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|Figure 1. Viktor Frankl, 1965. Creative Commons.|
Not long before the Dachau concentration camp was liberated in April 1945, Viktor Emil Frankl was seriously ill with typhus and writing feverishly on stolen scraps of paper, determined to keep himself and his ideas alive. Faced with the prospect of his own death and helpless as a physician to treat those dying all around him, he anchored his own will to live in what he believed to be his purpose. Two years earlier, he had recorded the central tenets of his psychotherapeutic approach of logotherapy while imprisoned by the Nazis in the Theresienstadt labor camp. His wife, Tilly, had sewn the manuscript into the lining of his coat before they were transported to Auschwitz in 1944, but it was confiscated on arrival along with the clothing, belongings, and identities of the prisoners who arrived by the thousands, until they were left with nothing but their “ridiculously naked lives.”1 “I felt like a father who was not spared watching his children murdered before his eyes,” Frankl later wrote. “The book was, in fact, my spiritual child who I’d hoped would survive even if I did not do so myself.”2
Logotherapy, an approach to mental health based on the determination of personal meaning and purpose, is commonly believed to have been generated from Frankl’s experiences as a Holocaust survivor. While he did write two books within the first few weeks of his release—Man’s Search for Meaning, which frames his beliefs against the backdrop of life in four Nazi prison camps; as well as The Doctor and the Soul, which describes the theoretical and practical aspects of his approach—he had in fact been developing his ideas since adolescence. Sometimes described as the originator of the third Viennese school of psychotherapy, Frankl had collaborated then broke with his hometown mentors and colleagues Freud and Adler, stating that the central motivating force for humans is the will to meaning, rather than the will to pleasure as Freud believed, or the will to power as posited by Adler.3
Introspective and reflective from an early age, Frankl had been interested in psychology and philosophy since childhood. He believed in the uniqueness of the human soul and opposed the reductionistic views of existentialist philosophers and physicians of his time.4 “Even [as a teen] I had developed two basic ideas,” Frankl wrote. “First, it is not we who should ask for the meaning of life, since it is we who are being asked. It is we ourselves who must answer the questions that life asks of us, and to these questions we can respond only by being responsible for our existence. The other basic idea I developed in my early years maintains that ultimate meaning is, and must remain, beyond our comprehension.”5
|Figure 2. Vienna, Austria 1900. Creative Commons.|
Frankl began to practice the therapeutic elements of his approach while still in medical school at the University of Vienna, when he organized youth counseling centers in Vienna and six other cities. He published papers on the need for mental health services for young people, in particular noting an increase in the suicide rate around the time that grades were posted.6,7 After graduation, he practiced as a psychiatrist at University Clinic in Vienna for seven years, where he worked with suicidal patients.8 He opened a private practice as a specialist in psychiatry and neurology in 1937, but it was shut down a few months later when Hitler’s troops marched into Austria in March 1938. He then accepted a position as the director of neurology at Rothschild Hospital, which granted him and his parents a temporary stay from deportation. During his time there he falsified the diagnoses of mentally ill patients to sabotage the Nazi euthanasia program and tended to the needs of Vienna’s Jewish population.9 “Up to ten suicide attempts came in every day,” wrote Frankl of his patients at that time, “so catastrophic was the mood of the Jewish population in Vienna!”10
The situation was becoming worse, and although Frankl was granted an immigration visa to the US in 1942, which would have allowed him to continue the research and writing of his book, he allowed it to expire so that he could remain with his aging parents.11 In September 1942, Viktor and Tilly Frankl were arrested and sent to Theresienstadt, along with his parents and his brother, Walter. Frankl’s father, Gabriel, died after six months in the camp. A short time later, Viktor, his mother Elsa, and Tilly were sent to Auschwitz. Elsa was murdered in the gas chambers on arrival. Tilly was sent to Bergen-Belsen, where she would later die of malnutrition or disease. Viktor spent a few days in Auschwitz before being sent to two labor camps at Dachau,12 where he “was not employed as a psychiatrist in camp, or even as a doctor, except for the last few weeks” but rather as “Number 119,104, [mostly] digging and laying tracks for railway lines.”13
|Figure 3. Life in Theresienstadt. Bedřich Fritta, c. 1943. Jewish Museum, Berlin|
Frankl is forthright about the brutal conditions at the prison camps as well as the stages and variety of human responses within them. “Disgust, horror, and pity are emotions that our spectator could not really feel any more,” he wrote about the emotional numbing of the prisoners. “The sufferers, the dying and the dead, became such commonplace sights to him after a few weeks of camp life that they could not move him any more.”14 However, he also noted that people have a choice in their response to suffering and that this freedom is a vital aspect of our humanity. Beauty, spirituality, and kindness took on new meaning in the camps, as did the importance of a person’s belief in the meaning and purpose of their life. Frankl attributed his survival to a focus on two of his own significant sources of meaning: his love and hope for a reunion with his wife, Tilly; and his determination to one day write and publish his book.15,16
After liberation, Frankl returned to Vienna to find that his beloved Tilly had died, as well as his mother, brother, and many friends. He grieved by burying himself in work. “Words gushed from my lips as I paced about the room,” he wrote. “Now and then—I see it still—I collapsed into a chair, weeping. So moved was I by thoughts that often overwhelmed me with painful vividness. The flood-gates had opened.”17
In the two books he wrote in the flood of work that accompanied his grief, he recorded both the theoretical framework and practical applications of logotherapy. “Man’s search for meaning is the primary motivation in his life and not a ‘secondary rationalization’ of instinctual drives,” he asserted. “This meaning is unique and specific in that it must and can be fulfilled by him alone; only then does it achieve a significance which will satisfy his own will to meaning.”18 Today, the Viktor Frankl Institute describes logotherapy and existential analysis as assisting people in “perceiving and removing those factors that hinder them in pursuing meaningful goals in their lives. Clients are sensitized for the perception of meaning potentialities; however, they are not offered specific meanings. Rather, they are guided and assisted in the realization of those meaning possibilities they have detected themselves.”19
|Figure 4. Dachau concentration camp. Creative Commons.|
Frankl offered three main concepts to frame his approach: freedom of will, a will to meaning, and the meaning of life. He acknowledged that humans are significantly affected and conditioned physically and emotionally by their genetics and environment, but that it was incorrect and dangerous to reduce a person to those factors alone: he maintained that we always have a choice.20-22 He proposed that a lack of meaning underpinned many of the problems he perceived in his time that remain issues today, such as violence, addiction, depression, suicidality, tribalism, and fanaticism.23,24 Rather than ignoring existential quandaries, Frankl encouraged therapists to help people uncover their own meaning, which is personal and often changing. Personal meaning, according to Frankl, could be discovered in three different ways: “by creating a work or doing a deed; by experiencing something or encountering someone; and by the attitude we take toward unavoidable suffering.”25 He was clear about his position that suffering should be relieved whenever possible, but for those who find themselves in situations they cannot change, there is still human dignity and meaning that may be encountered through “tragic optimism,” which allows an opportunity for personal accomplishment and change.26, 27
Frankl’s theories and ideas, as well as some specific therapeutic techniques such as paradoxical intention (the use of self-distancing and humorous exaggeration to break cycles of anxiety and obsession) and de-reflection (drawing attention away from symptoms), have been developed and embedded in some modern forms of psychotherapy.28 His work also remains relevant in addressing other medical, social, spiritual, and ethical issues of our time such as patient-centered care and shared decision-making;29-31 medical ethics;32,33 burnout and finding meaning in work;34-36 palliative and end-of-life care;37 and our response to crises such as the COVID-19 pandemic.38
Frankl continued to live out his own meaning and purpose through his work and relationships. He found love again with Eleanore Schwindt and they had a daughter together. He was the head of the neurology department at the Vienna Policlinic Hospital for twenty-five years, wrote more than thirty books, lectured internationally, and served as a visiting professor at many distinguished universities.39 He was also an avid, lifelong mountaineer and took flying lessons in his later years.40
Viktor Frankl died in 1997 at the age of ninety-two, but his legacy lives on. The Viktor Frankl Institute in Vienna continues to advance his ideas through research and training, and Man’s Search for Meaning has been in print for more than sixty years with more than fifteen million copies worldwide.41 However, Frankl himself best described the profound importance of his work when he was once asked in a classroom to describe the meaning of his own life. He wrote the response on a piece of paper and asked the students what they thought he had written. One student said, “The meaning of your life is to help others find the meaning of theirs.”
“That was it, exactly,” Frankl responded. “Those are the very words I had written.”42
- Viktor Frankl, Man’s Search for Meaning, 5th edition (Boston: Beacon Press, 2006), 16.
- Viktor Frankl, The Doctor and the Soul, 3rd Vintage Books edition (Knopf Doubleday: Kindle Edition, 2019), xi-xii.
- Frankl, Man’s Search for Meaning, 99.
- Alex Pattakos and Elaine Dundon, Prisoners of Our Thoughts: Viktor Frankl’s Principles for Discovering Meaning in Life and Work (Oakland: Berrett-Koehler Publishers, Incorporated, 2017), 43.
- Viktor Frankl, translated by Joseph Fabry and Judith Fabry, Recollections (Cambridge, MA: Perseus Books, 2000), 56.
- Frankl, Recollections, 68.
- Viktor Frankl, Alexander Batthyany, and Andrew Tallon, The Feeling of Meaninglessness: A Challenge to Psychotherapy and Philosophy (Milwaukee, WI: Marquette University Press, 2010), 15-16.
- Frankl, Recollections, 73-74.
- Viktor Frankl Institute, https://www.viktorfrankl.org/biography.html
- Frankl, Recollections, 76.
- William Winslade, Afterword to Man’s Search for Meaning, 157.
- Frankl, Recollections, 20-21.
- Frankl, Man’s Search for Meaning, 7.
- Ibid, 22.
- Ibid, 36 – 39.
- Winslade, Man’s Search for Meaning, 158.
- Frankl, Recollections, 105-106.
- Frankl, Man’s Search for Meaning, 99.
- Viktor Frankl Institute.
- Frankl, The Doctor and the Soul, 16.
- Ibid, xxvi.
- Frankl, Man’s Search for Meaning, 130.
- Viktor Frankl Institute.
- Frankl, Man’s Search for Meaning, 107.
- Ibid, 111.
- Ibid, 113.
- Ibid., 138.
- Viktor Frankl Institute.
- Frankl, The Doctor and the Soul, 281.
- Frankl, Batthyany, and Tallon.
- Frankl, Man’s Search for Meaning, 133.
- Frankl, The Doctor and the Soul, 274-275.
- Alfried Längle and Britt-Mari Sykes. “Viktor Frankl—Advocate for Humanity: On His 100th Birthday.” Journal of Humanistic Psychology 46, no. 1 (January 2006): 36–47.
- Frankl, The Doctor and the Soul, 118 – 119.
- S Southwick, LI Wisnesk, and P Starck. “Rediscovering Meaning and Purpose: An Approach to Burnout in the Time of COVID-19 and Beyond.” Am J Med. 2021 May 11: S0002-9343(21)
- Pattakos and Dundon, 35 – 154.
- William Breitbart, Christopher Gibson, Shannon R Poppito, and Amy Berg. “Psychotherapeutic Interventions at the End of Life: A Focus on Meaning and Spirituality.” The Canadian Journal of Psychiatry 49, no. 6 (June 2004): 366–72.
- A Gotlib. “Letting Go of Familiar Narratives as Tragic Optimism in the Era of COVID-19,” J Med Humanit. 2021 Mar;42(1):81-101.
- Viktor Frankl obituary, The New York Times, https://www.nytimes.com/1997/09/04/world/dr-viktor-e-frankl-of-vienna-psychiatrist-of-the-search-for-meaning-dies-at-92.html.
- Winslade, Man’s Search for Meaning, 164.
- Pattakos and Dundon, 50.
- Winslade, Man’s Search for Meaning, 164-165.
- Breitbart, William, Gibson, Christopher, Poppito, Shannon R, and Berg, Amy. “Psychotherapeutic Interventions at the End of Life: A Focus on Meaning and Spirituality.” The Canadian Journal of Psychiatry 49, no. 6 (June 2004): 366–72.
- Frankl, Viktor E. The Doctor and the Soul, 3rd Vintage Books Edition. Knopf Doubleday Publishing Group: Kindle Edition, 2019.
- Frankl, Viktor E. Man’s Search for Meaning (5th edition). Afterword by William Winslade. Boston: Beacon Press, 2006.
- Frankl, Viktor E. Recollections. Translated by Joseph Fabry and Judith Fabry. Cambridge, MA: Perseus Books, 2000.
- Frankl, Viktor E., Batthyany, Alexander, and Tallon, Andrew. The Feeling of Meaninglessness a Challenge to Psychotherapy and Philosophy. Milwaukee, Wis: Marquette University Press, 2010.
- Gotlib A. “Letting Go of Familiar Narratives as Tragic Optimism in the Era of COVID-19.” J Med Humanit. 2021 Mar;42(1):81-101.
- Längle, Alfried, and Sykes, Britt-Marie. “Viktor Frankl—Advocate for Humanity: On His 100th Birthday.” Journal of Humanistic Psychology 46, no. 1 (January 2006): 36–47.
- Noble, Holcomb B. “Dr. Viktor E. Frankl of Vienna, Psychiatrist of the Search for Meaning, Dies at 92.” The New York Times, September 4, 1997. https://www.nytimes.com/1997/09/04/world/dr-viktor-e-frankl-of-vienna-psychiatrist-of-the-search-for-meaning-dies-at-92.html.
- Pattakos, Alex, and Dundon, Elaine. Prisoners of Our Thoughts: Viktor Frankl’s Principles for Discovering Meaning in Life and Work. Oakland: Berrett-Koehler Publishers, Incorporated, 2017.
- Southwick S, Wisnesk LI, Starck P. “Rediscovering Meaning and Purpose: An Approach to Burnout in the Time of COVID-19 and Beyond.” Am J Med. 2021 May 11: S0002-9343(21)00309-0.
- Viktor Frankl Institute. www.viktorfrankl.org.
ANNE JACOBSON, MD, MPH, is a family physician, writer, consultant, and editor. Her published works may be found in Hektoen International, The Examined Life Journal, The Journal of the American Medical Association, in the anthology At The End of Life: True Stories About How We Die, and others. A collection of her writing may be found at www.thewritetowander.com.