgment is based on "a feeling for universal humanity": every human being is entitled to just treatment, regardless of age, race, or religion. This type of judgment is directed "by the deep feeling that the social order is meant to serve the individual in society." Right, loyalty, justice, and mercy unite and direct the process of justice. Such judgment is in accord with Kohlberg's postconventional stage and Bull's autonomous judgment level. 13.4 

•Ambivalent 
judgment incorporating a conflict between humanistic judgment and the two classes of egotistic judgment above. An array of personal and group needs is pined against the value of justice, with no clear-cut decision forthcoming. 

• 
Absence ofjudgment, a lack of personal judgment.The individual does not choose one of the above four judgments but rather responds with a simple confirmation of facts unaware of the existence of an internal confrontation of values or human needs. Such judgment is devoid of personal validity and is directed by rituals of thought and behavior. It indicates alienation from one's environment or a pathological trait in the person's judgmental process. 


A person's judgment profile may be determined by assessing the relative frequency of the classes of judgment chosen in response to a variety of moral dilemmas. Our study examines the correlation between meaning in life and moral judgment in criminal and noncriminal populations and in several socio-demographic subpopulations. 
Method 
Subjects. Our sample consisted of 532 subjects -88 male criminals and 444 male and fem ale noncriminals. The average age of the criminals was 25; about half had an elementary education, 40% had attended high school, and 10% had received a higher education. Most of the noncriminals were university students or high-school teachers. Other socio-demographic data are shown in Table 1. 
Measures. We used three questionnaires. One elicited socio-demographic data; another, based on Baruk's2 proposed set of moral dilemmas, assessed moral judgment; the third, a Hebrew translation of the PIL test5,6,7 measured meaning in life. Because the PIL test is known to Forum readers, only the moral judgment questionnaire is discussed here. 
The moral judgment questionnaire consists of a set of 16 dilemmas describing situations of moral conflict. The dilemmas were modified as to be relevant to modem Israeli society and their reliability was pretested. Each moral dilemma was followed by five possible solutions (corresponding to Baruk's five classes of moral judgment), plus a sixth open alternative Subjects were asked to choose among the listed solutions and, where none was perceived as appropriate, to offer a personal opinion. The open-ended answer was assigned by three raters to one of the fives modes of judgment.Where the raters disagreed, the data was not included. The follwing is a sample question: 
Reuven is walking along the road when he notices the enemy Simon lying injured on the pavement. Simon cries for help. Reuven refuses to give assistance and makes no effort to get Simon to a hospital, on the grounds that this is his opportunity to take revenge on his enemy. What is your view of Reuven's conduct? Choose one of the following opinions only after having read all . Or you may express your view in your own words. 
a. 
Reuven's behavior was shameful. An injured person should be given help no matter what the circumstances, even if he is one's enemy. [Humane judgment]. 

b. 
Reuven was incapable of extending help to Simon, since he was no longer his friend. This is the way people think, speak, and act. [Normative judgment]. 

c. 
What Reuven did was right. It was good that he gave no help to his enemy and in this way got rid of him. [Selfinterest judgment]. 

d. 
That's the way Reuven acted and took revenge on his enemy. [Absence ofjudgment]. 

e. 
It all depends on what Simon had done to Reuven. Maybe Simon killed Reuven's wife or had a hand in causing her death, so that Reuven was right in not helping. However, if the hostility between them was the result of an old debt or the like, then Reuven's behavior was not right. There are two sides to the story. [Ambivalent judgment]. 

f. 
If none of the above categories seem appropriate, note your own opinion________________ 


A score for each subject with respect to each judgment class was arrived at by dividing all responses within that class by the total number of answers given. For example, if a subject gave a humane judgment in 12 out of 16 dilemmas, the humanejudgment score would be 12/16 =0.75. For the purpose of our study the humane-judgment score is considered the moral judgment score. 
Procedure. The three questionnaires were administered as a single unit. Subjects responded individually without assistance, except for general verbal instructions at the beginning of the interview and repeated in the questionnaires.Subjects were told they were part of a random sample and the purpose of the questionnaire was to examine their attitudes, feeling, and thoughts. They were assured anonymity and permitted to place the completed questionnaire in a pile in any order they chose. They were informed that it was impossible for the researcher (or, in case of the criminals, the prison authorities) to trace any questionnaire to any individual. The questionnaires were administered to the prisoners in a private interview with one of the authors or one of three assistants, or in a group in which each subject answered individually. The questionnaires were administered to the noncriminals in small groups of four or five. 
Data Analysis. It seemed unlikely that the relation between PIL and moral judgnment would be fully linear. This correlation was more likely to be apparent at high and low levels of each variable, and more ambiguous in the middle. Accordingly, subjects were divided into low, medium, and high for each variable. PIL scores were divided into low ( 1.00 4.50), medium (4.51 -6.00), and high (6.01 -7.00) levels, a grouping similar to that suggested by Crumbaugh and Maholick,7 and moral-judgment scores were divided into low 
(0.00 -0.44), medium (0.45 -0.80), and high (0.81 -1.00). Both these divisions create a smaller range for the high and low scores (because a PIL score of less than 3.50 and a moral judgment score of less than 0.25 are rare) than for the middle scores, and avoid empty categories for all investigated groups. The association between PIL and moral judgment was measured by Gamma which measures the relative reduction in errors of predicting the order on the two variables.12 
Results 
Table 1 presents Gamma scores for noncriminals by gender, age, education, and religiosity, and for criminals. For noncriminals, a substantial positive Gamma emerged for both genders, for all ages and educational levels, and for two of the three levels ofreligiosity. The only exception was the almost nil Gamma for noncriminals who considered themselves traditional (observing some but not all the Jewish traditions and rituals). Of greatest interest is the similarity between the results for these subgroups and those for the criminals. This is an unusual finding because of the expected differences in psychological and sociological traits between criminals and noncriminals. 
Unfortunately the small number of criminal subjects prohibited investigation among more detailed subgroups. 
The consistency of the findings across almost all the socio-demographic groups substantiates the expected relation between PIL and moral judgment, This provides evidence that people with a high level of humane judgment tend to experience high existential meaning in life while those with a low level of humane judgment experience low existential meaning. 
Table I 
Gamma Scores of the Relation Between PIL and Moral Judgment for Various Socio-Demographic Groups 
Non(..Ti.minals Gamma N* 
Gender Males .366 262 Females .305 182 Age Less than 21 .470 58 21 -30 .232 242 Over30 .340 144 Education 8-12 years .516 80 13 years or more .284 206 Religiosity Religious .460 168 Traditional .004 111 Nonreligious .407 151 
Criminals Males only .412 88 
* Totals differ for each variable because of missing data. 
Discussion 
Moral judgment based on the principle of universal human justice requires detachment from personal and social egoism. Similarly, the ability to find meaning in life requires detachment from instinctual needs and the development of conscience through one's noetic dimension. Our study reveals a significant relation between these two characteristics of the individual across several socio-demographic groups. Relation between levels of moral judgment and meaning in life held for males and females regardless of education or religiosity, and for criminals and noncriminals. The comprehensiveness of these findings suggests that it reflects a true relationship. 
Frankl believes that both the instinctual and the spiritual are buried in the unconscious. Moral development that aims to free us from individual and social egotism is difficult to motivate. The intuitive aspiration for meaning is a primary force that can influence us to base our moral judgment and behavior on the principle of universal human justice. Attainment of this level of moral development helps us find purpose in life and avoid the experiencing of an existential vacuum. 
The findings of our study have practical implications for educators, psychologists, and psychiatrists regarding the development of unique methods of moral development. Specifically,they suggest that humane judgment and behavior can be reinforced by reference to the student's, patient's, or criminal's aspiration for meaning in life. 
MOSHE ADD AD is professor, Department ofCriminology, and AVRAHAM LESLAU is lecturer, Dpt. of Criminology and School ofEducation, Bar-llan University, Ramat-Gan, Israel. The authors are listed in alphabethical order. They acknowledge the assistance by Alina Korn and Helene Hogri, and give thanks to the Schnitzer Foundationfor Research on the Israeli Economy and Society for its financial support. 
REFERENCES 
1. 
Addad M. and M. Benezech. :"Moral Judgment, Extroversion, Ncuroticism, Delinquency." L'Evolution Psychiatriquc ,,51, 1987. 

2. 
Baruk, H. Tsedek, Binghanton, Swan House Publ., 1972. 

3. 
__, La Psychiatrie Sociale. Paris, Presse Univ. Francaise, 1982. 

4. 
Bull, NJ. Moral Judgment from Childhood to Adolescence. London, Routledge & Kegan Paul, 1969. 


5.Crumbaugh, J.C. "Cross Validation of PIL Test based on Frankl's Concepts(' J. of lndiv Psychology,.11._1968. 
6. 
____ and R. Henrion. "The PIL Test: Administration, Interpretation, Uses Theory and Critique." Intern. Forum for Logotherapy, 11, 1988 

7. 
____ and L.T. Maholick. "An Experimental Study in Existentialism," J. of Clinical Psychology, 20, 1964. 

8. 
Fabry, J.B. The Pursuit of Meaning. NY, Harper & Row, 1979. 

9. 
Frankl, V.E. Man's Search for Meaning. Boston, Beacon Press, 1959. 

10. 
____. The Unconscious God. New York, Simon & Schuster, 1975. 


I 1. ____. The Unheard Cry for Meaning. New York, Simon & Schuster, 1978. 
12. 
Goodman, L.A .. and W.H. Kruskal. "Measures of Association for Cross Classification,: J. Amer. Statistical Assoc., ±2_, 1954. 

13. 
Kohlberg, L. "Moral Education for a Society in Moral Transition." Educational Leadership, .5,Q. 1975. 

14. 
Lukas E. Meaningful Living. NY, Grove Press, 1984. 


Quotes from World Congress VII: 
The use of humor as a therapeutic tool implements the defiant power of the human spirit in disagreeable situations. When one is mired in a situation which, taken seriously, would lead one to becoming depressed or almost suicidal, the laughing at the fate becomes a survival tool per excellence. One remains fully cognizant of the adverse implication of the tragedy, but at the same time is able to transcend the circumstances, neutralizing them with a bit of levity. The alternative is either being driven to insanity by the terrible circumstances or remaining sane by refusing to let the circumstances make the individual buckle. In this context one can understand how the Jewish people have been able to survive over thousands of years of protracted exile, vilification, and social ostracization. At the same time, as the implications of their tragic history were confronted seriously, they also were able to compartmentalize their concerns into the intellectual motive sphere, and on another level make jokes about their fate. 
Reuven P. Bulka, "Jewish Humor -a Logotherapeutic Tool ofSurvival." 
If the horrors of Auschwitz and Treblinka were born in the philosophy of nihilism, then a more noetic understanding of the human being was born in the philosophy of logotherapy. Let us hope that rehumanization of our fellow man or woman is contagious. And let us hope that sufferings bravely borne are respected as one of the highest possible human achievements. 
Jerry L. Long, "World View and Meaning in Life 
A sense of futility, of meaninglessness, helps ignite and fuel an eating disorder, The anorexic and bulimic spend more and more time reflecting on themselves and their condition, and therefore depart from a sense of mission to others or to a cause. They thus move from self-esteem to hyperreflection, immobilization, self-destruction. And they move from a search for meaning to a plan of control. Logotherapy is the treatment of choice for eating disorders because it addresses the remedy for this particular addiction -restoring the meaning quest. 
Paul R. Welter, Logotherapy, Treatment ofChoice with EatingDisordered Clients. 
The Meaning of the Moment 
The Logotherapeutic Dimension of Everydayness 
Sandra A. Wawrytko 
In every successful movement there are the inaugurators and disseminators. While the first group provides the original stimulus, the latter carries it forward. Often the movement is taken beyond the scope and intention of the initiator, channeling it into many grassroot channels which insure growth and continuation. 
The line between these roles is never clear. Inaugurators often act as disseminators, otherwise they could never attract key disciples. Similarly, disseminators often have insights of their own to add to the ongoing flow of thought, as well as infusing inspiration. This situation holds true for Viktor Frankl and Joseph Fabry, one of Frankl's early disseminators. Each crosses roles in their support of logotherapy, and each pursues a single goal with a unique style and emphasis. 
The complementary nature of their approaches is clear in their key texts. Whereas Frankl institutes a "search" for meaning, Fabry provides the follow-through by proposing a "pursuit." In Man's Search for Meaning,.4 Frankl extends his experience of Nazi death camps into a theoretical explication of logotherapy, speaking alternately as a psychologist and a human being who has both suffered and self-transcended. In The Pursuit of Meaning3 Fabry draws upon the experiences of a variety of individuals, including Frankl, to discuss logotherapy's practical implications. Theory is woven into the fabric of his prose, but is meant to support the main thrust of application. Frankl utilizes experience as a means to the end of theory, while Fabry has as his end practical guidance of which theory is the means. 
Frankl himself has pointed approvingly to Fabry's practice-based presentation of logotherapy. In his foreword to the revised edition of Pursuit Frankl lauds Fabry's contributions to group therapy, by "making logotherapy available to the general public," and providing a "popular presentation" of logotherapeutic doctrines and techniques.3 In his original preface, Frankl listed the well-accomplished goals of Fabry as popularization without vulgarization, simplification without oversimplification, and the Americanization of logotherapy. 
Having used both texts in a pedagogical context, I have long been fascinated by the reactions each evokes in its readers. 
Upon delving into Man's Search for Meaning,4 students report being gripped by the power of the narrative. They find themselves irrevocably drawn into one of the most hideous experiences human beings have ever undergone. It is indeed one of those rare books which, once begun, is almost impossible to put down. Some have long harbored a morbid curiosity about the camps, and now see them through the eyes of a survivor who is also a scientifically trained observer. Others, both Jews and non-Jews, have consciously avoided the subject of the holocaust, hoping to insulate themselves from this distasteful truth of modem history. Yet, none has ever expressed anything but gratitude for having been forced to confront, and come to terms with, reality. 
The explanation for the depth and universality of these reactions seems to be that, through Frankl's extraordinary text, we are able to see one man's crisis transformed into a commentary on the human condition. As in medieval morality plays, Frankl becomes Everyman, forced to submit to the most severe trials imaginable in the course of human life. In triumphing over these trials, he becomes a role model, his responses a standard against which we judge ourselves. The question that enters the mind of nearly every reader is: how would I have fared under similar circumstances? Would I prove to be among the "decent" or the "indecent" race of humanity? 
Yet it is precisely this self-transcending strength exhibited by Frankl in the direst of situations that requires Fabry's alternative approach. Reading about the camp experiences, the average reader is awed. Although we cannot resist comparing our own lives and characters to Frankl's, he graciously observes that, like gas in an enclosed container, one's suffering fills one's entire life, the obvious difference in degrees of suffering cannot be dismissed so easily. Most readers are thankful that they will never face crises of such proportions to simultaneously test their mettle and demonstrate the intrinsic value of logotherapy. So they naturally ask themselves, how then can any of this apply to me, living the life of an ordinary human being? 
Fabry's The Pursuit ofMeaning..3 aptly subtitled Viktor Frankl, Logotherapy, and Life, opens for the reader a new and much less arduous avenue to logotherapeutic truth within everyday life. Fabry brings the high-flown truths of logotherapy within the scope of the average person. The message of logotherapy is not thereby weakened, merely made accessible to human beings at a variety of levels and made relevant to their lives, however ordinary they may seem by comparison to Frankl's experiences. Fabry shifts our focus from the background of a sublime ideal to the foreground of immediate reality. 
The Meaning of the Moment 
If asked to choose the single greatest contribution that Fabry has made to fostering the dissemination of logotherapy, I would offer his exquisitely simple application of Frankl' s concept of "the meaning of the moment." Though Fabry devotes little space to explicating this concept directly,3-PP36-38 it remains a vital undercurrent throughout his discussion. In the course of his narrative he supplies the reader with many definitions for the meaning of the moment through anecdotal examples. The importance of this one conceptual device reflects the importance of Fabry's approach, as compared to that of Frankl. While the concepts of ultimate and unconditional meaning are indeed grand, it is their very grandiosity which may hinder many from coming to terms with logotherapy's concrete relevance. Persons, who are little versed in the skill of abstraction, may assume that such meaning is too refined for their mundane existence. In a similar way, many people mistakenly confine religiosity to the presumed sacredness of institutions and rituals, and fail to see the sacred dimension imbedded in the secular. 
In emphasizing the intrinsic logotherapeutic significance of the meaning of the moment, Fabry expands on logotherapy' s recognition of the uniqueness of every human being and casts it in the form of an invitation to personally take possession of and responsibility for one's meaning. To fully realize our unique potential for meaning, each of us must take account of our unique situation, its inherent opportunities and obstacles. Thus, meaning becomes my meaning within my life at this moment. My intimate relationship with that meaning is inconceivable under the sweeping heading of universal, unconditional meaning. 
Wider Access 
This need to offer a doctrine at more than one level, to widen our access, is common to other philosophies as well. For example, the traditional ideal in Chinese culture was the sage, whose behavior reflected a sublime level of wisdom. Confucius, however, was well aware that few, including himself, could attain these heights. Thus, he focussed on the ideal of the cjun tzu,2 the "profound person." Rather than succumb to the pessimism-steeped either/or of sage or immoral person, Confucianism explores the many shades of gray that exist in the moral character of human beings, optimistic that, through an ongoing process of self-cultivation, we may come ever closer to the exalted state of the sap:e without ever reaching it. Such also seems to be the intent of Kant's moral Aufgabe5 to act "as if' we were totally rational individuals, knowing that only God can reach this rarefied realm. 
The importance of the unique context for each individual's hearing the doctrine has been a matter of serious attention among Confucianists. Not all persons hear the same message, nor do they necessarily incorporate it into their lives in identical ways. Hence, Mencius teaches that the chun-tzu offers instruction for five reasons: 
There are some upon whom the teaching descends like timely rain upon parched earth; 
There are some whose virtue is perfected; 
There are some whose talents are developed; 
There are some whose questions are answered; 
There are some who privately cultivate themselves.6,P-56 
As teachers, then, we must sensitize ourselves to the meaning of the moment as it applies to each of our students, evaluating what is timely for them to hear and incorporate. 
Buddhism contains a parallel insight, contained in the Buddha's parting words to his disciples to work out their own enlightenment after his death ("Be lamps unto yourselves").1,P50 Theravadan monks set out to fulfill this directive by becoming Buddhas themselves, treading the "Hinayana"(Small Vehicle) path. However, in the Mahayana (Large Vehicle), Boddhisattva emerged as universal guide. A key of the Mahayana doctrine is the recognition that not everyone is able to become a Buddha in this life. As a result, the force of Buddhism was felt beyond the dedicated pathway of an elite, sequestered in monasteries, seeking ultimate Buddhahood. The Bodhisattva ideal led out of monastic seclusion into the secular world, inviting participation by those for whom Bodhisattvahood was a more immediately realizeable goal. And so the two yanas coexist to this day. 
Since the Buddha himself thought of his doctrine as a cure for the suffering world, it is no violation of his intent to view the difference between these Buddhist paths as the difference between individual therapy and group therapy. Either we work on our own problems in isolation, or undertake the same work with the support of and giving support to other sufferers. Both paths lead to the same end, namely realization and implementation of meaning in our lives. 
The meaning of the moment offers great potential for a comparison of logotherapy with the "everyday mindedness" of Taoism and Zen Buddhism. Like adherents of these philosophies, Fabry recognizes the fact of change, life's perpetual flux of life, which in turn allows for the possibility of growth and the corresponding need for a continual shifting of perspectives. Because every moment may be the bearer of meaning, our everyday life constitutes a hidden wealth of values, if only we know how to see those values. 
Hence, for the Japanese the potential for enlightenment was contained in a cup of tea, the shooting of an arrow, or even the deadly play of swordsmanship--all aspects of their everyday life. Each was raised to the level of art, reflecting a conscious cultivation of its latent meanings. Paradoxically, meaning emerges only when that cultivation gives way to spontaneous experience. In this sense, the cultivation process, the pursuit of creative tension, becomes the means to the end of spontaneity-the flick of the tea whisk, the twang of the released bow, the gleam of the sword blade. In the modern American context, the same enlightenment potential can be said to exist within a jogging course, a game of pinball, or a dance. In short, any form of human activity eliciting total concentration to the point of self-transcendence may serve to reveal the omnipresent enlightenment experience--or the experience of unconditional meaning. At any moment we may awaken to the fact of our present state of enlightened existence, described in Zen as 
satori.. 
Significantly, the streams of the ideal and the real, the sublime and the mundane, flow into the same ocean of meaning. By addressing these simultaneously momentary and potentially momentous meanings, we equip ourselves for even the most severe crisis--such as Frankl's. Within Zen the point of contact is evident in the samurai code, as the following passage demonstrates: 
You must remember that swordsmanship is an art of realizing at a critical moment the Reason of life and death, it is not meant just to defeat your opponent. A samurai. ..[f]irst of all. . .is to have an insight into the Reason of life and death,when his mind is free from thoughts of selfishness.7, 
pp.432-33 The ultimate warrior, then, is the one who need not resort to violence nor demonstrate consummate skills of swordsmanship. We learn this lesson through the example of the 
Zen cat who catches the rat that no other cat can catch. When other cats beg for instruction she points out that her own skill is inferior to that of the self-forgetful cat who 'realized divine warriorship and killed not. •?,p.432 The sign of this skill comes in the fact that the divine 1,.;at nonetheless continued to perform her function eminently, for no rat dared cross her path. 
What is translated in the above passage as "Reason" is the Chinese character Ii, whose components are the symbol for jade plus a field of earth. Li represents the patterns or "laws" of nature, like the patterns or natural markings in a piece of jade, as contrasted with the laws imposed by human beings to secure social order. In the present context Ii may well be rendered as "meaning," the "meaning of life and death," which comes to us of its own accord at the point of self-transcendence (the absence of selfish thoughts). Thus the meaning of the moment--such as the skill of an expert swordsman--can be transformed into universal, unconditional meaning--an insight into the relationship between life and death. The transformation presupposes both the momentary meaning and the ability to comprehend its microcosmic significance vis-a-vis the macrocosm of ultimate meaning. 
Thus, Fabry's logotherapeutic emphasis on everyday mindedness brings us back full circle to Frankl's insights, just as Fabry's "pursuit" treads the same path as Frankl's "search." In pointing up this option Fabry has immeasurably enriched the scope and attraction of logotherapy for everyday-minded individuals. 
SANDRA A. WAWRYTKO, is executive director of the International Society for Philosophy and Psychotherapy and member ofthe executive Committee ofthe International Society for Chinese Philosophy. She is a lecturer, Department of Philosophy, San Diego State University. 
REFERENCES 
1. 
"Buddha's Farewell Address" in The Teachings of the Compassionate Buddha, ed. EA.Burtt. New Yorkj, New American Library, 1955. 

2. 
Confucius, Analecta (Lun Y), sec V. xv, xvii, VIII. vi,, XV, xx, xxii, XIV. 

3. 
Fabry, J.B. The Pursuit of Meaning,. Boston, Beacon Press, 1968. Rev. ed San Francisco, Harper & Row; 1980. 

4. 
Frankl, V.E. Man's Search for Meaning. New York, Simon and Schuster, 1962. 

5. 
Kant, Immanuel, The Metaphysic of Morals. 

6. 
Mencius, Mencius, 7 A.40. Toronto, University of Toronto Press, 1969. 

7. 
Suzuki, D.T. (translator) "The Swordman and the Cat" in Zen and Japanese Culture. Princeton, NJ, Princeton University Press, 1973. 


Quotes from World Congress VII: 
Decades of authoritarian education, self-aggrandizing, mystical ideas about a special German soul, and the role Germany should play in the world prepared the path for Hitler. Within families and schools, children were trained to select wrong values and goals; always to obey authorities and their orders; never to question, doubt, or resist them, and to reach life goals by attaining a position where they themselves can give orders and be obeyed and respected. Such an education creates good soldiers but not people with a desire to form their own decisions, stand up for them and accept responsibility for such decisions by their own free will, following their conscience. Neither does such an education create confidence and selfesteem for their own uniqueness. The best way, in my opinion, is to teach our children, at home and at school from an early age, the values for which logotherapy stands --pursuit of meaning, gaining self-esteem by learning to make one's own decisions, and accepting personal and social responsibility." 
Stephen S. Kalmar, "Logotherapy and the 
Holocaust." 
Whereas [Harry Stack] Sullivan sees conflict and suffering as essentially negative factors, Frankl sees them as necessary components in the everyday struggle of living.... He subscribes to the possibility that growth can come through tension, that suffering belongs in the center of existent...."The human potential at its best always allows for turning suffering into a human achievement and accomplishment." 
Robert C. Leslie, "Sullivan and Frankl: Giants in Modern Psychiatry." 
The International Forum for LOGOTHERAPY