Neil Jeyasingam

There are not many books that purport to provide a measured response to the worst human tragedy of all time, as well as the meaning of life. The classic text, “Man’s Search for Meaning”, by Viktor Frankl, responds to this, but also provides a fascinating insight into a historical window of psychotherapy, what it could have been, and what it still can be. The text comprises three parts. The first is astounding enough in its premise, as the account of a concentration camp prisoner during the Holocaust, who was also a psychiatrist. The account is strangely muted as well as graphic, alternating between humble recognition that there existed many other accounts that replicated the data, together with stark descriptions of suffering and unrelenting morbidity. Early on in the account, he describes how survival depended on striking bargains with, and even potentially becoming, one of the “Capos” – a “ruling class” of prisoners who had extra benefits, including a reduced risk of execution. Given the nature of what was necessary in order to protect oneself and one’s friends, he grimly notes “it is not the best of us that survived.” The firsthand account is understandably harrowing. He notes in particular the number of people who succumbed to their situation, with the first casualty being their will to live. It was those whose philosophy failed, who would be least likely to survive. The text also appropriately describes one of the most fundamental horrors of the Holocaust – how ordinary people were transformed into dispassionate murderers. He recalled a guard idly pointing prisoners in different directions as they walked past him, only later to realise the fate of those directed to the other side of the camp. However, the author’s mission is not merely to demonise. He makes considerable effort to point out the humanity, however rare, that was occasionally present in his oppressors. The account, amidst the loss (the author’s wife, and most of his family, were lost in the tragedy) and struggles (he describes treating the sick and dying whilst himself suffering from typhoid fever, aware that his utility was a fundamental component of his own survival), gradually is increasingly marked with moments of beauty. He describes one point, when he provided a group psychotherapeutic intervention in the camp, which itself arose as a direct result of his trauma. A primary insight he attained, was that in the presence of abject suffering, there was an unparalleled potential for personal growth. The school of therapy he championed was named “Logotherapy”. I would not be disappointed if you hadn’t heard of it – I hadn’t either. “We must never forget that we may also find meaning in life even when confronted with a hopeless situation, when facing a fate that cannot be changed…There are situations in which one is cut off from the opportunity to do one’s work or enjoy one’s life; but what can never be ruled out is the unavoidability of suffering. In accepting this challenge to suffer bravely, life has a meaning up to the last moment, and it retains this meaning literally to the end.” It is in the second and third parts of the book, where logotherapy takes centre stage, following the undeniable personal and observed experiences that precede. He describes logotherapy as a dialogue with the intent making sense of a patient’s current experiences. As with many second wave psychotherapies, it arose as a rejoinder to deterministic developmental theory – he provides the example of the psychotherapy of an government official who had learned from his prior therapist that he sought repeatedly to seek authoritarian paternal figures in a re-experiencing of his adolescence, whereas Frankl’s approach was to recognise that the patient’s current dissatisfaction with life was simply due to being in the wrong career. There are interesting – and somewhat unsatisfying – perspectives, such as the management of panic attacks. In modern psychotherapy (following the teachings of cognitive behavioural therapy), panic attacks are understood as a response to an external trigger leading to the sympathetic nervous system being unnecessarily activated, and thus understanding the triggers and using supportive techniques (such as breathing techniques) help to reduce panic attacks. Frankl espouses logotherapy’s solution to the panic attack as one of encouraging the individual to attempt to pre-emptively provoke the panic attack prior to the offending trigger, thus nullifying the anticipatory anxiety. It’s a reasonably sensible trick, except I struggle to understand what that has to do with logotherapy. It also does not seem terribly reliable to myself. He does, fortunately, also recognise the inconsistency of this approach. The third part, written in 1980s, must have occurred following awareness of the early days of cognitive behavioural therapy, or perhaps might have been written in spite of it. Maslow’s Hierarchy (published in 1943, whilst Frankl was still interred) is still cited today, in universities and journal clubs, as a foundation psychological theory. It describes the idea of a hierarchy of human needs – with physiological needs and safety being basic requirements that must be fulfilled, working one’s way to the elements that are at the top of the pyramid and are the “highest level” elements – issues of self-esteem and self-actualisation. You probably might have seen brightly coloured pictures of a triangle or pyramid, with “Self-actualisation” capping the top of the pyramid, either in a psychologist’s office or floating around the Internet. The history of this triangle is quite remarkable. Few are aware that Maslow was a proponent of what was called “gestalt therapy”  (named for “gestalt” as being a holistic therapy)- which, like logotherapy, emerged as a humanistic response against Freudian psychodynamic theory. Even fewer are aware that, for all of the apparent face validity of Maslow’s famous triangle, it has and always has had no actual evidence base beyond anecdotes- a major issue with gestalt theory as a whole. Many claim the same lack of evidence for many features of psychodynamic therapy, which I concede is accurate. It is one of those situations where both the