| President's Column - February 2002 |
September 11 has changed everything: the unthinkable has happened; the unimaginable has become a reality. We have been suddenly awakened to a new sense of vulnerability. What is so disturbing about Sept. 11 is that it happened so unexpectedly, so forcefully and on such a vast scale that it jolts us out of our complacency and makes us realize just how brief and fragile life really is. Since that infamous day, terrorism has dominated the media and occupied much of public consciousness. The aftershocks continue to quiver because of Anthrax scares and repeated warnings of more terrorist attacks. Terrorism has become the greatest threat to public health in recent years. There has been a real increase of post-traumatic stress disorder, nightmares, anxiety, and depression. One of the survivors has committed suicide. Many more are still going through a very trying time. In addition, millions of people are asking, 'How can life get back to normal, when we are living under the constant threat of bio-terror and other means of deadly attacks?' In spite of the successful military campaign in Afghanistan, ultimately the war on terrorism cannot be won by force alone. Victory over terrorism, especially on the home front, needs to be won psychologically as well. To a large extent, terrorism is defeated only when we are able to take the "terror" out of terrorism. To do so is to take away from the terrorists their most effective weapon. This paper presents lessons on how to triumph over terror based on Dr. Frank's logotherapy and the scientific research of positive psychology. These lessons are not intended to be a treatment plan for post-traumatic stress disorder; rather, they are time-tested, proven wisdoms for living in the face of terror and trauma. Anatomy of terror
The horrors of that day have traumatized millions of people. In a blink of the eye, tens of thousands lost family members and friends. Millions witnessed with their own eyes the deadly explosions when two jumble jets, in quick succession, smashed into the World Trade Towers. Countless lives have been changed drastically in terms of loss of loved ones, loss of jobs, loss of security and the shattering of cherished assumptions. But terror has always been with us and it will continue to be part of our lives. Human history is written in blood - the brutality and horrors of wars can be found in the chronicles of every nation. Moreover, terror has many faces; it lurks in dark corners or stalks the streets in different disguises ready to strike the unsuspected. Often, we may not even recognize it as terror until it has stuck us deeply, sometimes mortally. Most of us carry scars and wear wounds - some physical but most psychological or spiritual. For some, their wounds are still open and bleeding; for others, their scars are deep and hidden, emblems of shame, guilt and pain. Evil seems to have infected so many aspects of our lives. Wherever there is evil, terror is sure to follow:
In addition to social and personal evils, we have witnessed the destructive power of hurricanes, earthquakes, fires, floods, droughts, landslides, avalanches and sundry sorts of natural disasters and catastrophes. The litany of traumatic events can go on indefinitely. However, terror is not limited only to events capable of disturbing and destroying our lives. In some way, the worst kind of terror may be residing inside our heads; the kind of private hell from which there is no escape. Many are tormented by deep-seated dark suspicions, obsessive jealousies, shame, guilt, despair, depression, phobias, fear of fears, loss of memories, fictional horrors and phantom enemies created by their own morbid insecurities. Finally, terror can stem from existential anxieties, which seem to be universal:
The awareness that one day we will be reduced to nothingness may be very unsettling. While most people are afraid of a prolonged death, some may be more fearful of a premature death before they can accomplish their life tasks. What I have just presented is not a very pretty picture - too gloomy and depressing for many people. But it seems to be a helpful and realistic perspective from which to view Sept.11, not as an isolated disaster, but as a part of a much larger human tragedy that has finally descended on America. People from many countries have long been familiar with suffering and they have learned to live with a tragic sense of life. Only in North America, somehow our unparalleled and unprecedented success and affluence have created a false sense of security, an artificial bubble, much like the New York in Las Vegas. Many have come to view life as a fun party - Let the good time roll! Don't ruin the party by talking about suffering and death! But deep down, they may be secretly and desperately hoping that someone, some authority figure, would just step in and say "No" to their self-centered pursuits and direct them to a different path. Sept. 11 is a wake-up call, an explosive, jarring wake-up call! It is definitely not what anyone would have hoped for, but it has nevertheless awakened us to both the shallowness of pursuit of pleasure and success, and our need for a higher meaning and purpose. When we include the pervasive crisis of meaning as the backdrop, we come to a different kind of understanding of post-traumatic distress disorder. From this existential perspective terror can be amplified by our fear of death and fear of meaninglessness. The following lesson is important to keep in mind: In other words, a trauma may trigger a crisis of meaning, which in turn exacerbates the post-traumatic distress. If you are already in the throes of an existential crisis, your traumatic experience will be all more the distressing. However, terror can also be reduced by our acceptance of death and by resolving the existential crisis. According to logotherapy, meaning in life is an effective antidote to anxiety and fear. One of Frankl's favourite quotes is from Nietzsche: "Whoever has a reason for living endures almost any mode of life." Adversities and suffering become more bearable when one has something worthy living and dying for. Post-traumatic distress can become post-traumatic growth when the crisis of meaning becomes an opportunity for self-discovery. Thus, one of the positive outcomes of September 11 is that many people have begun to re-evaluate their priorities and made major changes so that they can achieve a sense of meaning for all aspects of their lives. Some very successful CEOs have resigned from high paying, 24/7 positions in order to devote more time to their families, friends, and more meaningful pursuits. Lesson No.2 Thus, a crisis can be an opportunity for a spiritual re-birth and a discovery of meaning for existence. Even in the most gloomy and hopeless circumstances, one can discover gifts of hope and grace, as demonstrated by Dr. Frankl in Nazi concentration camps. Soren Kierkegaard once said: "With the help of the thorn in my foot, I spring higher than any one with sound feet." Pain and suffering can indeed be a powerful source of inspiration and motivation. By combining Lessons 1 and 2, we come to yet another helpful lesson: Lesson No.3 Objectives of this paper The paper provides helpful lessons on how to cope effectively not only with the threats of terrorism, but also with the terror of living and dying. The materials are drawn primarily from Dr. Viktor Frankl's (Frankl, 1986; Wong, 2002) logotherapy, Wong's meaning-centered counseling (Wong, 1998, 1999, 2000) and the positive psychology of tragic optimism and meaning (Wong, 2002; Wong & McDonald, 2001.) The specific objectives are as follows:
Rationale for this paper Agreeing with Dr. Viktor Frankl, I propose that the greatest threat to contemporary healthcare is psychological/spiritual rather than physical. For example, exaggerated fear of terrorism can do more harm to more people than the isolated terrorist acts. Lesson No.4 Therefore, if we can deal with terror at the psychological and spiritual level, we will be in a much stronger position to cope with trauma and help those suffering from post-traumatic stress disorder. Furthermore, psychological/spiritual suffering is more prevalent than physical suffering, because the former represents the inherent, core condition of human existence, while the latter represents signal injuries and illnesses that are much less commonplace. Traditionally, psychotherapy deals with psychological suffering, while medicine deals with physical pain. But the boundary has been blurred. More and more physicians, nurses and physiotherapists realize that they need to address the patients' psychological and spiritual suffering. According to Frankl (1986), Western countries have suffered from a new kind of mass neurosis, which results from widespread feelings of meaninglessness. Misguided attempts to escape from these feelings of meaninglessness through the pursuits of pleasures eventually lead to disillusion, despair and self-destruction. Such pursuits often turn pleasures into addictions, which have already claimed countless victims and still counting. Existential frustration becomes compounded when individuals are also frustrated in their misguided attempts to achieve success. Thus, Frankl (1986) observes: "The feeling of meaninglessness not only underlies the mass neurotic triad of today, i.e., depression-addiction-aggression, but also may eventuate in what we logotherapists call a 'noogenic neurosis'" (p.298). Lessons from Logotherapy I cannot think of another human being more qualified than Dr. Viktor Frankl to teach us how to triumph over terror. As a holocaust survivor, he has suffered through unimaginable horrors in two Nazi death camps, and lost all his family members during the war. He has endured more traumas and atrocities, over a longer period, than most of us in North America. He has gone to the depth of hell, and returned triumphantly. After his liberation from the death camp, he was able to bestow unto the world a wonderful gift that has helped millions of suffering human beings. That amazing gift is logotherapy. What is logotherapy? As I have said elsewhere (Wong, 2002), logotherapy is Dr. Frankl, and Dr. Frankl is logotherapy, because he embodies the principles of logotherapy in his practice as well as in his everyday life. As a survivor of Nazi death camps, Dr. Frankl (1985) came to view suffering as a universal and unique human experience. More importantly, he has come to the amazing conclusion that suffering gives individuals the opportunity to realize their freedom and responsibility to choose the unique meaning of their suffering and existence. Logotherapy and existential analysis are often used interchangeably. Technically, logotherapy refers to spiritually oriented therapy through meaning, whereas existential analysis refers to the therapeutic approach employed to bring to consciousness clients' responsibility for meaningful living. Dr. Frankl suggests that we can view logotherapy in three different ways:
There are two defining attributes of logotherapy: 1. Logotherapy is concerned with the spiritual dimension of patients. Different from other approaches of psychotherapy, logotherpy is a spiritually oriented therapy - treating patients at their spiritual-existential level. It views the human quest for meaning as a universal human phenomenon, which reflects the spiritual dimension of humanity. Logotherapy does more than address spiritual issues; it regards the spiritual dimension of patients as the front and center of therapy. "A psychotherapy which not only recognizes man's spirit, but actually starts from it may be termed logotherapy. In this connection, logos is intended to signify 'the spiritual' and beyond that, 'the meaning'" (Frankl, 1986, p.xvii). Thus, the primary objective of logotherapy is not the removal of symptoms or psychological suffering, but the alleviation of spiritual distress due to existential crisis and meaninglessness. "What we are concerned with is a psychotherapy in spiritual terms… we must look beyond psychogenesis, past the affect-dynamics of neurosis, in order to see the distress of the human spirit-- and to try to alleviate this distress" (Frankl, 1986, p.11). Frankl made a point that spirituality is more than religion. Spirituality encompasses the truly human needs for meaning and responsibility, the capacity for faith in God and the defiant human spirit that transcend circumstances. At a time when medicine and psychotherapy were dominated by biological and environmental determinism, Dr. Frankl's emphasis on spirituality was nothing short of revolutionary. Only in the last decade, largely due to the efforts of Dr. Benson of Harvard University's Mind/Body Medical Institute, that spirituality has become accepted by the mainstream of medicine and psychology. 2. Existential analysis aims at bringing to consciousness the patient's sense of responsibility to live a meaningful life. Like psychoanalysis, existential analysis is a form of depth psychology. Freud believes that healing occurs, when psychoanalysis succeeds in bringing the repressed materials from the unconscious to consciousness. Frankl, on the other hand, believes that healing occurs, when existential analysis is able to bring one's hidden need and responsibility for meaning to consciousness. "Existential analysis aims at nothing more and nothing less than leading men to consciousness of their responsibility…. In this sense existential analysis also remains noncommittal on the question of 'to what' a person should feel responsible - whether to his God or his conscience or his society or whatever higher power" (Frankl, 1986, p.275). "Existential analysis, along with all forms of medical ministry, is content and must be content with leading the patient to an experience in depth of his own responsibility" (Frankl, 1986; P.276). Here, we see Adler's influence. For a brief period, Dr. Frankl studied with Adler and learned about the importance of social interest and social responsibility to mental health. However, Dr. Frankl went beyond people's general need to belong and contribute to a group; he emphasizes that they are also responsible for fulfilling their unique calling and for responding to the unique demand of meaning in every situation. Additional lessons from logotheapy Lesson 5 This is the basic tenet of logotherapy: life remains potentially meaningful, amid all the chaos, uncertainties and gloom of the world condition. Dr. Frankl (1986) states repeatedly, "So life is potentially meaningful under any conditions, be they pleasurable or miserable" (p.301). Individuals despairing of trauma and fearful of threatening situations can return time and again to this basic tenet for comfort and hope. This affirmation enables them move forward and discover the hidden meanings of suffering, just as survivors of a shipwreck seek the scattered treasures on the beach, to borrow a metaphor from Chesterton. For example, with a patient suffering from a serious physical illness, "the doctor, however, helped the patient to draw up a balance sheet. Against the evil of his illness there were sizable number of goods which could give meaning to his life, including a happy marriage and a healthy child" (Frankl, 1986, p.279). Dr.Yalom (1999) provides a moving account of Paula. She was abandoned by her physicians because they had concluded that nothing more could be done about her advancing cancer. Obviously, these doctors did not understand the importance of logotherapy as a medical ministry to dying patients. According to Yalom (1999), it was an Episcopal priest who taught her the meaning of suffering and reframed her cancer as a ministry. Once she embraced the challenge of ministering to other patients suffering from terminal cancer, her life was gloriously transformed. Her last days were full of joy and grace, as she imparted courage, comfort and hope to many other dying patients. Lesson 6 You have the freedom from instincts, inherited disposition, and environment. You can transcend all these determinants, powerful as they are. You can choose to be a master rather than a slave to the forces of nature and circumstances. Yes, you have the capacity to choose your own actions and reactions, your values and beliefs - this is the second basic tenet of logotherapy. In every situation, you can choose to be responsible or irresponsible, positive or negative. Even when all the freedoms are taken away from you, as Frankl loves to say, you are still free to choose your attitude towards the oppressive conditions of life: you can either react with anger, bitterness and despair, or you can take it as a challenge to achieve spiritual growth and demonstrate the defiant human spirit. It is neither biology, nor environment, but your own choices which decide your character and destiny. With freedom, comes responsibility. Regardless of your circumstances, you have the freedom and responsibility to do what is meaningful. Therefore, the important thing is not to ask whether life as a whole is meaningful, but rather what life demands from you in each situation. In fact, every life situation represents a summons to discover the unique meaning in that situation and to actualize your personal significance in life. Here are some helpful quotes from his 1986 book:
Lesson 7 The third basic tenet is that the quest for meaning is inherent in every person. You may not be fully aware of it, but it is always there, gnawing at your thirsty and hungry soul. So many people are busy with the pursuit of success, wealth, fame, pleasure, without realizing that they are actually seeking meaning and fulfillment in a misguided way. When all the things and people that keep them going are suddenly removed from them, a crisis of meaning ensues. What has been kept on the back burner now comes to the forefront. In fact, many life experiences are calling your attention to the silent cry for meaning. This is how Oz Guiness (2001) describes the seekers of meaning:
Frankl's three ways to discover meaning: Creative, experiential, and attitudinal Once you begin the quest for meaning in earnest, you will learn that there are three major values essential of the discovery of meaning. 1.Creative value - what you give to life through work and activities, which make a difference in the world. This will include your life work, your personal projects, which give you a sense of meaning and personal significance. However, you may argue that because of your physical condition, your age, or your circumstances, there is very little you can do, and limited activities do not seem to have any higher value. At this point, Dr. Frankl would suggest that the crucial thing is not what one works, but how one works - whether one is faithful and responsible in doing one's best. "The radius of his activity is not important; important alone is whether he fills the circle of his tasks" (p.43). 2. Experiential value - what you take from life - feeling the joy of living in what you receive or experience. This is more encompassing than creative value, because as long as you still receive some sensory input and have consciousness, you are capable of experiential value. Let's return to the example of Paula and find out how she was able to experience the beauty of the world even in her dying days. She explained to Dr. Yalom about she meant by the "Golden period" she was gong through: "Try to understand that what's golden is not the dying but the full living of life in the face of death. Think of the poignancy and preciousness of last times: the last spring, the last flight of dandelion fluff, the last shedding of wisteria blossoms" (Yalom, 1999, p.22). Dr. Frankl has provided many examples of experiential value - the beautiful sunset in an otherwise bleak and gloomy death camp, the beautiful music to an invalid patient, etc. Being fully alive, even in one precious moment is a sufficient reason for human existence. Here are two helpful quotations from Dr. Frankl's 1986 book:
3. Attitudinal value - how you view life - accepting what cannot be changed, adopt a positive attitude towards an unalterable fate. This is the most pervasive, all encompassing way of discovering meaning. No matter why you are, and no matter how disastrous your situation may be, you can always take a high and lofty view of life. The defiant human spirit can be demonstrated through your attitude more than anything else. Dr. Frankl (1986) believes that "A man's life retains its meaning up to the last breath. As long as he remains conscious, he is under obligations to realize values, even if those be only attitudinal values. As long as he has consciousness, he has responsibleness" (p.44-45). The American spirit has been mentioned over and over again since Sept.11. It refers to the spirit of defiance, courage and optimism in the face of adversities. In essence, this is similar to the kind of defiant human spirit as described by Dr. Frankl. Logotherapy and neurotic anxiety Fear and anxiety are a part of normal living, just as pain and suffering are an inevitable aspect of human existence. However, neurotic anxiety develops when we want to live in perfect security. "Demanding to be insured against any possible disaster, the anxiety neurotic is compelled to make a virtual cult of is security feeling… this striving for security does not take account of the approximation and provisionality of human existence" (Frankl, 1986, p.193). Neurotic anxiety is often related to existential anxiety. When one does not have anything worth living and worth dying for, when there is very little content to one's life, neurotic anxiety tends to expand to fill the empty space. When logotherapy succeeds in recovering the fullness of meaning, and the patient has something positive to concentrate on, neurotic anxiety disappears, because there is no longer room or time to worry about disasters or terrors. * Based on a workshop given at the Spirituality and Health in Medicine Course organized by Harvard Medical School and Mind/Body Medical Institute in Boston, December 15-17, 2001. |
Triumph
over Terror: Lessons from Logotherapy and Positive Psychology*
What
comes to your mind when you see or hear the word terror? What does
terror mean to you? For many people, it is the events and the images
of Sept. 11.