Episode 113: Book Club: Viktor Frankl’s “Man’s Search For Meaning”
Serena Mammen Weber, MD, Grace S. Kim, MD, Hassan Kanani, MD, David Puder, MD
There are no conflicts of interest in this episode.
In this episode, we will be going over a book every therapist and psychiatrist should read, Viktor Frankl’s “Man’s Search for Meaning.” Being in the trenches with our patients, we see so much pain and suffering and potentially undergo vicarious trauma ourselves through their suffering. The question, “What is the meaning of life?” often comes up in such a context.
The reason Viktor Frankl’s “Man’s Search for Meaning” is so powerful is because he himself suffered through such horrendous trauma at concentration camps during World War II, and yet found strength to live by uncovering meaning and purpose in his suffering. In writing this book, Dr. Frankl hoped that everyone would find their meaning, which allows accepting the invariable suffering in life with dignity and thereby providing endurance to keep moving forward.
If not already, we hope this podcast/article inspires you to read this incredible book and also to journey through finding meaning in your life and in your patients’ lives!
Who is Viktor Frankl?
Viktor Frankl (1905 - 1997) was a psychiatrist, neurologist, and a Holocaust survivor. He was also the founder of logotherapy and author of the influential book, Man’s Search for Meaning. He wrote it in nine days, following his liberation from the Türkheim camp, and it was published in 1946. The book became an international bestseller and in 1991 it was listed as one of the ten most influential books by the Library of Congress. Part I of the book, “Experiences in a Concentration Camp”, chronicles his time in multiple Nazi concentration camps during World War II. It describes the prisoner’s experience, common psychological effects, and how his “will to meaning” helped him survive. Part II, “Logotherapy in a Nutshell”, focuses more in detail on the theory and practice of logotherapy.
Frankl’s Experience in Concentration Camps & the Will to Meaning
At the start, Frankl describes in detail the inhumane conditions in which prisoners lived and the horrific treatment by Nazi guards and, even worse, by some fellow Jewish prisoners. He walks the reader through the psychological stages of the typical camp prisoner: shock, disgust, and then apathy; later, upon liberation, depersonalization and often bitterness.
In the podcast, we talk about how we had to take many pauses as we read through the first part because it is so weighty. Even though we cannot equate present times with Holocaust, reading this book has been timely because of what we have gone through collectively through pandemic. So many people were isolated and deprived of human connections. Many posed questions like, “What’s the point?” and visited our clinics to help alleviate their suffering. But finding meaning, as Frankl puts it, can justify suffering so that we continue to live.
Frankl argues that even in such an extreme environment, living through the worst conditions, one still had the freedom to choose the way in which he reacted to the circumstances both in attitude and behavior.
“The experiences of camp life show that man does have a choice of action. There were enough examples, often of a heroic nature, which proved that apathy could be overcome, irritability suppressed. Man can preserve a vestige of spiritual freedom, of independence of mind, even in such terrible conditions of psychic and physical stress.”
“The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal.”
He was strongly opposed to “pan-determinism”, the idea that man was simply responding like a robot, without choice, to a combination of his genes and environment and argued, in contrast to Freud, that extreme circumstances, rather than eliminating individual differences, actually exposed “the swine and the saints” among them.
“We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of human freedoms – to choose one’s attitude in any given set of circumstances, to choose one’s own way.”
This brings us to our discussion points regarding how suffering can reveal our animalistic self-preservations vs. sacrificial protective herd instinct. We can choose to act upon the quieter voice, even when self-preservation is yelling in our ears.
During such a process, we can choose our attitude towards that agonizing and stressful situation and allow the trauma to rebirth within us a sense of purpose; this gives us the endurance and inner strength to rise above our circumstances. As Nietzsche eloquently says, “That which does not kill us, makes us stronger.”
Frankl believed that finding and living out one’s meaning is “the primary motivational force in man” and this is the primary tenet on which his school of logotherapy is based. The will to meaning is in contrast to his Viennese colleagues’ focus on a will to pleasure (Freud) or a will to power (Adler). He frequently quotes Nietzsche, “He who has a why to live for can bear almost any how”, meaning that having a purpose gives one the strength and endurance to survive almost anything.
“A man who becomes conscious of the responsibility he bears toward a human being who affectionately waits for him, or to an unfinished work, will never be able to throw away his life.”
Frankl found meaning through work by focusing on a manuscript he wanted to rewrite so he could share his philosophy of logotherapy with the world. He found meaning in love, focusing on the image of his wife, from whom he had been separated upon arrival at the first camp. And he found meaning by responding with dignity to the unavoidable suffering in the concentration camp. He believed that suffering, rather than draining one’s life of meaning, offered the opportunity for greater meaning and that man has a responsibility to the unique meanings life has given him.
“When a man finds that it is his destiny to suffer, he will have to accept his suffering as his task, his single and unique task. He will have to acknowledge the fact that even in suffering he is unique and alone in the universe. No one can relieve him of his suffering or suffer in his place. His unique opportunity lies in the way in which he bears his burden.
Ultimately, man should not ask what the meaning of his life is, but rather he must recognize that it is he who is asked. In a word, each man is questioned by life and he can only answer to life by answering for his own life; to life he can only respond by being responsible. Thus, logotherapy sees in responsibleness the very essence of human existence.”
Frankl makes it clear that he is talking about suffering that cannot be avoided by the individual. He also states that suffering is not necessary for finding meaning, only that meaning can be found even in great suffering. Meaning gives one endurance and can reduce the pain of suffering. Frankl offers an example of a physician who came to him after losing his wife. In therapy, Frankl shows the man that by outliving his wife and experiencing this great suffering, he had spared his wife from the terrible pain of having to mourn him upon his death. This realization greatly alleviates the doctor’s suffering, as Frankl explains, “In some way, suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of sacrifice.” One may not be able to change his circumstances, but he can choose the attitude he takes and how he responds. “When we are no longer able to change a situation, we are challenged to change ourselves.”
We segue and talk about residency, working in a mental health profession, and burnout. Burnout sounds terrible but it leads us to ask questions like, “Why am I doing this thing?” It points us to reflection so we can pause, recalibrate and ask why we are in this. For those of us who are seemingly comfortable, there is still that aching underlying thought of “there must be something else” and/or “how do I live out that purpose?” These questions guide us to look for that meaning in life to keep us going.
Logotherapy in Practice
Logos is Greek for “meaning” and logotherapy is based on the concept that finding meaning is the primary motivational force of mankind. The goal of logotherapy is to help the patient become aware of the meanings of their life. It is analytical, but compared to traditional psychoanalysis, it is more future oriented and outwardly focused. That is, the therapist guides the patient towards realizing and carrying out his meaning outside of himself. The therapist, rather than interpreting the thoughts or feelings of a patient, guides the patient to see the world around him as it is. Frankl uses a metaphor of a logotherapist as an ophthalmologist, in contrast to a painter:
“A painter tries to convey to us a picture of the world as he sees it; an ophthalmologist tries to enable us to see the world as it really is. The logotherapist’s role consists of widening and broadening the visual field of the patient so that the whole spectrum of potential meaning becomes conscious and visible to him.”
Existential Frustration and Noö-dynamics
Frankl believed that the primary problem of young people, in both Europe and the United States, was the “existential vacuum,” the experience of life without meaning, and the boredom that results. This lack of meaning would cause existential frustration, which can then lead to “noögenic neuroses.” He claimed that instead of a “tensionless state,” man needs “noö-dynamics,” or a healthy amount of tension between where a man currently stands and the meaning he strives to fulfill. Stress is an important part of mental health, especially in those with psychiatric illness, and should not be avoided.
“If architects want to strengthen a decrepit arch, they increase the load which is laid upon it, for thereby the parts are joined more firmly together. So if therapists wish to foster their patients’ mental health, they should not be afraid to create a sound amount of tension through a reorientation toward the meaning of one’s life.”
In the podcast, we talk about how not all stress is bad. Obviously, we would not choose traumatic experiences, but voluntarily going through repetitive stress such as through exercise and doing things that are uncomfortable can help us to reset stress points, making us stronger physically and psychologically. Training programs might act in this way upon us, making us stronger despite the long hours.
Paradoxical Intention
Frankl believed happiness could not be achieved as a goal in itself, but as a side effect of finding and living out one’s meaning. Americans, in particular, with their pursuit of happiness, are great offenders of this.
“For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side effect of one’s dedication to a cause greater than oneself or as the by-product of one’s surrender to a person other than oneself.”
In fact, this hyper-intention, or the forced and excessive focus on a goal, can work counter to achieving many different things. The logotherapy technique of “paradoxical intention,” where one can treat a neurotic symptom by taking the opposite attitude towards it, is based on this idea. Through this practice, Frankl describes having cured patients of various issues including symptoms of social anxiety, sexual impotence, obsessive-compulsive behavior, and insomnia.
It’s okay not to be happy. We don’t have to keep trying or pretending to be, “Everything is awesome.” As we search for and live for our meaning in life, let happiness ensue.
How do we practically live out this search for meaning?
Frankl describes three ways one could find meaning in life: by doing good work, experiencing goodness and love, and through suffering with dignity. He believed that those inmates who had a task or person waiting outside were most likely to survive, rather than grow in their apathy and give up in their fight for survival.
Another way to look at this is to ask questions to ourselves and our patients -- “Does this align with your values?”
Conclusion
Frankl ends his book calling for the rehumanization of psychiatry. He explains that doctors ought to see each patient as an individual human being and not simply a machine determined by external factors. He again speaks against pan-determinism and restates his belief that man has the freedom to choose how he responds to the circumstances he is given in life.
“A human being is not one thing among others; things determine each other, but man is ultimately self-determining. What he becomes—within the limits of endowment and environment—he has made out of himself.”
“Our generation is realistic, for we have come to know man as he really is. After all, man is that being who invented the gas chambers of Auschwitz; however, he is also that being who entered those gas chambers upright, with the Lord’s Prayer or the Shema Yisrael on his lips.”