INDEX EXISTENTIALISM ORIGIN AND DEVELOPMENT ROLLO MAY BIOGRAPHY THEORY PSYCHOPATHOLOGY VICTOR FRANKL BIOGRAPHY THEORY PSYCHOPATHOLOGY

EXISTENTIALISM Existentialism is concerned with ontology or the study of the nature of being. It is best understood by being-in the-world. The use of hyphens is the best we can do in English to convey the idea that a person and the environment are an active unity. Existentialists reject dualism that a split between mind and body, experience and environment. Being and world are inseparable, because they are both essentially created by the individual. Phenomenological, the world we relate to is our own construction that to a greater or lesser extent reflects the construction of others, depending on how conventional we are. For example, a Christians world includes a superior being that can be communicated with, whereas the atheists existence contains no such superior being. ORIGIN AND DEVELOPMENT The philosophers who are especially pertinent to the development of existential psychotherapy are those whose work is directly aimed at making sense of human existence. But the philosophical movements that are of most importance and that have been directly responsible for the generation of existential therapy are phenomenology and existential philosophy. The starting point of existential philosophy can be traced back to the nineteenth century and the work of Kierkegaard and Nietzsche. Both were in conflict with the predominant ideologies of their time and committed to the exploration of reality as it can be experienced in a passionate and personal manner. Kierkegaard (181355) protested vigorously against popular misunderstanding and abuse of Christian dogma and the so-called 'objectivity' of science (Kierkegaard, 1841, 1844). He thought that both were ways of avoiding the anxiety inherent in human existence. He had great contempt for the way in which life was being lived by

those around him and believed that truth could ultimately only be discovered subjectively by the individual in action. What was most lacking was people's courage to take the leap of faith and live with passion and commitment from the inward depth of existence. This involved a constant struggle between the finite and infinite aspects of our nature as part of the difficult task of creating a self and finding meaning. As Kierkegaard lived by his own word he was lonely and much ridiculed during his lifetime. Nietzsche (18441900) took this philosophy of life a step further. His starting point was the notion that God is dead, that is, the idea of God was outmoded and limiting (Nietzsche, 1861, 1874, 1886) and that it is up to us to re-evaluate existence in light of this. He invited people to shake off the shackles of moral and societal constraint and to discover their free will in order to live according to their own desires, now the only maintainable law in his philosophy. He encouraged people to transcend the mores of civilization and choose their own standards. The important existential themes of freedom, choice, responsibility and courage are introduced for the first time. Heidegger (18891976) applied the phenomenological method to understanding the meaning of being (Heidegger, 1962, 1968). He argued that poetry and deep philosophical thinking can bring greater insight into what it means to be in the world than can be achieved through scientific knowledge. He explored human being in the world in a manner that revolutionizes classical ideas about the self and psychology. He recognized the importance of time, space, death and human relatedness. He also favoured hermeneutics, an old philosophical method of investigation, which is the art of interpretation. Unlike interpretation as practised in psychoanalysis (which consists of referring a person's experience to a pre-established theoretical framework) this kind of interpretation seeks to understand how the person himself subjectively experiences something.

Sartre (190580) contributed many other strands of existential exploration, particularly in terms of emotions, imagination, and the person's insertion into a social and political world. Otto Rank, an Austrian psychoanalyst who broke with Freud in the mid-1920s, was the first existential therapist. Ludwig Binswanger, in Switzerland, also attempted to bring existential insights to his work with patients, in the Kreuzlingen sanatorium where he was a psychiatrist. Much of his work was translated into English during the 1940s and 1950s and, together with the immigration to the USA of Paul Tillich (Tillich, 1952) and others; this had a considerable impact on the popularization of existential ideas as a basis for therapy (Valle and King, 1978; Cooper, 2003). Rollo May played an important role in this, and his writing (1969, 1983; May et al., 1958) kept the existential influence alive in America, leading eventually to a specific formulation of therapy (Bugental, 1981; May and Yalom, 1985; Yalom, 1980). In Europe, after Otto Rank, existential ideas were combined with some psychoanalytic principles and a method of existential analysis was developed by Medard Boss (1957a, 1957b, 1979) in close cooperation with Heidegger. In Austria, Viktor Frankl developed an existential therapy called logotherapy (Frankl, 1964, 1967), which focused particularly on finding meaning.

ROLLO MAY

Biography He is the most influential existential theorist in America. May was born in Ada, Ohio in 1909. He experienced a difficult childhood, with his parents divorcing and his sister becoming schizophrenic. He was the first son of a family with six children. His mother often left them to care for themselves, so with his sister being a schizophrenic, he endured a great deal of responsibility. His educational career took him to Michigan State College majoring in English and Oberlin College for a bachelor's degree, teaching for a time in Greece, to Union Theological Seminary for a BD during 1938, and finally to Teachers College, Columbia University for a PhD in clinical psychology during 1949. May was a founder and faculty member of Saybrook Graduate School and Research Centre in San Francisco. He spent the final years of his life in Tiburon on San Francisco Bay, where he died in October.

THEORY May was influenced by American humanism, and interested in reconciling existential psychology with other philosophies, especially Freud's.

May considered Otto Rank (1884-1939) to be the most important precursor of existential therapy. May used some traditional existential terms in a slightly different fashion than others, and he invented new words for traditional existentialist concepts. Destiny, for example, could be "thrownness" combined with "fallenness" the part of our lives that is determined for us, for the purpose of creating our lives. He also used the word "courage" to signify resisting anxiety. Stages of development Innocence the pre-egoic, pre-self-conscious stage of the infant. An innocent is only doing what he or she must do. However, an innocent does have a degree of will in the sense of a drive to fulfill needs. Rebellion the rebellious person wants freedom, but does not yet have a good understanding of the responsibility that goes with it. Decision The person is in a transition stage in their life such that they need to be more independent from their parents and settle into the "ordinary stage". In this stage they must decide what to do with their life, and fulfilling rebellious needs from the rebellious stage. Ordinary the normal adult ego learned responsibility, but finds it too demanding, and so seeks refuge in conformity and traditional values. Creative the authentic adult, the existential stage, self-actualizing and transcending simple egocentrism. These are not "stages" in the traditional sense. A child may certainly be innocent, ordinary or creative at times; an adult may be rebellious. The only association with certain ages is in terms of importance: rebelliousness is more important for a two year old or a teenager. May perceived the sexual mores of the 1960s and 1970s, as well as commercialization of sex and pornography, as having influenced society such that people believed that love and sex are no longer associated directly. According to May, emotion has become separated

from reason, making it acceptable socially to seek sexual relationships and avoid the natural drive to relate to another person and create new life. May believed that sexual freedom can cause modern society to neglect more important psychological developments. May suggests that the only way to remedy the cynical ideas that characterize our times is to rediscover the importance of caring for another, which May describes as the opposite of apathy. Four worlds One can distinguish four basic dimensions of human existence: the physical, the social, the psychological and the spiritual. On each of these dimensions people encounter the world and shape their attitude out of their particular take on their experience. Their orientation towards the world defines their reality. The four dimensions are obviously interwoven and provide a complex four-dimensional force field for their existence. Individuals are stretched between a positive pole of what they aspire to on each dimension and a negative pole of what they fear. Physical dimension the physical dimension (Umwelt) individuals relate to their environment and to the givens of the natural world around them. This includes their attitude to the body they have, to the concrete surroundings they find themselves in, to the climate and the weather, to objects and material possessions, to the bodies of other people, their own bodily needs, to health and illness and to their own mortality. The struggle on this dimension is, in general terms, between the search for domination over the elements and natural law (as in technology, or in sports) and the need to accept the limitations of natural boundaries (as in ecology or old age). While people generally aim for security on this dimension (through health and wealth), much of life brings a gradual disillusionment and realization that such security can only be temporary. Recognizing limitations can bring great release of tension.

Social dimension: On the social dimension (Mitwelt) individuals relate to others as they interact with the public world around them. This dimension includes their response to the culture they live in, as well as to the class and race they belong to (and also those they do not belong to). Attitudes here range from love to hate and from cooperation to competition. The dynamic contradictions can be understood in terms of acceptance versus rejection or belonging versus isolation. Some people prefer to withdraw from the world of others as much as possible. Others blindly chase public acceptance by going along with the rules and fashions of the moment. Otherwise they try to rise above these by becoming trendsetters themselves. By acquiring fame or other forms of power, individuals can attain dominance over others temporarily. Sooner or later, however, everyone is confronted with both failure and aloneness. Psychological dimension: On the psychological dimension (Eigenwelt) individuals relate to themselves and in this way create a personal world. This dimension includes views about their own character, their past experience and their future possibilities. Contradictions here are often experienced in terms of personal strengths and weaknesses. People search for a sense of identity, a feeling of being substantial and having a self. But inevitably many events will confront them with evidence to the contrary and plunge them into a state of confusion or disintegration. Activity and passivity are an important polarity here. Self-affirmation and resolution go with the former and surrender and yielding with the latter. Facing the final dissolution of self that comes with personal loss and the facing of death might bring anxiety and confusion to many who have not yet given up their sense of self-importance. Spiritual dimension: On the spiritual dimension (berwelt) (van Deurzen, 1984) individuals relate to the unknown and thus create a sense of an ideal world, an ideology and a philosophical outlook. It is here that they find meaning by putting all the pieces of the puzzle

together for themselves. For some people this is done by adhering to a religion or other prescriptive world view, for others it is about discovering or attributing meaning in a more secular or personal way. The contradictions that have to be faced on this dimension are often related to the tension between purpose and absurdity, hope and despair. People create their values in search of something that matters enough to live or die for, something that may even have ultimate and universal validity. Usually the aim is the conquest of a soul, or something that will substantially surpass mortality (as for instance in having contributed something valuable to humankind). Facing the void and the possibility of nothingness are the indispensable counterparts of this quest for the eternal. Books His first book, The Meaning of Anxiety, was based on his doctoral dissertation, which in turn was based on his reading of the 19th century philosopher Sren Kierkegaard. His definition of anxiety is "the apprehension cued off by a threat to some value which the individual holds essential to his existence as a self" (1967, p. 72). He also quotes Kierkegaard: "Anxiety is the dizziness of freedom". In 1956, he edited the book Existence with Ernst Angel and Henri Ellenberger. Existence helped introduce existential psychology to the US. Love and Will is another of Mays famous texts. This book investigates the shifting viewpoints of love and sex in human behaviour. During the Sexual Revolution in the 1960s, many individuals were exploring their sexuality. Free sex was replacing the ideology of free love. May explains that love is intentionally willed by an individual, whereas sexual desire is the complete opposite. Real human instinct reflected upon deliberation and consideration [clarification needed]. May then shows that to give in to

these impulses does not actually make one free, but to resist these impulses is the meaning of being free. PSYCHOPATHOLOGY According to May, feelings of anxiety stem from loneliness and emptiness. Like Freud he believed that anxiety signals an internal conflict, but his theorising about the nature and source of conflict differs. For him anxiety is not simply an unpleasant feeling; it is the human beings basic reaction to a danger to his existence, or to some value he identifies with his anxiety. Since ontological anxiety is a threat to values, no one can escape anxiety, for no values are unassailable. The conflict that generates ontological anxiety is between being and nonbeing .anxiety occurs as the individual attempts to realize his or her potentialities. If, for example, a mans overtures at friendship have been rejected he faces a fundamental conflict between being and nonbeing: he can try to understand the reasons for rejection by questioning the other person, or he can avoid asking questions that may prove embarrassing. He is thus faced with a fundamental choice, a choice that generates anxiety. If the man decides to assume the responsibility question the person, he is using the experience of ontological anxiety constructively. If he fails to ask the pertinent question, he is denying his responsibility and blocking the realization of his potentialities. In this case, may would say he is guilty. He clarified the meaning of ontological anxiety further by dividing it into two components: normal anxiety and neurotic anxiety. Normal anxiety is anxiety that is proportionate to the threat to our values .it does not involve repression and can be confronted constructively on a conscious level. Neurotic anxiety, in contrast, is a reaction that is disproportionate to the threat and involves repression. Neurotic anxiety arises when we are unable to address the normal anxiety arising at the time of actual crisis in our growth and threat to our

values. For example, normal anxiety occurs for many of us when we first move out of our parents home. We experience a threat to our family security. Yet if we confront this threat directly we are able to live through it successfully and to emerge from the crisis as a more independent and self-reliant person.in contrast, if we feel threatened and repress our feelings of anxiety, we may find ourselves calling and writing to home almost daily .such behaviour will keep us overtly dependent on our parents for support, help and advice; hinders friendship with others and prevents us from solving our own problems. For May, the goal in helping people to maximize their mental health is not to free the person from all anxiety .it is rather to help free them from neurotic anxiety, so that they can confront normal anxiety constructively. Normal anxiety is an integral part of growth and creativity.

VICTOR FRANKL

Biography Viktor Frankl was born in Vienna on March 26, 1905. His father, Gabriel Frankl, was a strong, disciplined man from Moravia who worked his way from government stenographer to become the director of the Ministry of Social Service. His mother, Elsa Frankl (ne Lion), was more tender hearted, a pious woman from Prague. The middle of three children, young Viktor was precocious and intensely curious. Even at the tender age of four, he already knew that he wanted to be a physician. Frankl married in 1942, but in September of that year, he, his wife, his father, mother, and brother, were all arrested and brought to the concentration camp at Theresienstadt in Bohemia. His father died there of starvation. His mother and brother were killed at Auschwitz in 1944. His wife died at Bergen-Belsen in 1945. In April of 1945, Frankls camp was liberated, and he returned to Vienna, only to discover the deaths of his loved ones. Although nearly broken and very much alone in the world, he was given the position of director of the Vienna Neurological Policlinic -- a position he would hold for 25 years. He has 32 books to his name, and they have been translated into 27 languages. Viktor Emil Frankl died on September 2, 1997, of heart failure

THEORY Viktor Frankls theory and therapy grew out of his experiences in Nazi death camps. Watching who did and did not survive (given an opportunity to survive!), he concluded that the philosopher Friedrich Nietzsche had it right: He who has a why to live for can bear with almost any how. (Friedrich Nietzsche, quoted in 1963, p. 121) He saw that people who had hopes of being reunited with loved ones, or who had projects they felt a need to complete, or who had great faith, tended to have better chances than those who had lost all hope. He called his form of therapy logotherapy, from the Greek word logos, which can mean study, word, spirit, God, or meaning. It is this last sense Frankl focuses on, although the other meanings are never far off. Comparing himself with those other great Viennese psychiatrists, Freud and Adler, he suggested that Freud essentially postulated a will to pleasure as the root of all human motivation, and Adler a will to power. Logotherapy postulates a will to meaning. Frankl also uses the Greek word nos, which means mind or spirit. In traditional psychology, he suggests, we focus on psychodynamics, which sees people as trying to reduce psychological tension. Instead, or in addition, Frankl says we should pay attention to nodynamics, wherein tension is necessary for health, at least when it comes to meaning. People desire the tension involved in striving for some worthy goal! Conscience One of Viktor Frankl's major concepts is conscience. He sees conscience as a sort of unconscious spirituality, different from the instinctual unconscious that Freud and others emphasize. The conscience is not just one factor among many; it is the core of our

being and the source of our personal integrity. He puts it in no uncertain terms: " (B)eing human is being responsible -- existentially responsible, responsible for one's own existence." (1975, p. 26) Conscience is intuitive and highly personalized. It refers to a real person in a real situation, and cannot be reduced to simple "universal laws." It must be lived. (M)eaning is something to discover rather than to invent." (1975, p. 113) It has a reality of its own, independent of our minds. Like an embedded figure or a "magic eye" picture, it is there to be seen, not something created by our imagination. We may not always be able to bring the image -- or the meaning -- forth, but it is there. It is, he says, "...primarily a perceptual phenomenon." (1975, p. 115) (M)an must be equipped with the capacity to listen to and obey the ten thousand demands and commandments hidden in the ten thousand situations with which life is confronting him." (1975, p. 120) And it is our job as physicians, therapists, and educators to assist people in developing their individual consciences and finding and fulfilling their unique meanings. The existential vacuum This striving after meaning can, of course, be frustrated, and this frustration can lead to nogenic neurosis, what others might call spiritual or existential neurosis. People today seem more than ever to be experiencing their lives as empty, meaningless, purposeless, aimless, adrift, and so on, and seem to be responding to these experiences with unusual behaviours that hurt themselves, others, society, or all three. One of his favourite metaphors is the existential vacuum. If meaning is what we desire, then meaninglessness is a hole, emptiness, in our lives. Whenever you have a vacuum, of course, things rush in to fill it.

Frankl suggests that one of the most conspicuous signs of existential vacuum in our society is boredom. He points out how often people, when they finally have the time to do what they want, dont seem to want to do anything! People go into a tailspin when they retire; students get drunk every weekend; we submerge ourselves in passive entertainment every evening. The "Sunday neurosis," he calls it. So we attempt to fill our existential vacuums with stuff that, because it provides some satisfaction, we hope will provide ultimate satisfaction as well. We might also fill our lives with certain neurotic vicious cycles, such as obsession with germs and cleanliness, or fear-driven obsession with a phobic object. The defining quality of these vicious cycles is that, whatever we do, it is never enough. A similar idea is hyperintention. This is a matter of trying too hard, which itself prevents you from succeeding at something. One of the most common examples is insomnia: Many people, when they cant sleep, continue to try to fall asleep, using every method in the book. Of course, trying to sleep itself prevents sleep, so the cycle continues. A third variation is hyperreflection. In this case it is a matter of thinking too hard. Sometimes we expect something to happen, so it does, simply because its occurrence is strongly tied to ones beliefs or attitudes - the self-fulfilling prophecy. Frankl mentions a woman who had had bad sexual experiences in childhood but who had nevertheless developed a strong and healthy personality. When she became familiar with psychological literature suggesting that such experiences should leave one with an inability to enjoy sexual relations, she began having such problems! Frankl calls depression, addiction, and aggression the mass neurotic triad. He refers to research that shows a strong relationship between meaninglessness (as measured by "purpose in life" tests) and such behaviours as criminality and involvement with drugs. He warns us that violence, drug use, and other negative behaviours, demonstrated

daily on television, in movies, even in music, only convinces the meaning-hungry that their lives can improve by imitation of their "heroes." Finding meaning So how do we find meaning? Frankl discusses three broad approaches. 1) The first is through experiential values, that is, by experiencing something - or someone - we value. This can include Maslows peak experiences and aesthetic experiences such as viewing great art or natural wonders. The most important example of experiential values is the love we feel towards another. 2) A second means of discovering meaning is through creative values, by doing a deed, as he puts it. This is the traditional existential idea of providing oneself with meaning by becoming involved in ones projects, or, better, in the project of ones own life. It includes the creativity involved in art, music, writing, invention, and so on. Frankl views creativity (as well as love) as a function of the spiritual unconscious, that is, the conscience. The irrationality of artistic production is the same as the intuition that allows us to recognize the good. 3) The third means of finding meaning is one few people besides Frankl talk about: attitudinal values. Attitudinal values include such virtues as compassion, bravery, a good sense of humour, and so on. But Frankl's most famous example is achieving meaning by way of suffering. He gives an example concerning one of his clients: A doctor whose wife had died mourned her terribly. Frankl asked him, If you had died first, what would it have been like for her? The doctor answered that it would have been incredibly difficult for her. Frankl then pointed out that, by her dying first, she had been spared

that suffering, but that now he had to pay the price by surviving and mourning her. In other words, grief is the price we pay for love. In Man's Search for Meaning, he says this: "...everything can be taken from a man but one thing: the last of the human freedoms -- to choose one's attitude in any given set of circumstances, to choose one's own way." (1963, p. 104) Transcendence Here we see Frankls religious bent: Suprameaning is the idea that there is, in fact, ultimate meaning in life, meaning that is not dependent on others, on our projects, or even on our dignity. It is a reference to God and spiritual meaning. Logos is deeper than logic. Again, it was his experiences in the death camps that led him to these conclusions: "In spite of all the enforced physical and mental primitiveness of the life in a concentration camp, it was possible for spiritual life to deepen.... They were able to retreat from their terrible surroundings to a life of inner riches and spiritual freedom." (1963, p. 56) It should be understood that Frankl's ideas about religion and spirituality are considerably broader than most. His God is not the God of the narrow mind, not the God of one denomination or another. It is not even the God of institutional religion. God is very much a God of the inner human being, a God of the heart. Even the atheist or the agnostic, he points out, may accept the idea of transcendence without making use of the word "God." He is there, according to Frankl, within each of us, and it is merely a matter of our acknowledging that presence that will bring us to suprameaning. On the other hand, turning away from God is the ultimate source of all the ills we have already discussed. ... (O)nce the angel in us is repressed, he turns into a demon." (1975, p. 70) Psychopathology

Frankl gives us details as to the origin of a variety of psychopathologies. For example, various anxiety neuroses are seen as founded on existential anxiety - "the sting of conscience." (1973, p. 179) The individual, not understanding that his anxiety is due to his sense of unfulfilled responsibility and a lack of meaning, takes that anxiety and focuses it upon some problematic detail of life. The hypochondriac, for example, focuses his anxiety on some horrible disease; the phobic focuses on some object that has caused him concern in the past; the agoraphobic sees her anxiety as coming from the world outside her door; the patient with stage fright or speech anxiety focuses on the stage or the podium. The anxiety neurotic thus makes sense of his or her discomfort with life. Obsessive-compulsive disorder works in a similar fashion. The obsessive-compulsive person is lacking the sense of completion that most people have. Most of us are satisfied with near certainty about, for example, a simple task like locking one's door at night; the obsessive-compulsive requires a perfect certainty that is, ultimately, unattainable. Because perfection in all things is, even for the obsessive-compulsive, an impossibility, he or she focuses attention on some domain in life that has caused difficulties in the past. Schizophrenia is also understood by Frankl as rooted in a physiological dysfunction, in this case one which leads to the person experiencing himself as an object rather than a subject. Most of us, when we have thoughts, recognize them as coming from within our own minds. We "own" them, as modern jargon puts it. The schizophrenic, for reasons still not understood, is forced to take a passive perspective on those thoughts, and perceives them as voices. And he may watch himself and distrust himself -- which he experiences passively, as being watched and persecuted. Frankl believes that this passivity is rooted in an exaggerated tendency to self-observation. It is as if there were a separation of the self as

viewer and the self as viewed. The viewing self, devoid of content, seems barely real, while the viewed self seems alien. Although logotherapy was not designed to deal with severe psychoses, Frankl nevertheless feels that it can help: By teaching the schizophrenic to ignore the voices and stop the constant selfobservation, while simultaneously leading him or her towards meaningful activity, the therapist may be able to short-circuit the vicious cycle.