- Please note that the term neurosis has been replaced by mental or personality disorder in APA’s Diagnostic Statistics Manual
- Existential-analytical logotherapy or existential analysis refers to the therapeutic process of logotherapy
- Logotherapy can complement the goal of psychotherapy
- Logotherapy focuses on the discovery of responsibility and existential meaning, while psychotherapy tends to focuses more narrowly on removing symptoms
- General existential analysis addresses the human concerns about the meaning of life and the meaning of death
- Special existential analysis addresses the existential needs underlying neurosis, depression and psychosis.
- Frankl makes it clear that Logotherapy is not a general purpose treatment for every disorder.
- Meaning-centered counselling and therapy covers all three areas: (1) the general quest for meaning, (2) various mental disorders, and (3) noogenic or existentially based disorders.
Etiology of neuroses
- Neurosis may result from four sources: Physical, psychological, societal and existential
- Suffering and existential vacuum can lead to neuroses
- The tragic triad: pain, guilt and death (grief)
- The neurotic triad: depression, aggression and addiction
- Existential triad: boredom, despair, and meaninglessness
- Any of the above three triads can lead to suicide and criminal behavior
- Logotherapy is a special therapy for existential or noogenic neuroses
Classification of Neurosis according to Etiology
- Somatogenic neurosis – caused by biological conditions such as dysfunctioning of endocrine glands or autonomous nervous systems
- Psychogenic neurosis – caused by psychological factors, such as attitudes and societal conditions
- Psycho-somatic neurosis – physical illness triggered (but not caused) by psychological factors, such as asthma
- Reactive neurosis – arising from fight for or flight from something; over-reacting to symptoms of a somatic or psychological disturbance
- Noogenic neurosis – arising from spiritual or existential causes, such as a crisis of conscience or existential vacuum
Certain widespread attitudes in our society may lead to personality disorders, such as antisocial, borderline, obsessive-compulsive; dependent tendencies). These attitudes are:
- Fatalism – Everything is pre-determined and controlled by outside factors; becoming cynical and pessimistic
- Fanaticism – Taking one’s idealized value to an extreme and absolute approach; intolerant and ignoring the views and personhood of others
- Provisory attitude – Drifting aimlessly; lack of goals and commitment; only interested in the present with no concern for the future
- Collectivistic thinking – Conforming to the group, abrogating one’s individuality and personal responsibility
These attitudes may reflect and be related to the rise of the Nazi movement.
Treatment of Collective Neurosis
- Rediscover their own areas of freedom and responsibility
- Rediscover their values and purpose
- Understand their own uniqueness
- Pursue their personal goals
- Socratic dialogue and re-education of attitudes are helpful
- In Socratic dialogue, the therapist draws out what is already inside the client
- Re-education involves confronting and modifying harmful attitudes
Individual neurotic patterns
- Anticipatory anxiety can result in a self-sustaining vicious cycle
- Anxiety about anxiety may increase anxiety
- Avoidance or flight from fear may reinforce symptoms of fear and anxiety
- May lead to anxiety disorders, such as panic attack and phobias
Excessive fighting against something
- Fighting against obsessions and compulsions only make them stronger, because of the vicious cycle of pressure and counter pressure
- Neurotic pursuit of happiness, status or power as a terminal value
- Giving up relationships and other meaningful activities in their pre-occupation with misguided pursuits
- Could lead to addiction
- Pre-occupation with self-monitoring or navel-gazing
- Tendency to catastrophize minor failures and obstacles
- Hyper-intention coupled with hyper-reflection could result in a feedback system that increases the problem, such as insomnia or erectile dysfunction
- Existential anxiety may express itself in hypochondria
- For example, fear of death centers on a single organ or a particular fatal disease
- A general anxiety about life may result in anxiety neurosis (The case of a depressed woman)
- The task of the logotherapy is to reshape a crisis into a spiritual rebirth
- The task of the logotherapist is to be a midwife in Socratic dialogue
- The challenge is to lead the patient to independent responsibility
- The symptoms of depression and anxiety will vanish once the patient discover her unique and singular task of her life
- Vanity and pride often prevent people from discovering their unique life tasks in their concrete situations
Treatment of Individual Neuroses
- Focus not on delving into the roots of the disorder, but on breaking the vicious circle
- Paradoxical intention makes use of the uniquely human capacity for self-distancing to break the vicious cycle of anticipatory anxiety or the tendency to flee from something.
- Self-distancing enables us to step away from ourselves and laugh at ourselves
- De-reflection makes use of the unique human capacity for self-transcendence to counteract obsessive-compulsive disorder of hyper-reflection
- Self-transcendence means the human tendency to turn to something or some one bigger than themselves
- It has a constitutional or physiological basis
- Today, this neurosis is called obsessive-compulsive disorder (OCD)
- The patient has lost his instinctive certainty about things so obvious (2 plus 2 equal 4)
- The patient compensates by seeking 100% certainty to overcome his skeptic thinking
- He wants too much; therefore, he can never attain what he is striving for – perfect security in cognition and emotion
- He gets trapped in a vicious loop – his unrealistic quest for certainty only makes him more anxious about his uncertainty which creates greater need for certainty
- Worry about this problem results in hyper-reflection and intensifies his anxiety
- Generally, the logotherapist is not concerned with treating the symptom or the disease; rather, he should set out to transform the client’s attitude towards neurosis.
- Logotherapy should aim at relaxing the patient and relieve the anxiety toward OCD.
- Remove patients’ unfounded fear that they may become psychotic.
- Learn to accept the core of his suffering as his fate or as “the will of God”.
- The patient is not responsible for his obsessive ideas, but responsible for his attitude towards these ideas.
- One task of the therapy is to rediscover the instinctive certainty which has been buried by deep emotional layers of the personality.
- This may be accomplished through re-education and cognitive therapy.
Treating the skeptic worldview
- The neurotic’s skeptic worldview demands proof of 100% certainty and obviousness.
- The ultimate quest for 100% certainty is regarding the meaning of existence.
- Patients need to learn to accept the limits of rationality. The datum “I doubt everything” actually means “everything thing except this particular datum.”
- Need to challenge patient’s exaggerated rationalism which underlines skepticism (p.197).
- They not only doubt the logical validity of their thinking and memory; they also doubt the moral validity of their own action – therefore, they are often tormented as to what they ought to do in various situations.
- The therapist makes use of the patient’s capacity for freedom to choose not to be too conscientious or skeptical.
The ABCD of Meaning-Centered Conselling
(To be used together with the PURE model)
- Acceptance – Accepting the symptoms and problems; accepting one’s limitations and fate; accepting one’s responsibility in areas where one still has freedom; accept the existential givens, including one’s mortality.
- Belief – Believe and affirm that healing is possible and wholeness is attainable; believe that meaning and hope can be discovered in every situation right up to the last minute of one’s life; believe that a better future is achievable through meaning-seeking and meaning-making.
- Commitment – Commit oneself to some future goals. Pursue meaningful goals and projects. Have the courage to take responsible actions and make the right choices in every situation.
- Discovery – Discover the meaning and purpose in life; discover the freedom from symptoms and the joy of living.