Logotherapy. Elisabeth Lukas

a question of preventing the development of psychic disorders, and that the concept of the human being applied to those who are under threat is extremely important. To begin with, a few words about this category of psychic disorders, which were formerly referred to as “neuroses”.

      Neuroses are caused by multiple factors. Genetic predispositions combine with significant educational or environmental influences, small mistakes have decisive consequences, and unfortunate coincidences also play a role. Above all, the person concerned surrenders without a fight to inner obstacles. Two characteristics may generally be observed: a strong susceptibility to feelings of insecurity and a “hanging on” to certain thoughts.

       1) On susceptibility to feelings of insecurity

      The spiritual dimension of the “neurotic” (today called an “anxiety sufferer”) is unblocked and unrestricted, and the intellect is also unaffected. But the patient does not, so to speak, trust his or her own spirit. What is missing is not so much health as the security of being healthy. There is doubt about everything, especially about the self, and insecurity penetrating into the deepest existential layers of being. As a result, there is no trust in the capacities of the self (“I can’t do that”) but at the same time trust in a tendency to do everything badly (“I only do stupid things”). Although the irrationality of these feelings, which are unnecessarily negative, is fully recognised, there is always a temptation to take them seriously. The patient is always running away from something that is always catching up. This annoys the patient – to the point of self-hatred, which has an additionally weakening effect. An inescapable vicious circle of lack of trust and resulting misfortune is created. Insecurity, anxiety, low selfesteem and increased irritability become spiritual traps.

      The neurotic, having become insecure for some psychophysical reason, has a particular need for the support of the spiritual.¹⁵)

       2) On “hanging on” to thoughts

      The “neurotic” (today called an “anxiety sufferer”) cannot get rid of doubting and complaining thoughts. It is immeasurably difficult for the sufferer to draw a line under things. His or her thoughts dwell endlessly on small inconveniences which have been or could be experienced, and make an “elephant out of every mosquito”. In logotherapy we speak of “hyperreflexion”, which exaggerates and aggravates every minor life crisis.

      This “hanging on” to thoughts is highly likely to have a neurophysiological factor. Sensitive measurements of electrical impulses in the cerebral cortex when isolated groups of cells are stimulated show different progressions in different people. In some people the activation response to stimuli is slower than in others. If groups of cells are activated in rapid succession, they easily get into a state of permanent activation. This could be a clue as to why anxiety sufferers are more sensitive, tense and excitable than their fellow human beings: their vegetative system often reacts more excitably than in others. Thus, whenever a person has a strong predisposition to hyperreflection, the way is prepared for a neurotic disorder. Nevertheless, powerful psychotherapeutic weapons should not immediately be brought into play. As soon as an insecure person sees him or herself as needing therapy, he or she slips a level deeper into a presupposed inability to master life. What needs to be made clear to a person in danger of neurosis is not his or her illness, but his or her remaining health! Any overdose of psychotherapy both intensifies the insecurity (“I need help, I cannot do it alone”) and reinforces the circling around problems in thought – thus problem-oriented discussions play completely into the hands of the illness! At this stage it is better to encourage the endangered person to trust in themselves and the world, and to let go of fruitless thoughts.

      Now to the promised case study:

      A young pregnant woman was referred to me by her GP to me to learn relaxation exercises. During the period when she was coming to me regularly for training, her husband once asked for a private conversation with me. The conversation is sketched out in sections with a specialist commentary.

       Section 1

      At first the man seemed embarrassed and did not come to the point. He confined himself to superficial conversation.

      Commentary: The man’s insecurity was noticeable. To relieve him of the idea that he had to “confess” unwanted things, I said to him, “Just tell me what you’d like to tell”. This instruction often has a paradoxical effect, as the forbearance opens floodgates and the inhibited person begins to pour out his or her heart. But I honestly meant it; the responsibility for the conversation should remain with the person seeking help.

      Section 2

      The man reported that he had a damaged disc and various resulting problems with his back.

      Commentary: One could presume that his back pain had to do with the problems he wanted to discuss. This “conversation opener” was not, however, completely appropriate for a meeting with a psychologist, who is not an expert on damaged discs. Clearly his thoughts were circling around something that was not currently the focus of our attention. I listened in silence, to give the man the opportunity to come back from his detours to the essentials.

      Section 3

      The man continued his remarks about his back. He had been provided with detailed medical information, and knew all about the connections, for example, between long drives and curvature of the spine.

      Commentary: A further indication of the man’s insecurity emerged, namely an attempt to get rid of his internal insecurity by obtaining information. Intelligent, but spiritually handicapped persons often read a lot of life counselling and technical literature, without being able to obtain decisive impetus from them. I do not, however, want to assert “psychologistically” that any interest in autodidactic training is an expression of insecurity. In any case, an interruption of the man’s long-winded deliberations was indicated, and so with the question: “Can you do something to relieve your pain?” I led him back into the constructive realm.

      Section 4

      The man said he could. He was receiving special massages and physiotherapy. There was a pause in the conversation.

      Commentary: Apparently, the keyword had been spoken. Now I just had to wait. In the silence that followed, the man decided to reveal his problem.

       Section 5

      The man embarrassedly explained that he would become sexually excited during the massages. Then he would be embarrassed in front of the women who treated him, he would tense up and become cramped. His concerns went beyond this, however. He expressed it in these words: “That’s not what I want, I’m not like that! I don’t understand myself anymore. I love my wife and I’m not interested in anyone else. Is it possible that I am unconsciously trying to cheat on her? It weighs me down and it is extremely embarrassing.” He also mentioned that he had thought about running away: “I’d like to cancel the treatment, but I don’t know how to explain it to my doctor and my wife.”

      Two- and Three-dimensional Interpretations

      Let us consider this case according to dimensional ontology. What is visible to the spectator?

       On the somatic level

      Physically, a low sexual arousal threshold, possibly associated with vegetative and hormonal factors. However, the erections at unsuitable moments that he described are not unusual. After all, they took place in a context conducive to sexual arousal: he was undressed and being touched by women … diagnostically this suggests nothing abnormal!

      On the psychic level

      The psychic symptoms were more drastic, though also not alarming. He was astonishingly unsure of himself, worked himself up into unnecessary worries and attributed excessive importance to the matter. A hypersensitivity in the area of shame triggered a desire for avoidance.

      On the noetic level

      There was a clear spiritual statement: he loved his wife and he wanted to remain faithful to her. There was no extramarital sexual activity, and his erections during