Three seminal essays by Viktor Frankl highlight the deep spirituality that he believed to be at the heart of man's search for meaning and purpose in this world. Humanity returns consciously or unconsciously to this universal spirituality in its quest for a fulfilling existence.
A niece of Frankl, Liesl Kosma, translated the short essay called “Medical and Religious Pastoral Care.” In this piece, Frankl reflects on the intersection of psychiatry and religion in responding to spiritual crises to achieve psychological healing. A psychotherapy that helps a person to know the meaning of his or her existence equips them with strengths to overcome the everyday challenges of living. Within Frankl's framework, life is not governed primarily by drives and instincts as described by Freud, but rather personal choices through which each person exercises his or her free will, his or her decisions defining the path he or she traverses to achieve an authentic humanity. A spiritual self derives strength from beliefs that anchor man within the cosmos, often expressed within the constructs of religion. This spirituality is both conscious and unconscious, the latter serving as a powerful source of guidance, which can assist each person to achieve equanimity and peace.
The essay “Ten Theses Concerning a ‘Person’” was written by Frankl in 1950 and is a remarkable forerunner to Eric Cassell's (1982) classic writing about personhood in his “The Nature of Suffering.” Frankl views each person as absolutely unique, dignified and spiritual, and he contrasts the indivisible nature of a person with the way that organic matter can be broken down. Recognition of the profound value of each person invites respect and reverence for a hierarchy of values and meaning, including the “summit of such values,” which Frankl terms G-d.
The existential person is “a deciding being,” taking responsibility for what and against what he or she decides. Rather than a direction governed by pleasure or power, a search for meaning is the great force behind the choices made. Moreover, in differentiating a spiritual unconscious from the instinctual unconscious of psychoanalysis, Frankl sees the human person enter into a transcendent relationship with a higher cosmic power. Accessing this spirituality is a dynamic process, assisted by the world's great religions, but also helped by medical professionals appreciating the importance of “things spiritual” to our essential humanity. A “psychology without soul” risks being blind to the dignity and integrity of each person, to being value blind, and to missing the very meaning of life. For Frankl, healing achieves a “body-mind-soul unity” (p. 64), which coalesces psychology with spirituality as inseparable dimensions of authentic personhood.
“Time and Responsibility” was a lecture delivered by Frankl in 1947 and translated here by Shimon Cowen. In this lecture, Frankl laments the neglect by behavioral science of meaning as a prime source of adaptation and coping. Frankl's existential lens views acceptance of responsibility as the key to man's freedom, rather than viewing life, and indeed illness, as a consequence of fate. Coping with illness necessitates courage and choice rather than passive fatalism. The taking up of responsibility is therefore an important pivot of psychotherapy in its efforts to promote healing. Modern attributions of causality to genetics, biology, or even the instinctual inner world deny man's ability to exercise choice and responsibility about how one lives.
Time comes to the fore as one context for our search for meaning, but for Frankl, the passing of time, and its division into past, present, and future, is only “an illusion of consciousness.” Undue attention to living in the present might lead to a relative neglect of the past or the potential of the future, missing the value of regret and atonement as a pathway to healing and greater fulfillment. Appreciation and celebration of the totality of life is crucial. Although everything is transitory, it is also eternal and thus creates the legacy of our lives, our creative selves! In the final analysis, we all aspire to approach the closure of our lives with a sense of a true goodness that is sufficient.
In these writings, as Frankl ponders mystery and things unknowable to the human mind, he shares his spirituality and conviction, his reverence for the sacred, and his belief in the transcendent. Alongside this, he maintains professional neutrality as his physician's stance toward others, based on deep respect for their humanity, irrespective of their personal convictions. Indeed, the physician must support each patient's search for meaning in a nondirective, yet facilitative, manner. And for Frankl, a collaborative cooperation is desirable between psychotherapy and pastoral care in the service of promoting true healing for our patients.
These writings have great relevance to supportive and palliative care through their respect for humanity, their thoughtful reflection on the purpose of life, and their attention to the existential issues so commonly met on this quest. Viktor Frankl is a stimulating teacher, and this monograph will be a helpful resource for clinicians seeking to enrich the care they deliver to the dying. It has my unreserved recommendation.
