17 March

Viktor Frankl
Logotherapy, Existential Analysis

Influenced
Irvin Yalom

Viktor Emil Frankl, MD, PhD (26 March 1905 – 2 September 1997) was an Austrian neurologist and psychiatrist as well as a Holocaust survivor. Frankl was the founder of logotherapy, which is a form of existential analysis, the "Third Viennese School of Psychotherapy". His best-selling bookMan's Search for Meaning (published under a different title in 1959: From Death-Camp to Existentialism, and originally published in 1946 as Trotzdem Ja Zum Leben Sagen: Ein Psychologe erlebt das Konzentrationslager) chronicles his experiences as a concentration camp inmate which led him to discover the importance of finding meaning in all forms of existence, even the most sordid ones, and thus a reason to continue living. Frankl became one of the key figures in existential therapy and a prominent source of inspiration for humanistic psychologists.

Life before 1945
Frankl was born in Vienna into a Jewish family of civil servants (Beamtenfamilie). His interest in psychology surfaced early. For the final exam (Matura) in Gymnasium, he wrote a paper on the psychology of philosophical thinking. After graduating from Gymnasium in 1923, he studied medicine at the University of Vienna and later specialized in neurology and psychiatry, concentrating on the topics of depression and suicide. His early development was influenced by his contacts with Sigmund Freud and Alfred Adler, although he would later diverge from their teachings.

Doctor, therapist
During part of 1924 he became the president of the Sozialistische Mittelschüler Österreich, a Social Democratic youth movement for high school students throughout Austria.

While still a medical student between 1928 and 1930, he organized and offered a special program to counsel high school students free of charge. The program involved the participation of psychologists such as Charlotte Buhler, and it paid special attention to students at the time when they received their report cards. In 1931, not a single Viennese student committed suicide. The success of this program grabbed the attention of the likes of Wilhelm Reich who invited him to Berlin.

From 1933 to 1937, Viktor Frankl completed his residency in neurology and psychiatry at the Steinhof Psychiatric Hospital in Vienna. He was responsible for the so-called Selbstmörderpavillon, or "suicide pavilion". Here, he treated over 30,000 women prone to suicide. In 1937, he established an independent private practice in neurology and psychiatry at Alser Strasse 32/12 in Vienna.

Starting from the Nazi takeover of Austria in 1938, he was prohibited from treating "Aryan" patients due to his Jewish identity. In 1940 he started working at the Rothschild Hospital, where he headed its neurological department. This hospital was the only one in Vienna to which Jews were still admitted. His medical opinions saved several patients from being euthanised via the Nazi euthanasia program. In December 1941 he married Tilly Grosser.

Prisoner, therapist
On 25 September 1942, Frankl, his wife and his parents were deported to the Nazi Theresienstadt Ghetto. There Frankl worked as a general practitioner in a clinic. When his skills in psychiatry were noticed, he was assigned to the psychiatric care ward in block B IV, establishing a camp service of "psychohygiene" or mental health care. He organized a unit to help newcomers to the camp overcome shock and grief. Later he set up a suicide watch, assisted by Regina Jonas. On 29 July 1943, Frankl organized a closed event for the Scientific Society at Theresienstadt, and with the help of Leo Baeck he offered a series of open lectures, including "Sleep and Sleep Disturbances", "Body and Soul", "Medical Care of the Soul", "Psychology of Mountaineering", "How to keep my nerves healthy?", "Medical ministry", "Existential Problems in Psychotherapy", and "Social Psychotherapy". His father Gabriel died of pulmonary edema and pneumonia at Theresienstadt.

On 19 October 1944, Frankl and his wife Tilly were transported to the Auschwitz concentration camp, where he was processed. He was moved to Kaufering, a Nazi concentration camp affiliated with Dachau concentration camp, where he arrived on 25 October 1944. There he was to spend 5 months working as a slave laborer. In March 1945, he was offered to be moved to the so called rest-camp Türkheim, also affiliated with Dachau. He decided to go to Türkheim, where he worked as a doctor until 27 April 1945, when Frankl was liberated by the Americans.

Meanwhile, his wife Tilly was transferred from Auschwitz to the Bergen-Belsen concentration camp, where she died. Frankl's mother Elsa was killed by the Nazis in the gas chambers of Auschwitz, and his brother Walter died working in a mining operation that was part of Auschwitz. Apart from him, among Frankl's immediate relatives, the only survivor of the Holocaust was his sister Stella. She had escaped from Austria by emigrating to Australia.

Life after 1945
Liberated after three years in concentration camps, Frankl returned to Vienna. During 1945 he wrote his world-famous book titled Trotzdem Ja Zum Leben Sagen: Ein Psychologe Erlebt das Konzentrationslager (translated: "...Saying Yes to Life in Spite of Everything: A Psychologist Experiences the Concentration Camp", known in English by the title Man's Search for Meaning(1959). In this book, he described the life of an ordinary concentration camp inmate from the objective perspective of a psychiatrist.

After enduring the suffering in these camps, Frankl validated his hallmark conclusion that even in the most absurd, painful and dehumanized situation, life has potential meaning and that therefore even suffering is meaningful. This conclusion served as a strong basis for his logotherapy and existential analysis, which Frankl had described before WWII.

An example of Frankl's idea of finding meaning in the midst of extreme suffering is found in his account of an experience he had while working in the harsh conditions of the Nazi's concentration camps:

We stumbled on in the darkness, over big stones and through large puddles, along the one road leading from the camp. The accompanying guards kept shouting at us and driving us with the butts of their rifles. Anyone with very sore feet supported himself on his neighbor's arm. Hardly a word was spoken; the icy wind did not encourage talk. Hiding his mouth behind his upturned collar, the man marching next to me whispered suddenly: "If our wives could see us now! I do hope they are better off in their camps and don't know what is happening to us."

That brought thoughts of my own wife to mind. And as we stumbled on for miles, slipping on icy spots, supporting each other time and again, dragging one another up and onward, nothing was said, but we both knew: each of us was thinking of his wife. Occasionally I looked at the sky, where the stars were fading and the pink light of the morning was beginning to spread behind a dark bank of clouds. But my mind clung to my wife's image, imagining it with an uncanny acuteness. I heard her answering me, saw her smile, her frank and encouraging look. Real or not, her look was then more luminous than the sun which was beginning to rise.

A thought transfixed me: for the first time in my life I saw the truth as it is set into song by so many poets, proclaimed as the final wisdom by so many thinkers. The truth – that love is the ultimate and the highest goal to which man can aspire. Then I grasped the meaning of the greatest secret that human poetry and human thought and belief have to impart: The salvation of man is through love and in love. I understood how a man who has nothing left in this world still may know bliss, be it only for a brief moment, in the contemplation of his beloved. In a position of utter desolation, when man cannot express himself in positive action, when his only achievement may consist in enduring his sufferings in the right way—an honorable way—in such a position man can, through loving contemplation of the image he carries of his beloved, achieve fulfillment. For the first time in my life I was able to understand the meaning of the words, "The angels are lost in perpetual contemplation of an infinite glory."

Frankl's concentration camp experiences thus shaped both his therapeutic approach and philosophical outlook, as reflected in his seminal publications. He often said that even within the narrow boundaries of the concentration camps he found only two races of men to exist: decent and unprincipled ones. These were to be found in all classes, ethnicities, and groups.

In 1946 he was appointed to run the Vienna Polyclinic of Neurology. He remained there until 1971. In 1947 he married his second wife Eleonore Katharina Schwindt. She was a practicing Catholic and the couple respected each other's religious backgrounds, going to both church and synagogue, and celebrating Christmas and Hanukah. They had one daughter, Gabriele, who went on to become a child psychologist.

In 1955 he was awarded a professorship of neurology and psychiatry at the University of Vienna, and as visiting professor, he resided at Harvard University (1961), at Southern Methodist University, Dallas (1966) and at Duquesne University, Pittsburgh (1972). He lectured and taught seminars all over the world and received 29 honorary doctoral degrees. Frankl published 39 books, which were translated into as many as 40 languages.

The American Psychiatric Association awarded Frankl the 1985 Oskar Pfister Award for important contributions to religion and psychiatry.

Frankl died of heart failure on 2 September 1997. He was survived by his wife Eleonore, his daughter Dr. Gabriele Frankl-Vesely, his grandchildren Katharina and Alexander, and his great-granddaughter Anna Viktoria.

Legacy
Frankl's logotherapy and existential analysis is considered the third Viennese School of Psychotherapy, among the broad category that comprises existentialists. For Irvin Yalom, Frankl, "who has devoted his career to a study of an existential approach to therapy, has apparently concluded that the lack of meaning is the paramount existential stress. To him, existential neurosis is synonymous with a crisis of meaninglessness".

He is thought to have coined the term Sunday neurosis. The term refers to a form of anxiety resulting from an awareness in some people of the emptiness of their lives once the working week is over. Some complain of a void and a vague discontent. This arises from an existential vacuum, or feeling of meaninglessness, which is a common phenomenon and is characterised by the subjective state of boredom, apathy, and emptiness. One feels cynical, lacks direction and questions the point of most of life's activities.

Existential therapy
Existential psychotherapy is a philosophical method of therapy that operates on the belief that inner conflict within a person is due to that individual's confrontation with the givens of existence.[1]These givens, as noted by Irvin D. Yalom, are: the inevitability of death, freedom and its attendant responsibility, existential isolation (referring to Phenomenology), and finally meaninglessness. These four givens, also referred to as ultimate concerns, form the body of existential psychotherapy and compose the framework in which a therapist conceptualizes a client's problem in order to develop a method of treatment. In the British School of Existential therapy (Cooper, 2003), these givens are seen as predictable tensions and paradoxes of the four dimensions of human existence, the physical, social, personal and spiritual realms (Umwelt, Mitwelt, Eigenwelt and Überwelt).

Background
The philosophers who are especially pertinent to the development of existential psychotherapy are those whose work is directly aimed at making sense of human existence. But the philosophical movements that are of most importance and that have been directly responsible for the generation of existential therapy are phenomenology and existential philosophy.

The starting point of existential philosophy (see Warnock, 1970; Macquarrie, 1972; Mace, 1999; Van Deurzen and Kenward, 2005) can be traced back to the nineteenth century and the work ofKierkegaard and Nietzsche. Both were in conflict with the predominant ideologies of their time and committed to the exploration of reality as it can be experienced in a passionate and personal manner.

Kierkegaard (1813–55) protested vigorously against popular misunderstanding and abuse of Christian dogma and the so-called 'objectivity' of science (Kierkegaard, 1841, 1844). He thought that both were ways of avoiding the anxiety inherent in human existence. He had great contempt for the way in which life was being lived by those around him and believed that truth could ultimately only be discovered subjectively by the individual in action. What was most lacking was people's courage to take the leap of faith and live with passion and commitment from the inward depth of existence. This involved a constant struggle between the finite and infinite aspects of our nature as part of the difficult task of creating a self and finding meaning. As Kierkegaard lived by his own word he was lonely and much ridiculed during his lifetime.

Nietzsche (1844–1900) took this philosophy of life a step further. His starting point was the notion that God is dead, that is, the idea of God was outmoded and limiting (Nietzsche, 1861, 1874, 1886) and that it is up to us to re-evaluate existence in light of this. He invited people to shake off the shackles of moral and societal constraint and to discover their free will in order to live according to their own desires, now the only maintainable law in his philosophy. He encouraged people to transcend the mores of civilization and choose their own standards. The important existential themes of freedom, choice, responsibility and courage are introduced for the first time.

While Kierkegaard and Nietzsche drew attention to the human issues that needed to be addressed, Husserl's phenomenology (Husserl, 1960, 1962; Moran, 2000) provided the method to address them in a rigorous manner. He contended that natural sciences are based on the assumption that subject and object are separate and that this kind of dualism can only lead to error. He proposed a whole new mode of investigation and understanding of the world and our experience of it. Prejudice has to be put aside or 'bracketed', in order for us to meet the world afresh and discover what is absolutely fundamental and only directly available to us through intuition. If people want to grasp the essence of things, instead of explaining and analyzing them, they have to learn to describe and understand them.

Heidegger (1889–1976) applied the phenomenological method to understanding the meaning of being (Heidegger, 1962, 1968). He argued that poetry and deep philosophical thinking can bring greater insight into what it means to be in the world than can be achieved through scientific knowledge. He explored human being in the world in a manner that revolutionizes classical ideas about the self and psychology. He recognized the importance of time, space, death and human relatedness. He also favoured hermeneutics, an old philosophical method of investigation, which is the art of interpretation. Unlike interpretation as practised in psychoanalysis (which consists of referring a person's experience to a pre-established theoretical framework) this kind of interpretation seeks to understand how the person himself subjectively experiences something.

Sartre (1905–80) contributed many other strands of existential exploration, particularly in terms of emotions, imagination, and the person's insertion into a social and political world. The philosophy of existence on the contrary is carried by a wide-ranging literature, which includes many other authors than the ones mentioned above. Other existential authors are for instance Karl Jaspers(1951, 1963), Paul Tillich, Martin Buber, and Hans-Georg Gadamer within the Germanic tradition and Albert Camus, Gabriel Marcel, Paul Ricoeur, Maurice Merleau-Ponty, Simone de Beauvoirand Emmanuel Lévinas within the French tradition.

From the start of the 20th century some psychotherapists were, however, inspired by phenomenology and its possibilities for working with people. Otto Rank, an Austrian psychoanalyst who broke with Freud in the mid-1920s, was the first existential therapist. Ludwig Binswanger, in Switzerland, also attempted to bring existential insights to his work with patients, in the Kreuzlingensanatorium where he was a psychiatrist. Much of his work was translated into English during the 1940s and 1950s and, together with the immigration to the USA of Paul Tillich (Tillich, 1952) and others, this had a considerable impact on the popularization of existential ideas as a basis for therapy (Valle and King, 1978; Cooper, 2003). Rollo May played an important role in this, and his writing (1969, 1983; May et al., 1958) kept the existential influence alive in America, leading eventually to a specific formulation of therapy (Bugental, 1981; May and Yalom, 1985; Yalom, 1980).Humanistic psychology was directly influenced by these ideas.

In Europe, after Otto Rank, existential ideas were combined with some psychoanalytic principles and a method of existential analysis was developed by Medard Boss (1957a, 1957b, 1979) in close co-operation with Heidegger. In Austria, Viktor Frankl developed an existential therapy called logotherapy (Frankl, 1964, 1967), which focused particularly on finding meaning. In France the ideas of Sartre (1956, 1962) and Merleau-Ponty (1962) and of a number of practitioners (Minkowski, 1970) were important and influential but no specific therapeutic method was developed from them.

Development in Britain
Britain became a fertile ground for the further development of the existential approach when R. D. Laing and David Cooper, often associated with the anti-psychiatry movement, took Sartre's existential ideas as the basis for their work (Laing, 1960, 1961; Cooper, 1967; Laing and Cooper, 1964). Without developing a concrete method of therapy they critically reconsidered the notion of mental illness and its treatment. In the late 1960s they established an experimental therapeutic community at Kingsley Hall in the East End of London, where people could come to live through their madness without the usual medical treatment. They also founded the Philadelphia Association, an organization providing alternative living, therapy and therapeutic training from this perspective. The Philadelphia Association is still in existence today and is now committed to the exploration of the works of philosophers such as Wittgenstein, Derrida, Levinas and Foucault as well as the work of the French psychoanalyst Lacan. It also runs a number of small therapeutic households along these lines. The Arbours Association is another group that grew out of the Kingsley Hall experiment. Founded by Berke and Schatzman in the 1970s, it now runs a training programme in psychotherapy, a crisis centre and several therapeutic communities. The existential input in the Arbours has gradually been replaced with a more neo-Kleinian emphasis.

The impetus for further development of the existential approach in Britain has largely come from the development of a number of existentially based courses in academic institutions. This started with the programmes created by Emmy van Deurzen, initially at Antioch University in London and subsequently at Regent's College, London and since then at the New School of Psychotherapy and Counselling, also in London. The latter is a purely existentially based training institute, which offers postgraduate degrees validated by the University of Sheffield and Middlesex University. In the last decades the existential approach has spread rapidly and has become a welcome alternative to established methods. There are now a number of other, mostly academic, centres in Britain that provide training in existential counselling and psychotherapy and a rapidly growing interest in the approach in the voluntary sector and in the National Health Service.

British publications dealing with existential therapy include contributions by Jenner (de Koning and Jenner, 1982), Heaton (1988, 1994), Cohn (1994, 1997), Spinelli (1997), Cooper (1989, 2002), Eleftheriadou (1994), Lemma-Wright (1994), Du Plock (1997), Strasser and Strasser (1997), van Deurzen (1997, 1998, 2002); van Deurzen and Arnold-Baker (2005); van Deurzen and Kenward (2005). Other writers such as Lomas (1981) and Smail (1978, 1987, 1993) have published work relevant to the approach although not explicitly 'existential' in orientation. The journal of the British Society for Phenomenology regularly publishes work on existential and phenomenological psychotherapy. An important development was that of the founding of the Society for Existential Analysis in 1988, initiated by van Deurzen. This society brings together psychotherapists, psychologists, psychiatrists, counsellors and philosophers working from an existential perspective. It offers regular fora for discussion and debate as well as major annual conferences. It publishes the Journal of the Society for Existential Analysis twice a year. It is also a member of the International Federation for Daseinsanalysis, which stimulates international exchange between representatives of the approach from around the world. An international Society for Existential Therapists also exists. It was founded in 2006 by Emmy van Deurzen and Digby Tantam, and is called the International Community of Existential Counsellors and Therapists (ICECAP).

Existential Therapy's View of the Human Mind
Existential therapy starts with the belief that although humans are essentially alone in the world, they long to be connected to others. People want to have meaning in one another's lives, but ultimately they must come to realize that they cannot depend on others for validation, and with that realization they finally acknowledge and understand that they are fundamentally alone (Yalom, 1980). The result of this revelation is anxiety in the knowledge that our validation must come from within and not from others.

Psychological Dysfunction
Because there is no single existential view, opinions about psychological dysfunction vary.

For theorists aligned with Yalom, psychological dysfunction results from the individual's refusal or inability to deal with the normal existential anxiety that comes from confronting life's "givens": mortality, isolation, meaninglessness, and freedom.

For other theorists, there is no such thing as psychological dysfunction or being mentally ill. Every way of being is merely an expression of how one chooses to live one's life. However, one may feel unable to come to terms with the anxiety of being alone in the world. If so, an existential psychotherapist can assist one in accepting these feelings rather than trying to change them as if there is something wrong. Everyone has the freedom to choose how they are going to be in life, however this may go unexercised because making changes is difficult; it may appear easier and safer not to make decisions that one will be responsible for. Many people will remain unaware of alternative choices in life for various societal reasons.

The Good Life
Existentialism suggests that it is possible for people to face the anxieties of life head-on and embrace the human condition of aloneness, to revel in the freedom to choose and take full responsibility for their choices. They courageously take the helm of their lives and steer in whatever direction they choose; they have the courage to be. One does not need to arrest feelings of meaninglessness, but can choose new meanings for their lives. By building, by loving, and by creating one is able to live life as one's own adventure. One can accept one's own mortality and overcome fear of death. Though the French author Albert Camus denied the specific label of existentialist, in his novel, L'Etranger, his main character Meursault, ends the novel by doing just this. He accepts his mortality and rejects the constrictions of society he previously placed on himself, leaving him unencumbered and free to live his life with an unclouded mind.

Existential Therapy
The existential psychotherapist is generally not concerned with the client's past; instead, the emphasis is on the choices to be made in the present and future. The counselor and the client may reflect upon how the client has answered life's questions in the past, but attention ultimately shifts to searching for a new and increased awareness in the present and enabling a new freedom and responsibility to act. The patient can then accept they are not special, and that their existence is simply coincidental, without destiny or fate. By accepting this, they can overcome their anxieties, and instead view life as moments in which they are fundamentally free. (The outline above is based on a strictly Sartrean perspective)

Four worlds
Existential thinkers seek to avoid restrictive models that categorize or label people. Instead they look for the universals that can be observed cross-culturally. There is no existential personality theory which divides humanity into types or reduces people to part components. Instead there is a description of the different levels of experience and existence with which people are inevitably confronted. The way in which a person is in the world at a particular stage can be charted on this general map of human existence (Binswanger, 1963; Yalom, 1980; van Deurzen, 1984). One can distinguish four basic dimensions of human existence: the physical, the social, the psychological and the spiritual. On each of these dimensions people encounter the world and shape their attitude out of their particular take on their experience. Their orientation towards the world defines their reality. The four dimensions are obviously interwoven and provide a complex four-dimensional force field for their existence. Individuals are stretched between a positive pole of what they aspire to on each dimension and a negative pole of what they fear.

Physical dimension On the physical dimension (Umwelt) individuals relate to their environment and to the givens of the natural world around them. This includes their attitude to the body they have, to the concrete surroundings they find themselves in, to the climate and the weather, to objects and material possessions, to the bodies of other people, their own bodily needs, to health and illness and to their own mortality. The struggle on this dimension is, in general terms, between the search for domination over the elements and natural law (as in technology, or in sports) and the need to accept the limitations of natural boundaries (as in ecology or old age). While people generally aim for security on this dimension (through health and wealth), much of life brings a gradual disillusionment and realization that such security can only be temporary. Recognizing limitations can bring great release of tension.

Social dimension On the social dimension (Mitwelt) individuals relate to others as they interact with the public world around them. This dimension includes their response to the culture they live in, as well as to the class and race they belong to (and also those they do not belong to). Attitudes here range from love to hate and from cooperation to competition. The dynamic contradictions can be understood in terms of acceptance versus rejection or belonging versus isolation. Some people prefer to withdraw from the world of others as much as possible. Others blindly chase public acceptance by going along with the rules and fashions of the moment. Otherwise they try to rise above these by becoming trendsetters themselves. By acquiring fame or other forms of power, individuals can attain dominance over others temporarily. Sooner or later, however, everyone is confronted with both failure and aloneness.

Psychological dimension On the psychological dimension (Eigenwelt) individuals relate to themselves and in this way create a personal world. This dimension includes views about their own character, their past experience and their future possibilities. Contradictions here are often experienced in terms of personal strengths and weaknesses. People search for a sense of identity, a feeling of being substantial and having a self. But inevitably many events will confront them with evidence to the contrary and plunge them into a state of confusion or disintegration. Activity and passivity are an important polarity here. Self-affirmation and resolution go with the former and surrender and yielding with the latter. Facing the final dissolution of self that comes with personal loss and the facing of death might bring anxiety and confusion to many who have not yet given up their sense of self-importance.

Spiritual dimension On the spiritual dimension (Überwelt) (van Deurzen, 1984) individuals relate to the unknown and thus create a sense of an ideal world, an ideology and a philosophical outlook. It is here that they find meaning by putting all the pieces of the puzzle together for themselves. For some people this is done by adhering to a religion or other prescriptive world view, for others it is about discovering or attributing meaning in a more secular or personal way. The contradictions that have to be faced on this dimension are often related to the tension between purpose and absurdity, hope and despair. People create their values in search of something that matters enough to live or die for, something that may even have ultimate and universal validity. Usually the aim is the conquest of a soul, or something that will substantially surpass mortality (as for instance in having contributed something valuable to humankind). Facing the void and the possibility of nothingness are the indispensable counterparts of this quest for the eternal.