PSYCHOLOGICAL STRESS AND PROFESSIONAL QUALITY OF LIFE

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CHAPTER 2 THE LOGOTHERAPY THEORY OF VIKTOR E. FRANKL

“The human needs a framework of values, a philosophy of life…in about the same sense that he needs sunlight, calcium, and love.”
~ Abraham Maslow

 INTRODUCTION

Yalom (1980 p. 1) identified four “…ultimate concerns…” of being-in-the world: (1) death, (2) freedom, (3) isolation, and (4) meaninglessness. He explains that these concerns are not the result of internalised psychodynamic projections or instinctual strivings. Rather, the four ultimate concerns flow from people’s struggles with the “…existential givens…” of life: (1) everybody will die, (2) humans have an innate freedom and are therefore ultimately responsible for themselves – there is no one to blame, (3) even if people have meaningful interpersonal relationships, the profound fear of being alone in the universe, remains, and (4) there is an ongoing struggle to find meaning in our daily actions (Yalom, 1980, p. 1). These anxieties, which form the bedrock of existential psychology, challenge humans with the unnerving realisation that being-in-the-world is not an easy and emotionally painless experience (Heidegger, 1962; Kierkegaard, 1957; May, 1961; Spinelli, 2007).
Existential psychology, which focusses on the study of how individuals experience the world, tends to emphasise the sombre and darker aspects of the human condition (Wong, 2009a). In contrast, logotherapy, which is regarded as a positive-oriented school of existential psychology (Cho, 2008; Fabry, 1994), adopts an optimistic view by emphasising the affirmative, creative and meaning-centred aspects of being human (Frankl, 2008). In this regard Frankl (1967, p. ix) asserts that “… there are as many existentialisms as there are existentialists.”
Consistent with the optimistic logotherapy perspective of human potential, Shantall (2002) explains that the act of reflecting on existential (ultimate) concerns ought to be considered a uniquely human achievement: no animal or other earthly being, apart from humans, is capable of reflecting on its own existence. Shantall’s assertion points to the phenomenological aspects of logotherapy that, according to Frankl (1967, 2004), refers to the ‘language’ of a pre-reflective self-understanding, versus an interpretation of a given phenomenon based on preconceived patterns and ideas. Frankl (2006) echoes Shantall’s (2003) perspective when he notes that the act of existential questioning and reflection is meant to inspire humans to search for and discover meaning in life.
The purpose of this chapter is to contextualise the study in relation to Frankl’s logotheory. Logotherapy was profoundly interwoven and influenced by Frankl’s life experiences. In Section 2.2, an overview of Frankl’s life experiences is provided. According to Shantall (2003) logotherapy is based on three fundamental tenets, namely the (1) freedom of will, (2) will to meaning, and (3) meaning of life. These three tenets are discussed in Section 2.3. In Section 2.4, three logotherapy concepts, namely, (1) meaning, (2) existential frustration, and (3) tragic optimism, are discussed.
Logotherapy techniques aim, amongst others, to enhance people’s awareness of the unique meaning-centred opportunities that await them in the future. The purpose of Section 2.5 is to discuss the following six logotherapy techniques namely, (1) Socratic dialogue, (2) paradoxical intention, (3) attitude modulation, (4) goal setting, (5) the mountain range exercise, and (6) logo-autobiography. Some criticism against logotherapy are discussed in Section 2.6. The chapter is concluded in Section 2.7 by means of a reflective discussion.

 PRISONER 119 104: VIKTOR EMIL FRANKL

Shortly after the Great Depression of the 1930’s, the National Socialist German Workers’ (Nazi) Party rose to power in Germany. The Nazi ideology was, inter alia, rooted in anti-Semitism, totalitarianism and militant Nationalism. What resulted from this ideology was an unquenchable thirst for power that left scores of victims in its wake (Shantall, 2002). Yet, amidst the Nazi tyranny there were also those individuals who managed to retain their human dignity; those individuals who, in the face or ever looming nihilistic darkness, transcended to the pinnacle of optimal humanity; individuals who could triumphantly declare that they had suffered through the worst of atrocities while maintaining a sense of inner peace (Frankl, 2006).
The journey towards the pinnacle of optimal humanity was not romantic, tranquil or peaceful. It was an arduous, fierce and brutal struggle between life and death. However, it was also drenched in meaning. The self-transcending journey of, amongst others, one man, was to influence the lives of millions of people and challenge the prevailing psychology discourse at large (Frankl, 1962). This was the journey of prisoner 119 104.
In September 1942 a young, yet world-renowned, Jewish medical doctor, his bride, his parents and his brother were arrested in Vienna and transported to a Nazi concentration camp in Auschwitz (Boeree, 2006). It was events that occurred there, and at three other camps, that led the young doctor – prisoner 119 104 – to realise the significance of meaning in life. Prisoner 119 104 was Viktor Emil Frankl (Boeree, 2006).
Viktor Frankl’s inborn optimism convinced him, prior to being transported to Auschwitz, to sew his life’s work, in the form of a manuscript, into the lining of his pocket (Frankl, 2008). When arriving at Auschwitz, Frankl had to part with his life’s work. However, his spiritual aspirations were not dampened by the loss of his manuscript or by the stench of death, guilt and pain that embodied the concentration camp experience. Rather, it propelled him forward in his journey towards the pinnacle of optimal humanity (Shantall, 2002). Amongst others, Frankl would spend whatever time at his disposal to reconstruct his manuscript, first in his mind, then on slips of paper.
In a truly logotherapy fashion, Frankl epitomised the truism that the surest way of discovering meaning, is through being. In other words, he actualised timeless values in the face of psycho-social suffering by embodying meaning-directed living; the values that Frankl actualised in the most appalling of concentration camp circumstances were irreversibly meaningful (Shantall, 2002). Thus, in contrast to Maslow’s (1970) view that lower order needs have to be satisfied before one can aspire to living an actualised life, Frankl’s (2008) experiences suggested that human beings can self-transcend and actualise their potential in even the harshest of conditions.
Frankl’s lost manuscript, and subsequent experiences, were later commemorated in his book The doctor and the soul (Frankl, 1965, 1986). His other pioneering work, namely Man’s search for meaning (Frankl, 1959, 1984, 2006, 2008) has sold millions of copies worldwide (Boeree, 2006). There were, amongst others, six specific events that acted as ‘turning points’ in Frankl’s life. These turning points are reminiscent of Yalom’s (1980) ultimate concerns. Furthermore, the experiences influenced the development of Frankl’s logotherapy theory. These six turning points were:
(1) One day I want to be a doctor and a good person – Frankl was born on 26 March 1905. At the age of three Frankl decided that he wanted to become a medical doctor (Shantall, 2003). However, Frankl also wanted to be a good human being. He believed that meaning could be discovered by reaching out beyond one’s own fears and doubts in order to be of service to others. Hence, Frankl regarded practising medicine as ‘not just an occupation’, but as a calling from life itself to discover meaning through relating to others. Paradoxically, his service to others also became a gift to himself (Shantall, 2002). Furthermore, Frankl viewed his life and calling in a highly responsible way and took a fearless stance amidst even the harshest of concentration camp circumstances. Frankl was, in the final analysis, more than just a medical doctor and a good person. Rather, his life served as a monument and inspiration for others (Shantall, 2003).
(2) Someone is watching over me – Frankl (1997, p. 31) recalls the following childhood experience: “One sunny morning, I awakened. With my eyes still closed, I was flooded by the utterly rapturous sense of being guarded, sheltered. When I opened my eyes, my father was standing there, bending over me, smiling.” The aforementioned experience afforded Frankl with the insight and belief that life has human beings’ best interest at heart. This does not imply that life is meant to be a journey grounded in joy and hedonistic pleasure. Rather, life can, from a metaphorical perspective, be regarded as a classroom’ where humans have the task of discovering the potential meaning hidden in every situation (Wong, 1998a). Hence, Frankl suggests that life is always ‘watching over’ humans in the sense that it is constantly questioning humans. The manner in which humans choose to respond to the ‘call of life’ may assist them to discover meaning.
Therefore, from a logotherapy perspective, it is an important to (1) be aware that life is a constantly evolving process, and (2) engage in on-going virtuous actions and reflective contemplation. By engaging in this process of virtuous living humans can discover and actualise logotherapeutically meaningful values such as integrity, honour and courage.
(3) One day I too shall have to die – “One evening, just before falling asleep, I was startled by the unexpected thought that one day I too would have to die. What troubled me then – as it has done throughout my life – was not the fear of dying, but the question of whether the transitory nature of life might destroy its meaning” (Frankl, 1997, p. 29). Frankl’s existential angst, as indicated in the mentioned quote, led him to the realisation that meaning is often hidden amidst the transitory nature of life. Yet, he also suggested that the fleeting quality of life does not eradicate its meaning (Frankl, 2006). Rather, it points toward the importance and subsequent responsibility that humans have been endowed with; the responsibility to reach out to others, to embrace the possibilities of meaning as well as to fully utilise the limited time afforded to them: “Birth and death enclose us in a space of time given to us to occupy” (Shantall, 2003, p. 7).
(4) An education towards meaning – At the age of thirteen Frankl was challenged by a school teacher who explained that life, in the final analysis, was nothing more than a reductionist process of combustion (Frankl, 2000). The young Frankl responded by exclaiming that if that was the case, life would have no meaning – a worldview that he vehemently opposed.
In 1924, at the age of 19, Frankl published an academic paper, on Sigmund Freud’s invitation, in the International Journal of Psychoanalysis. However, he became disenchanted with the reductionist psychoanalytic perspective. Frankl subsequently joined Alfred Adler’s school of Individual Psychology. Then, in 1925, Frankl published an academic paper in the International Journal of Individual Psychology. He was expelled from the Society of Individual Psychology after publically proclaiming that Adler’s school of thought ought to move beyond ‘psychologism’, i.e. the hypothesis that the psychologist is a technician and the patient a machine that needs to be ‘fixed’. From Frankl’s perspective, it was important to focus on the human being behind the psychological diagnosis, and not just the disease. Apparently, Adler never spoke to Frankl again.
The search for meaning emerges as a prominent theme in Frankl’s education, which spanned across all the seasons of his life. Frankl regarded it as his life mission to oppose nihilism (Marshall, 2009). In other words, to contest the doctrine that life is, essentially, meaningless. He subsequently established the ‘Third Viennese School of Psychotherapy’, namely logotherapy (Lukas, 1998). The term, logotherapy, can be literally translated as ‘healing through meaning.’
(5) Honour thy father and thy mother – In 1942 Frankl was invited by the United States Consulate-General in Vienna to collect an American immigrant visa. This would have afforded Frankl the ‘freedom’ to move from Nazi occupied Vienna to the safety of the United States of America and continue with his work and research. Because the visa did not cover his elderly parents or brother, Frankl had to choose to accept the invitation and leave his family behind, or stay with them in Vienna. This was, as Frankl (2006) states, not an easy choice. Frankl had wished for “…a ‘hint’ from Heaven…” to guide him to make a meaningful choice (Frankl, 2006, p. xv).
When returning from the Consulate, he noticed a piece of marble lying on a table in his parents’ home. When enquiring from his father where the piece of marble came from, he was informed that it was from a Jewish Synagogue that had been destroyed by the Nazis. Inscribed on this piece of marble was one of the Ten Commandments: ‘Honour thy father and thy mother that thy days may be long upon the land the Lord thy God giveth thee’ (Deuteronomy 5:16). This was Frankl’s ‘hint’ from heaven. He rejected the American visa and, a few days later, he and his entire family were rounded up and sent to Nazi concentration camps. Frankl’s entire family, except his sister who managed to escape prior to captivity, perished during their incarceration.
(6) Liberation from Auschwitz – The concentration camp experiences infiltrated every fibre of the inmate’s being (Frankl, 1986). Life assumptions related to, amongst others, invulnerability, trust in the world as a good and safe place, as well as confidence in human goodness, were shattered; the prisoners were ‘changed’ by their experiences.
Liberation from the concentration camps then again challenged the assumptive worlds that prisoners came to internalise during their incarceration. Values that they freely enjoyed in the pre-Holocaust period had to be re-actualised. Amongst others, families, homes and the prisoners’ assumptive worlds had to be rebuilt. Additionally, the ‘new found’ freedom had to be embraced.
According to Frankl (2006) the sudden release from the camps created a ‘moral deformity’ amongst the inmates: they turned from the oppressed, to the oppressors.
Frankl (2006) continues: the liberated inmates had to be led back to the values and worldviews that had defined their pre-Holocaust lives.
Many pre-Holocaust values were inevitably closely tied to familial relationships. However, disillusionment followed when the inmates realised that there were no family members awaiting them as they has passed away in the concentration camps (Shantall, 2002). Frankl and his comrades were confronted with the ‘ultimate concern’ that “…suffering has no limits…” (Frankl, 2006, p. 92). Even the psychological ‘pleasure’ of liberation was bestowed with pain. Yet, life remained unconditionally meaningful.
Logotherapy is a culmination of philosophical thought, empirical testing and real life application. The aforementioned ‘turning points’ discussion reveals how Frankl’s life experiences served as the testing ground to formulate and examine his theory. With these experiences as foundation, Frankl conceptualised logotherapy in terms of three pillars.

CHAPTER 1 INTRODUCTION
1.1 Background to the study
1.2 Research problem and rationale
1.3 Research aim and objectives
1.4 Thesis statement
1.5 Delineations and limitations
1.6 Significance of the study
1.7 Overview of chapters
CHAPTER 2 THE LOGOTHERAPY THEORY OF VIKTOR E. FRANKL
2.1 Introduction
2.2 Prisoner 119 104: Viktor Emil Frankl
2.3 The pillars of logotherapy
2.4 Logotherapy concepts
2.5 Logotherapy techniques
2.6 Criticism of logotherapy
2.7 Reflective discussion and conclusion
CHAPTER 3 PSYCHOLOGICAL STRESS AND PROFESSIONAL QUALITY OF LIFE
3.1 Introduction
3.2 Psychological stress
3.3 Professional quality of life
3.4 Strategies to address stress and professional quality of life
3.5 Conclusion
CHAPTER 4 RESEARCH METHODOLOGY
4.1 Introduction
4.2 Research design and methodology
4.3 Ethical considerations
4.4 Research design and methodology: Application and justification
4.5 Conclusion
CHAPTER 5 RESULTS AND DISCUSSION
5.1 Introduction
5.2 Results and discussion: Phase 1
5.3 Results and discussion: Phase 2
5.4 Results and discussion: Phase 3
5.5 Conclusion
CHAPTER 6 CONCLUSION
6.1 Introduction
6.2 Summary of results and findings
6.3 Conclusion
6.4 Finale
References
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