Viktor Frankl on the Power of “Meaning” and the Conception of Psychiatry

On August 19th, 2017, I posted here the article “Does your life have purpose?”. I provided some evidence that people who feel purpose in life have better physical and mental health and live happier lives. The famous Viennese psychiatrist Viktor Frankl put “meaning” and “purpose” at the centre of his psychotherapeutic approach, which he called “logotherapy” (German Wikipedia here). His book “Man’s Search for Meaning”, which was published in almost 150 editions and translated in 50 languages, is one of the most influential books of the 20th century.

Man's Search for Meaning

In this small book of just a bit over a hundred pages, he describes the existential experience of survival of three years in Nazi concentration camps, among them Auschwitz. While Frankl published many books on psychiatry and psychotherapy, especially on logotherapy, he conveys the basis of a deeply humanistic approach to psychiatry on the last few pages of his first and most important book. While I recommend the book not only to everybody who treats patients but to everybody with a spiritual mind, I publish the most important phrases on the foundations of psychiatry below.

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 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.”

And further (you can find the next paragraph as my “mission statement” on my home page):

“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.”

Frankl continues with the following statement on his understanding of the conception of psychiatry:

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.”

This leads him to the following concluding remark:

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 that 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 and not on conditions.”

While there is so much truth in this words, Frankl – in my opinion – was wrong in his estimation that a humanized psychiatry begins to loom on the horizon. Determinism and reductionism dominate at least academic psychiatry, and we have to ask ourselves whether we are asking the right questions.