Diamonds in the defects: using logotherapy in medicine
Updated: Oct 2, 2019
Logotherapy is a way to find healing through finding meaning, and effectively addresses existential crises. Ideally, every doctor should be able to recognise existential distress in their patients. Correctly referring in these situations allows for holistic care, honouring the three-dimensional human, who has a body, mind and spirit.
The first time I heard about Logotherapy light bulbs went off in my head, and I felt that I’d been handed a key. I knew I’d found a powerful way to help my patients, and I didn’t even know, until that moment, that I’d been looking.
In my work as a clinical geneticist, I consulted with individuals and families who have genetic conditions or birth defects (also called congenital disorders).
These diagnoses often raise existential questions and cause suffering for families. Many individuals and their relatives struggle to find meaning in their situation.
They have difficulty envisioning a positive future, and are often guilt-ridden about what has occurred. Though they can be supported to live good quality lives, changing the underlying genetic problem is not possible. There is no ‘cure’ in the narrow, Western, medical sense of the word. So how do such individuals and/or their families get up each morning and live a rich and fulfilled life?
Logotherapy is based on the works of Viktor Frankl, a famous Viennese existentialist philosopher, psychiatrist and neurologist, and Holocaust survivor. He is the author of the best-seller Man's Search for Meaning, which records his experiences in the Nazi concentration camps. The word 'logos' is a Greek word which also denotes 'meaning'. The word 'therapy' originates from the Greek word 'therapia' which literally means 'service'.
Logotherapy is both a meaning-centered life philosophy and therapy. As a therapy it focuses on finding healing through finding meaning.
Logotherapy is founded on the belief that the strongest motivation in human nature is the search for meaning in one's life. Frankl asserted that three facts are fundamental to human experience: freedom of will; the will to meaning; and the meaning of life. He also emphasised the uniqueness and three-dimensional nature of each person; we all have a body, mind and essence (spirit). If we do not acknowledge, honour and support each of these aspects we are reducing humans in some way.
One dictionary definition of medicine is that it is “the science or practice of the diagnosis, treatment and prevention of disease”. Notably this definition excludes the concept of healing. The dictionary defines healing as “becoming sound again”, the roots of the word relating to the concept of ‘wholeness’. Medicine encompasses both science and art: scientific knowledge may aid in the diagnosis, treatment and prevention of disease, even effecting a cure.
But it is the art of medicine which allows healing, wholeness, to take place, with or without a cure. Logotherapy can, therefore, be used to practice the art of medicine as it honours holistic care.
Frankl maintained that doctors are able to address the physical, psychological and spiritual (essential) dimensions of their patients. In his book The Doctor and the Soul he said that doctors will be “…in a position to help the suffering human person entrusted to us, and trusting us, to achieve his wholeness – and health.” Frankl spoke of this concept of using logotherapy to address existential suffering in patients as Medical Ministry, which I prefer to call the practice of Meaningful Medicine.
Following training, I used logotherapy in my medical practice. In analysing some of the sessions with patients or their relatives, I’ve noted the following outcomes:
• Allows them to regain a positive outlook on life.
• Enables future-oriented thinking and the setting of concrete goals. Stuck energy is freed for use to enact meaningful goals.
• Increased self-awareness of their positive qualities and personal strengths.
• Gain clarity on their meaningful values.
• Become determined to make choices aligned with their meaningful values.
• Are determined to take responsible action and to face fears, thereby empowering them and making them feel free.
• Suffering awakened them from a mundane life. For some this allowed them to identify a life task springing directly from their painful experience.
• Regained a sense of control about their ability to make choices and deal with life.
• Acceptance that the underlying genetic problems or diagnoses are beyond their control.
• Experienced a sense of gratitude, bringing appreciation of every moment of their lives.
I found that logotherapy is a simple yet powerful tool that provides individuals with concrete ways to realize their unique potential. Logotherapy transcends cultural, educational, and language barriers because discovery of meaning is common to the human experience. Protracted counseling is not required to facilitate meaning-discovery: these shifts in perspectives happened in only a few short sessions (between one and six sessions).
The participants became more fully themselves and learned to appreciate life in all its fullness. They did this not in spite of, but because of the conditions and disability that confronted them.
Using logotherapy provided me with a new perspective from which to work, particularly in the field of clinical genetics. It is often tempting, and all too easy, to fall into a trap of genetic determinism when meeting with patients and their families to discuss genetic conditions. But by focusing on every person as a unique three dimensional being, fragmentation and reductionism are not possible. By staying grounded in logotherapy, there is no fear in addressing patients’ philosophical distress as they face their diagnoses.
Logotherapy provides the tools to recognize and “listen to the unheard cry for meaning” (Frankl, Doctor and the Soul), and respond appropriately. For me the joy of using logotherapy in medicine was that I could facilitate healing in situations in which it was rarely possible to effect a physical cure, and I could optimise patient wellbeing where treatment and cure was possible.