A similar case, dealing, however, with speaking rather than writing, was related to me by a colleague in the Laryngological Department of the Vienna Poliklinik Hospital. It was the most severe case of stuttering he had come across in his many years of practice. Never in his life, as far as the stutterer could remember, had he been free from his speech trouble, even for a moment, except once. This happened when he was twelve years old and had hooked a ride on a streetcar. When caught by the conductor, he thought that the only way to escape would be to elicit his sympathy, and so he tried to demonstrate that he was just a poor stuttering boy. At that moment, when he tried to stutter, he was unable to do it. Without meaning to, he had practiced paradoxical intention, though not for therapeutic purposes.
However, this presentation should not leave the impression that paradoxical intention is effective only in mono-symptomatic cases. By means of this logotherapeutic technique, my staff at the Vienna Poliklinik Hospital has succeeded in bringing relief even in obsessive-compulsive neuroses of a most severe degree and duration. I refer, for instance, to a woman sixty-five years of age who had suffered for sixty years from a washing compulsion. Dr. Eva Kozdera started logotherapeutic treatment by means of paradoxical intention, and two months later the patient was able to lead a normal life. Before admission to the Neurological Department of the Vienna Poliklinik Hospital, she had confessed, “Life was hell for me.” Handicapped by her compulsion and bacteriophobic obsession, she finally remained in bed all day unable to do any housework. It would not be accurate to say that she is now completely free of symptoms, for an obsession may come to her mind. However, she is able to “joke about it,” as she says; in short, to apply paradoxical intention.
Paradoxical intention can also be applied in cases of sleep disturbance. The fear of sleeplessness12 results in a hyper- intention to fall asleep, which, in turn, incapacitates the patient to do so. To overcome this particular fear, I usually advise the patient not to try to sleep but rather to try to do just the opposite, that is, to stay awake as long as possible. In other words, the hyper-intention to fall asleep, arising from the anticipatory anxiety of not being able to do so, must be replaced by the paradoxical intention not to fall asleep, which soon will be followed by sleep.
Paradoxical intention is no panacea. Yet it lends itself as a useful tool in treating obsessive-compulsive and phobic conditions, especially in cases with underlying anticipatory anxiety. Moreover, it is a short-term therapeutic device. However, one should not conclude that such a short-term therapy necessarily results in only temporary therapeutic effects. One of “the more common illusions of Freudian orthodoxy,” to quote the late Emil A. Gutheil, “is that the durability of results corresponds to the length of therapy.”13 In my files there is, for instance, the case report of a patient to whom paradoxi- cal intention was administered more than twenty years ago; the therapeutic effect proved to be, nevertheless, a permanent one.
One of the most remarkable facts is that paradoxical intention is effective regardless of the etiological basis of the case concerned. This confirms a statement once made by Edith Weisskopf-Joelson: “Although traditional psychotherapy has insisted that therapeutic practices have to be based on findings on etiology, it is possible that certain factors might cause neuroses during early childhood and that entirely different factors might relieve neuroses during adulthood.”14
As for the actual causation of neuroses, apart from constitutional elements, whether somatic or psychic in nature, such feedback mechanisms as anticipatory anxiety seem to be a major pathogenic factor. A given symptom is responded to by a phobia, the phobia triggers the symptom, and the symptom, in turn, reinforces the phobia. A similar chain of events, however, can be observed in obsessive-compulsive cases in which the patient fights the ideas which haunt him.15 Thereby, however, he increases their power to disturb him, since pressure precipitates counterpressure. Again the symptom is reinforced! On the other hand, as soon as the patient stops fighting his obsessions and instead tries to ridicule them by dealing with them in an ironical way—by applying paradoxical intention—the vicious circle is cut, the symptom diminishes and finally atrophies. In the fortunate case where there is no existential vacuum which invites and elicits the symptom, the patient will not only succeed in ridiculing his neurotic fear but finally will succeed in completely ignoring it.
As we see, anticipatory anxiety has to be counteracted by paradoxical intention; hyper-intention as well as hyper- reflection have to be counteracted by dereflection; dereflection, however, ultimately is not possible except by the patient’s orientation toward his specific vocation and mission in life.16
It is not the neurotic’s self-concern, whether pity or contempt, which breaks the circle formation; the cue to cure is self-transcendence!
The Collective Neurosis
Every age has its own collective neurosis, and every age needs its own psychotherapy to cope with it. The existential vac- uum which is the mass neurosis of the present time can be described as a private and personal form of nihilism; for nihilism can be defined as the contention that being has no meaning. As for psychotherapy, however, it will never be able to cope with this state of affairs on a mass scale if it does not keep itself free from the impact and influence of the contemporary trends of a nihilistic philosophy; otherwise it represents a symptom of the mass neurosis rather than its possible cure. Psychotherapy would not only reflect a nihilistic philosophy but also, even though unwillingly and unwittingly, transmit to the patient what is actually a caricature rather than a true picture of man.
First of all, there is a danger inherent in the teaching of man’s “nothingbutness,” the theory that man is nothing but the result of biological, psychological and sociological conditions, or the product of heredity and environment. Such a view of man makes a neurotic believe what he is prone to believe anyway, namely, that he is the pawn and victim of outer influences or inner circumstances. This neurotic fatalism is fostered and strengthened by a psychotherapy which denies that man is free.
To be sure, a human being is a finite thing, and his freedom is restricted. It is not freedom from conditions, but it is freedom to take a stand toward the conditions. As I once put it: “As a professor in two fields, neurology and psychiatry, I am fully aware of the extent to which man is subject to biological, psychological and sociological conditions. But in addition to being a professor in two fields I am a survivor of four camps —concentration camps, that is—and as such I also bear witness to the unexpected extent to which man is capable of defying and braving even the worst conditions conceivable.”17
Critique of Pan-Determinism
Psychoanalysis has often been blamed for its so-called pansexualism. I, for one, doubt whether this reproach has ever been legitimate. However, there is something which seems to me to be an even more erroneous and dangerous assumption, namely, that which I call “pan-determinism.” By that I mean the view of man which disregards his capacity to take a stand toward any conditions whatsoever. Man is not fully conditioned and determined but rather determines himself whether he gives in to conditions or stands up to them. In other words, man is ultimately self-determining. Man does not simply exist but always decides what his existence will be, what he will become in the next moment.
By the same token, every human being has the freedom to change at any instant. Therefore, we can predict his future only within the large framework of a statistical survey referring to a whole group; the individual personality, however, remains essentially unpredictable. The basis for any predictions would be represented by biological, psychological or sociological conditions. Yet one of the main features of human existence is the capacity to rise above such conditions, to grow beyond them. Man is capable of changing the world for the better if possible, and of changing himself for the better if necessary.
Let me cite the case of Dr. J. He was the only man I ever encountered in my whole life whom I would dare to call a Mephistophelean being, a satanic figure. At that time he was
generally called “the mass murderer of Steinhof” (the large mental hospital in Vienna). When the Nazis started their euthanasia program, he held all the strings in his hands and was so fanatic in the job assigned to him that he tried not to let one single psychotic individual escape the gas chamber. After the war, when I came back to Vienna, I asked what had happened to Dr. J. “He had been imprisoned by the Russians in one of the isolation cells of Steinhof,” they told me. “The next day, however, the door of his cell stood open and Dr. J. was never seen again.” Later I was convinced that, like others, he had with the help of his comrades made his way to South America. More recently, however, I was consulted by a former Austrian diplomat who had been imprisoned behind the Iron Curtain for many years, first in Siberia and then in the famous Lubianka prison in Moscow. While I was examining him neurologically, he suddenly asked me whether I happened to know Dr. J. After my affrmative reply he continued: “I made his acquaintance in Lubianka. There he died, at about the age of forty, from cancer of the urinary bladder. Before he died, however, he showed himself to be the best comrade you can imagine! He gave consolation to everybody. He lived up to the highest conceivable moral standard. He was the best friend I ever met during my long years in prison!”
This is the story of Dr. J., “the mass murderer of Steinhof.” How can we dare to predict the behavior of man? We may predict the movements of a machine, of an automaton; more than this, we may even try to predict the mechanisms or “dynamisms” of the human psyche as well. But man is more than psyche.
Freedom, however, is not the last word. Freedom is only part of the story and half of the truth. Freedom is but the negative aspect of the whole phenomenon whose positive aspect is responsibleness. In fact, freedom is in danger of degenerating into mere arbitrariness unless it is lived in terms of responsibleness. That is why I recommend that the Statue of Liberty on the East Coast be supplemented by a Statue of Responsibility on the West Coast.
The Psychiatric Credo
There is nothing conceivable which would so condition a man as to leave him without the slightest freedom. Therefore, a residue of freedom, however limited it may be, is left to man in neurotic and even psychotic cases. Indeed, the innermost core of the patient’s personality is not even touched by a psychosis.
An incurably psychotic individual may lose his usefulness but yet retain the dignity of a human being. This is my psychiatric credo. Without it I should not think it worthwhile to be a psychiatrist. For whose sake? Just for the sake of a damaged brain machine which cannot be repaired? If the patient were not definitely more, euthanasia would be justified.
Psychiatry Rehumanized
For too long a time—for half a century, in fact—psychiatry tried to interpret the human mind merely as a mechanism, and consequently the therapy of mental disease merely in terms of a technique. I believe this dream has been dreamt out. What now begins to loom on the horizon are not the sketches of a psychologized medicine but rather those of a humanized psychiatry.
A doctor, however, who would still interpret his own role mainly as that of a technician would confess that he sees in his patient nothing more than a machine, instead of seeing the human being behind the disease!
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. In the concentration camps, for example, in this living laboratory and on this testing ground, we watched and witnessed some of our comrades behave like swine while others behaved like saints. Man has both potentialities within himself; which one is actualized depends on decisions but not on conditions.
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.
This part, which has been revised and updated, first appeared as “Basic Concepts of Logotherapy” in the 1962 edition of Man’s Search for Meaning.
1. It was the first version of my first book, the English translation of which was published by Alfred A. Knopf, New York, in 1955, under the title The Doctor and the Soul: An Introduction to Logotherapy.
2. Magda B. Arnold and John A. Gasson, The Human Person, Ronald Press, New York, 1954, p. 618.
3. A phenomenon that occurs as the result of a primary phenomenon.
4. “Some Comments on a Viennese School of Psychiatry,” The Journal of Abnormal and Social Psychology, 51 (1955), pp. 701–3.
5. “Logotherapy and Existential Analysis,” Acta Psychotherapeutica, 6 (1958), pp. 193–204.
6. A prayer for the dead.
7. L’kiddush basbem, i.e., for the sanctification of God’s name.
8. “Thou hast kept count of my tossings; put thou my tears in thy bottle! Are they not in thy book?” (Ps. 56, 8.)
9. In order to treat cases of sexual impotence, a specific logotherapeutic technique has been developed, based on the theory of hyper-intention and hyper-reflection as sketched above (Viktor E. Frankl, “The Pleasure Principle and Sexual Neurosis,” The International Journal of Sexology, Vol. 5, No. 3 [1952], pp. 128–30). Of course, this cannot be dealt with in this brief presentation of the principles of logotherapy.
10. Viktor E. Frankl, “Zur medikamentösen Unterstützung der Psychotherapie bei Neurosen,” Schweizer Archiv für Neurologie und Psychiatrie, Vol. 43, pp. 26–31.
11. New York, The Macmillan Co., 1956, p. 92.
12. The fear of sleeplessness is, in the majority of cases, due to the patient’s ignorance of the fact that the organism provides itself by itself with the minimum amount of sleep really needed.
13. American Journal of Psychotherapy, 10 (1956), p. 134.
14. “Some Comments on a Viennese School of Psychiatry,” The Journal of Abnormal and Social Psychology, 51 (1955), pp. 701–3.
15. This is often motivated by the patient’s fear that his obsessions indicate an imminent or even actual psychosis; the patient is not aware of the empirical fact that an obsessive-compulsive neurosis is immunizing him against a formal psychosis rather than endangering him in this direction.
16. This conviction is supported by Allport who once said, “As the focus of striving shifts from the conflict to selfless goals, the life as a whole becomes sounder even though the neurosis may never completely disappear” (op. cit., p. 95).
17. “Value Dimensions in Teaching,” a color television film produced by Hollywood Animators, Inc., for the California Junior College Association.
POSTSCRIPT
1984
Dedicated to the memory of
Edith Weisskopf-Joelson, whose
pioneering efforts in logotherapy
in the United States began as early
as 1955 and whose contributions
to the field have been invaluable.
THE CASE FOR A
TRAGIC OPTIMISM
LET US FIRST ASK OURSELVES WHAT SHOULD BE understood by “a tragic optimism.” In brief it means that one is, and remains, optimistic in spite of the “tragic triad,” as it is called in logotherapy, a triad which consists of those aspects of human existence which may be circumscribed by: (1) pain; (2) guilt; and (3) death. This chapter, in fact, raises the question, How is it possible to say yes to life in spite of all that? How, to pose the question differently, can life retain its potential meaning in spite of its tragic aspects? After all, “saying yes to life in spite of everything,” to use the phrase in which the title of a German book of mine is couched, presupposes that life is potentially meaningful under any conditions, even those which are most miserable. And this in turn presupposes the human capacity to creatively turn life’s negative aspects into something positive or constructive. In other words, what matters is to make the best of any given situation. “The best,” however, is that which in Latin is called optimum—hence the reason I speak of a tragic opt
imism, that is, an optimism in the face of tragedy and in view of the human potential which at its best always allows for: (1) turning suffering into a human achievement and accomplishment; (2) deriving from guilt the opportunity to change oneself for the better; and (3) deriving from life’s transitoriness an incentive to take responsible action.
This chapter is based on a lecture I presented at the Third World Congress of Logotherapy, Regensburg University, West Germany, June 1983.
It must be kept in mind, however, that optimism is not anything to be commanded or ordered. One cannot even force oneself to be optimistic indiscriminately, against all odds, against all hope. And what is true for hope is also true for the other two components of the triad inasmuch as faith and love cannot be commanded or ordered either.
To the European, it is a characteristic of the American culture that, again and again, one is commanded and ordered to “be happy.” But happiness cannot be pursued; it must ensue. One must have a reason to “be happy.” Once the reason is found, however, one becomes happy automatically. As we see, a human being is not one in pursuit of happiness but rather in search of a reason to become happy, last but not least, through actualizing the potential meaning inherent and dormant in a given situation.