Book Review: Swimming against The Tide: Recovering the Human Spirit in Psychology and Medicine

Book Review

This book is an important contribution to understanding Viktor Frankl’s journey as a psychiatrist and psychotherapist and man of religious faith as he developed his approach to therapy-Logotherapy.

Renowned Franklin scholar Rabbi Shimon Cowen brings to light some of the earlier writings of Frankl in which Frankl clearly relates psychology to religious concepts. In particular he notes changes made in the original text of his “Ten Theses Concerning the Person” which specifically mention God and contrasts this with the final text which has these references deleted. Translations of “The Science of the Soul” and “Time and Responsibility” also witness to Frankl’s personal religious beliefs.

Cowen sees Frankl as a living example of finding meaning through self-transcendence and he suggests this is the central task of life itself. He suggests that it is not just any meaning but ultimate and universal meaning to which the trajectory of self-transcendence leads and that Frankl, at least originally, shared Cowen’s own vision that this self-transcendence is a journey towards the divine. His commentary on the translations provides a glimpse of Frankl’s development of a secular therapy, Logotherapy, which remains consistent with a religious framework while maintaining both the emphasis on self-transcendence and the reality of an ultimate or universal meaning in life.

Frankl’s own life journey is remarkable. It has been detailed in many places. First his survival through the concentration camps of World War II and then his place as a significant and widely recognised force in modern Book Review psychology. Yet Logotherapy remains either a hidden or a minor force in today’s approach to therapy.

Frankl was originally a follower and disciple of Sigmund Freud. He came to view Freud‘s psycho-analysis as reductionist in not presenting a complete picture of the human being. This came to a head when he applied for membership of the Vienna Psychoanalytic Society and met with one of Freud‘s associates who questioned him on what his own neurosis might be. Frankl states that he then went to a park and sat down and pondered “what kind of science is psychoanalysis if you can’t judge it on rational grounds, but you have to be indoctrinated first before you can agree with it?‘‘ Before the war he began writing his seminal work published in English as “The Doctor and the Soul: from psychotherapy to logotherapy” only to lose his manuscript when taken into the concentration camps. He had then to overcome his own suicidal thoughts at this tragic loss.

He had already been showing his courage in the face of adversity as he protected patients in Vienna from the “mercy killing“ of the mentally ill. He did this by changing their diagnosis and their locations when he had the opportunity. He needed such courage to survive the concentration camps.

There are possibly two journeys here. The first is the practical and somewhat accidental journey that saw “Man’s Search for Meaning“ become his most famous work and propel him onto the world stage. The second is his own journey as he developed an approach to therapy, Logotherapy, that includes the dimension of the human spirit.

Frankl suggests that his development of Logotherapy’s understanding of the human owes much to Rabbi Judah Loew, the “Marahal of Prague”. Both identify physical “somatic”, mental “psyche” and finally spiritual “noetic” faculties in the human person. This last is the meaning making faculty. However, it can be misguided and be prone to biases and personal interest. The Marahal Proposes a fourth dimension, a “unitive” faculty oriented towards self-transcendence and ultimate meaning oriented towards the divine.

Frankl adopted the first three dimensions in his model of the human. However he recognises the possible aberration of the noetic when he talks of pathologies which can arise within and hence usurp the noetic faculty. Perhaps this is where his concept of conscience as an overarching guide has it source. In his “Theory and Therapy of Mental Disorders” he suggests that “Noogenic neuroses are illnesses “from the spirit” – but they are not illnesses “in the spirit”. That is, the spirit itself, conscience, remains healthy despite the disoriented noetic faculty.

Logotherapy as a therapy based on the spiritual dimension cannot fully address the human condition. For conditions of the body and mind other approaches are required. So, although rejecting the absolutism of Freud as reductionism, Frankl did not fully reject Freudian concepts and understood that in treatment it was necessary to employ other therapeutic approaches, including Freud’s. Cowen’s translation of some of Frankl’s original writing sheds light on this:

“where the spiritual “I” merges into its unconscious depths… There we speak of conscience, love and art. Where the psychophysical “I” erupts into consciousness, there we speak of neurosis or of psychosis.” Where the psychophysical (soma and psyche) assumes total control, therapy is indicated. Hence treatments focussed on lower levels of the human being are not only appropriate but absolutely necessary. Yet the higher dimension remains. Frankl suggests “psycho-analysis is effective… (because) it ultimately does contain the tacit appeal to the free and responsible “I“ which it in fact presupposes“ This is a work of significant scholarship. Comprehensive references are provided both from Cowen’s personal translations of Frankl’s work and from well-known Frankl books published in English. It is disappointing that one has to search for the dates of some of the translations (e.g. The Science of the Soul) because this is not provided as a subheading under the title. Hence the reader might assume they are placed in a similar timeframe to Time and responsibility (1947) and the Ten Theses Concerning the ‘Person’ (1950). This was a time before Frankl’s work was more widely recognised by publication in English of Man’s Search for Meaning, originally published as From Death Camp to Existentialism. (circa. 1959). For The Science of the Soul this is important as it in fact dates from dialogues in 1984 and thus provides evidence of Frankl’s personal religious development and how this relates to his ongoing development of Logotherapy.

The reader may not share what seems to be Cowen’s delight as he quotes Frankl’s statement that “psychology is ultimately enclosed within a more comprehensive, theological dimension” seeing this and similar statements as significant because they are statements by “a great psychologist as a proposition of psychology” and subjugates psychotherapy to theology.

The value of this book is in the way it documents Frankl’s personal journey in developing a secular therapy compatible with both secular and religious frameworks for life.

So was the genius of Frankl, as outlined in this book, to translate his own faith into a secular approach to therapy? His therapeutic approach recognised the spiritual dimension of the human person and represented the human spirit as a third dimension, in addition to the body “soma” and mind “psyche”. He is not alone. Others have recognised that the human being is spiritual, with the capacity for the spiritual hard-wired int the brain [1] but not necessarily expressed religiously. Frankl suggests that “. a religious sense is existent and present in each and every person, albeit buried… in the unconscious” [2]. As this book clearly points out, he translated religious self-transcendence oriented towards the divine into a need for each person to find meaning in life by devotion to a cause or person(s) beyond the self, a devotion that in turn requires self-transcendence.

So what of Frankl‘s own faith and his apparent abandonment of references to the divine as he developed his Logotherapy concepts? Was it a commercial necessity? Was it a realisation that development of a therapeutic approach in a post enlightenment society required a secular model? Cowen suggests it may be because he believed that imposing a religious framework on a patient was “therapeutically unproductive.” Whatever his motivation he remained committed to swimming against the tides of reductionism and a purely mechanistic approach to the human and this compendium of his early writing chronicles that so very well.

On the other hand was it simply part of Frankl‘s own faith development? Did he recognise the spiritual dimension of the human being as a reality for every person, although not necessarily expressed in a religious faith? Had he indeed reached the “universalising” stage six of faith development as suggested by Fowler [3]? In this stage of faith development one is not hampered by differences in religious or spiritual beliefs but regards all beings as worthy of compassion and deep understanding. It does not depend on a religious affiliation as such, while perhaps remaining faithful to a particular religion.

In “Man’s Search for Ultimate Meaning” Frankl quotes Einstein: “to be religious is to have found an answer to the question what is the meaning of life?“. Perhaps it is the early stages of that journey that is chronicled in detail in this excellent book.