“How adverse events, could have some meaning”

Aug 15th “How adverse events, could have some meaning”

Dr. Victor Frankl was a powerful man. Not muscle and brawn powerful, but psychologically powerful. Frankel was an Austrian psychiatrist who spent 1944 in Nazi concentration camps, where, in addition to suffering the daily torture and slave labor, he was forced to experience the deaths of his mother, brother and wife.

Victor Frankl

Out of the tragedy of Dr. Frankl’s heart rending story came “Man’s Search for Meaning” his most popular book, a tribute to hope and possibility in the direst of circumstances and one that describes his experience in Auschwitz and Dachau as well as the development of a healing modality called “Logotherapy”. Derived from “logos” the Greek word for “plan”, or more loosely “that which gives reason for being”, Logotherapy, as defined by Frankl, can be thought of as an emotionally resilient way of living that “aims to unlock the will-to-meaning of life”.

What Frankl noticed during his time enduring some of the most inhumane conditions in the history of man was that those around him who did not lose their sense of purpose and meaning in life were able to survive much longer than those who did. Frankl was so impressed by the survival benefits of “meaning”, that he devoted the rest of his life to using it therapeutically to improve the quality of life of his patients.

Logotherapy posits three basic assumptions:

1. No matter what is occurring, all the circumstances of life have meaning.
2. People have a will, an inner drive, to find that meaning.
3. People have freedom to find meaning in the circumstances of life, as disquieting as they may be.

According to Frankl, there was a link between all dysfunction, including neurosis, hatred, addiction, compulsion, even criminal behaviors, and a lack of meaning associated with distressing incidents. Furthermore, the insightful medical man asserted that, inevitably, sometime in their lives, all human beings would confront what he called a “Tragic Triad” composed of pain, guilt and suffering. Frankl believed that, no matter how adverse events could be, there was meaning to be found in readjusting our attitudes and perceptions to transform them into opportunities for psychological growth and development.

Modern psychiatric researchers, independent of Frankl’s findings, have also come to realize the importance of meaning for mental well-being and for addressing fundamental concerns of existence including isolation, meaninglessness, loss of freedom and death. According to their theories, meaning could be divided into three components: significance, purpose and coherence. Based on this formulation, something is meaningful when it has some importance (significance), has a point (purpose) and when we can understand it (coherence). Whether it’s to get through a particularly traumatic tribulation, perhaps the loss of a job or a health crisis or simply to improve the quality of an already joy-filled life, these building blocks can be leveraged to create meaning from scratch.

The first thing we have to do to find meaning in a harrowing experience is to establish the importance. What can come out of our specific angst? How is it significant? How will it make us better, stronger or more effective?

Secondly, we must be able to characterize an end point. Can we spot an end point? What will the end point be like? What will we be like at the end point?

Lastly, our experience must make sense to us. We have to know why we’re participating, why it’s happening and it must somehow be coherent with the rest of our lives; it must fit into some kind of pattern and context.

Let’s take a practical example. One of the most agonizing of life’s experiences is the loss of a loved one and, sooner or later, it’s something we’re all going to have to deal with. So, say we’re confronted with the death of someone close to us. To synthesize and marshal the meaning necessary to help us deal with what could otherwise be devastating and overwhelming, it might be helpful to take the following 3 action steps:

Step #1 – See how the death is significant. Maybe it relieved the deceased of their suffering or possibly you want to apply some religious importance to say, they’re in better place, heaven or in God’s hands.

Step #2 – Look for an endpoint and characterize it. Maybe it will make the survivors stronger. Perhaps there is some lesson to be learned. Or maybe as the old saying goes, when one door closes, another one opens and we’re about to experience a new opportunity.

Step #3 – Attribute the death to a cause, something that makes sense. Was illness involved? Was the beloved ready to go? Was it just his time? This step is most certainly the hardest when a seemingly random act of violence or accident leads to dying, but it’s a step that must be taken if we are truly going to be able to find the meaning required to help us go on. If need be, coherence can be discovered just by acknowledging randomness as part of the overall scheme of life and death; the Master Plan of reality where all beginnings have their end and everything that is born ultimately must die.

In a therapeutic setting the psychologist utilizing Frankl’s logotherapeutic methodology will leverage three primary techniques known as Paradoxical Intention (PI), De-reflection, and Socratic Dialogue (SD).

Paradoxical Intention (PI) attempts to get the client to do exactly what he or she is afraid of. In other words, the feared action is carried out without the harmful consequences the client expects. The benefits of PI are based in a reduction of what Frankl calls “Anticipatory Anxiety”, a type of stress that manifests as a result of a potentially failed or unmet expectation. For example, if a patient has insomnia, he or she may experience Anticipatory Anxiety as a result of failing to achieve their goal of falling asleep. Under these circumstances a therapist might suggest PI, recommending that the patient change their goal to see how long they can go without falling asleep, which alleviates the Anticipatory Anxiety by eliminating the relevance and impact of success/failure.

De-reflection is based on the idea that, at times, particularly during suffering, we become hyper-reflective, and excessively introspective, focusing inwardly on ourselves, our thoughts and our perceptions. De-reflection helps the patient deflect the internalization that shows up as perpetual self-observation. According to this concept when we detach from our internal dialogue and perceptions through De-reflection, it becomes easier to be aware of the more meaningful, purposeful activities which Frankl believed were essential to achieving wellness. For example, if a traumatized patient is constantly internalizing their experiences and living in perpetual state of self-observation, they may not be able to seek and find the meaning in their distressing experiences. Through De-reflection, he or she may be able to replace their chronic self-observation with a meaningful pursuit, which is essential for achieving existential wellness.

Socratic Dialogue (SD) is a process, first described by the philosopher Socrates. Psychologists sometime refer to SD as “Maieutic Dialogue”, after the Greek term for midwifing. Socratic Dialogue incorporates an interviewing technique which is a type of “cooperative argument” designed to elicit the patient’s own internal wisdom, “midwifing” to awareness the knowledge that the client already possesses. This protocol uses questioning, which helps the patient accept personal responsibility for living a meaningful and purposeful life. According to Frankl, Socratic inquiry should “stand with one leg firmly in the client’s way of looking at her world and the other in the new territory”. He recommends questions like: “As you look back on your life, what are the moments when you were most yourself?” or “What is life asking of you at this time, even in all your suffering?”. These questions in effect deliver or “give birth to” the meaningful possibilities associated with the client’s experiences, which he or she already intuitively knows.

Did you know-

“Well-being” is not the same as “pleasure”. The difference between the two can be measured in the blood. In an August, 2013 paper published by in the Proceedings of the National Academy of Sciences, patients were assessed and categorized as primarily “pleasure seeking” (looking to achieve immediate physical or experiential sensations) or primarily “well-being seeking” (looking for meaning and a noble purpose to their existence). When blood samples from the two groups were examined, it was shown that plasma drawn from the pleasure seeking group contained higher levels of inflammatory chemicals and was associated with exaggerated stress response, while that associated with the well-being seeking group had decreased genetic markers for stress and inflammation, as well as an increase in the strength and responsiveness of the immune system.