Pastoral Logotherapy and the Care of Souls
Rev. Tom Edmondson
24th Logotherapy World Congress
Panel: Religion, Spirituality, and Transcendence
As a local church pastor who integrates Logotherapy and Existential Analysis into pastoral care, I have a special appreciation of Man’s Search for Ultimate Meaning (2000). The thesis statement for this book is found in the Preface to the First English Edition and is stated as follows: “There is … a religious sense deeply rooted in each and every man’s unconscious depths” (Frankl, 2000, p. 14). This thesis is unpacked and developed throughout the book in Frankl’s discussion of the spiritual unconscious, intuition, artistic creativity, dreams, and the conscience. While we may briefly define Logotherapy as “therapy through meaning,” Frankl was also clear that Logotherapy and Existential Analysis is a spiritual therapy. Not spiritual in a religious sense, but as in recognizing the human spirit as the dimension of human nature that searches for meaning.
Generally, Frankl’s writings leave revealed theology and religion to pastors, priests, and rabbis, but in this particular book he addressed religion, spirituality, and transcendence via the conscience, dreams, creativity, and ultimate meaning in relation to the human noëtic realm. These discussions include examples of people who experienced neurotic or psychotic disturbances but still had access—though sometimes severely limited—to their noëtic core. It was this connection to the transcendent via their noëtic cores that, despite their physical or psychological limitations, allowed them to express creative, experiential, and attitudinal values, cope with their disorders, or achieve a certain level of healing.
Returning to the thesis statement in the preface, Frankl added a corollary statement that this inner religious sense “may break through unexpectedly, even in cases of severe mental illness such as psychoses” (Frankl, 2000, pp. 14-15). This point is repeated in Frankl’s 1985 Oskar Pfister Award Lecture also titled, “Man’s Search for Ultimate Meaning,” and is included in this same volume. It addresses religion from an existential point-of-view. Rather than making truth claims for one religion or another, Frankl asserted that human religious behavior is more than just an existential response to life, but also stands as phenomenological proof of the existence of an inner religious sense:
In a book of mine, The Will to Meaning, I describe the case of a severe manic phase (Frankl, 1984b), in other books of mine a patient suffering from an endogenous depression (Frankl, 1985a) and other patients suffering from schizophrenia (Frankl, 1984a, b)—all of them showed an indestructible and indelible sense of religiousness [emphasis added]” (Frankl, 2000, p. 153).
Thus, we can see that from beginning to end, in the English edition of Man’s Search for Ultimate Meaning and its supplementary materials, Frankl’s presentation of evidence for the existence of an “inner religious sense” is reinforced with examples that include neurotic and psychotic issues.
In this paper, I present six statements culled from the following books and essays: Man’s Search for Ultimate Meaning (2000), On the Theory and Therapy of Mental Disorders (2004), The Will to Meaning (1988), and the essay, “Psychotherapy, Art, and Religion,” found in Psychotherapy and Existentialism: Selected Papers on Logotherapy (Frankl and Crumbaugh, 1967). These six theses express Frankl’s conviction that, though hindered by illness of the mind or body, there is an uninjured human spirit. And in each of these six examples particularly, religion or spirituality was the bridge either to noëtic healing or the adoption of attitudinal values in unalterable situations.
We have already read the first thesis from Man’s Search for Ultimate Meaning, but here is the longer version which includes the corollary statement: “There is … a religious sense deeply rooted in each and every man’s unconscious depths … this sense may break through unexpectedly, even in cases of severe mental illness such as psychoses” (Frankl, 2000, pp. 14-15). The inclusion of the phrase, “may break through unexpectedly, even in cases of severe mental illness such as psychoses” reminds us that it is often the experience of neurosis or psychosis that brings a person to an awareness of unconscious—or repressed—spirituality. The fact that it breaks through—even unexpectedly—serves as phenomenological proof of this inner religious sense grounded in the human spirit.
Thesis one, then, speaks to the fact that behind the psychosis or neurosis, there is an “uninjured” human spirit to be uncovered and activated in the healing process. This is the stated purpose for the practice of Existential Analysis, as Frankl wrote in On the Theory and Therapy of Mental Disorders: “Existential analysis awakens … a humanity that is uninjured and is incapable of being injured. Existential analysis tries to teach us how to make this visible even through the veil of neurotic derangement and psychotic madness [emphasis added]” (Frankl, 2004, p. 60).
Each thesis in the discussion that follows, adds a nuance to this exploration of accessing the human spirit when working with people experiencing a neurosis or psychosis. Thesis 2 comes from Frankl’s essay, “Psychotherapy, Art, and Religion” (Frankl, 1967, pp. 165-181). This example is actually a fuller account of an artist’s spiritual crisis that is briefly described in Man’s Search for Ultimate Meaning, pp. 50-55. In this longer but earlier version, we learn that the patient’s presenting issue was neurotic behavior and artistic frustration—she couldn’t paint. It was only during the course of treatment that the real issue emerged. As Frankl wrote: “the patient was struggling for two things: her work and God … The religious problem was not apparent in the beginning of the treatment but spontaneously broke through in its own course [emphasis added]” (Frankl, 1967, pp. 165-166). Thesis 2 follows: “Psychotherapy, handled correctly, will release a patient’s religiosity [emphasis added], even if that religiosity was dormant and its release was not at all intended by the therapist” (Frankl, 1967, p. 166). Because Frankl believed the inner religious sense is a human characteristic—a strength rather than a crutch—he was able to recognize it as such and assist the artist in her search for meaning/healing along spiritual lines. But we could imagine a very different outcome for her if she had been treated by someone from a different school of thought whose weltanschauung considered the religious sense as the neurosis rather than its cause and its cure.
Theses 3 – 6 are drawn from the chapter, “Medical Ministry” in The Will to Meaning: Foundations and Applications of Logotherapy (Frankl, 1988, pp. 131-141). Frankl’s discussion of Joan of Arc in this chapter serves as an excellent setup for these four theses:
There is no doubt that from the psychiatric point of view, the saint would have had to be diagnosed as a case of schizophrenia; and as long as we confine ourselves to the psychiatric frame of reference, Joan of Arc is “nothing but” a schizophrenic. What she is beyond a schizophrenic is not perceptible within the psychiatric dimension. As soon as we follow her into the noological dimension and observe her theological and historical importance, it turns out that Joan of Arc is more than a schizophrenic. The fact of her being a schizophrenic in the dimension of psychiatry does not in the least detract from her significance in other dimensions. And vice versa. Even if we took it for granted that she was a saint, this would not change the fact she was also a schizophrenic (Frankl, 1988, p. 29).
From this example, it is easy to see the logic of Thesis 3:
One is not justified in assuming that a neurosis or psychosis must be detrimental to the religious life of the patient. It need not be a handicap but may well be a challenge and stimulus which triggers a religious response [emphasis added]. Even if it is a neurosis that drives a person to religion, religion may become genuine, in the long run, and finally help the person to overcome the neurosis. It therefore is not justified a priori to exclude people with neurotic traits from the theological profession (Frankl, 1988, pp. 132-133).
The primary example Frankl used to support Thesis 3 was of a Carmelite nun struggling with depression. She had the further burden of being shamed by a superior who told her that a nun should not be depressed. Frankl helped her to overcome this by suggesting the opposite, that perhaps only a Carmelite sister could master depression in the admirable way that she did. In so doing, he appealed to her inner noëtic self to find meaning in her suffering, which relieved her of the guilt she was feeling. This also illustrates how a person’s spiritual core can be the source of noögenic distress but also of noögenic healing.
This leads logically to Thesis 4: “People need not become bad monks and nuns because of a neurosis, but may well become good monks and nuns in spite of it. In some cases, they even become good monks and nuns because of a neurosis [emphasis added]” (Frankl, 1988, p. 137).
The neurosis, in Frankl’s view, did nothing to minimize the Carmelite sister’s value as a nun. Rather, it offered her the ability to be a good—or even better—nun because of it. On a more basic level, it could be said that a neurosis does not make a person morally good or bad. As Frankl wrote in The Unheard Cry for Meaning:
Time and again, we psychiatrists meet patients whose response to their delusions is anything but pathological. I have met paranoiacs who, out of their delusional ideas of persecution, have killed their alleged enemies; but I have also met paranoiacs who have forgiven their supposed adversaries. The latter have not acted out of mental illness but rather reacted to this illness out of their humanness (Frankl, 1978, p. 49).
Values extend from a person’s noëtic core and, therefore, may break through despite neurosis or psychosis. Similarly, mental illness does not keep one from knowing or speaking the truth: “Two times two equals four even if a paranoiac makes the statement” (Frankl, 1986, p. 15). Again, this is based on the idea that behind the psychosis or neurosis is an “uninjured” noëtic core, which is also home to the inner religious sense. Thesis 5:
Neurosis is not necessarily detrimental to religion. The neurotic may be religious either despite or because of being neurotic [emphasis added]. This fact reflects the independence and authenticity of religion. To all appearances religion is indestructible and indelible. Even psychosis cannot destroy it (Frankl, 1988, pp. 137-138).
Frankl further illustrated this with the story of a man in his sixties who had suffered for decades from auditory hallucinations (schizophrenia). Human opinion of this man was not high. Frankl wrote: “I was facing a ruined personality. Everyone in his environment regarded him as an idiot” (Frankl, 1988, p. 138). He had wanted to be a priest when he was young, but obviously this did not happen. He was cared for by his sister and his religious service was limited to singing in the choir. Because of his mental condition he often became easily excitable but was able to regain self-control. When Frankl asked him for whom he was calming himself, he responded, “For God’s sake.” Even the ability to cope with one’s own mental disorder, in other words, can be aided by an appeal to the inner religious sense.
This leads to thesis 6 which serves as a great summary statement for appealing to the counselee’s inner religious sense via Existential Analysis: “Taking religion seriously allows for drawing upon the spiritual resources of the patient. In this context spiritual means uniquely and truly human (Frankl, 1988, p. 140). This drives home the point that behind every illness is an “uninjured spirit,” where the patient can choose to exercise freedom and responsibleness. Thus, diseases of the body and the mind, tragic though they are, ultimately do not have to control how a person responds to them.
What can pastors, rabbis, priests, and others who serve a religious or spiritual community, gain from this discussion? I will not attempt a full answer to this question today, but I will suggest some possible answers to be further explored. First, we are members of the clergy who integrate Logotherapy and Existential Analysis into pastoral care, we are not medical doctors, nor are we psychiatrists. Therefore, we are not suited to treat people experiencing psychosis, but we can minister to them. Frankl’s statements about the inner religious sense breaking through even in spite of psychosis should guide us in caring for them. Thus, when ministering to someone experiencing psychosis—and like any other Logotherapist—we can attempt to connect with them via their noëtic core.
An anecdotal example I would like to offer comes from my grandmother. At the end of her life she was in home hospice care and suffering greatly in her body. Because of this, she was treated with morphine, which caused her to fall into a morphine induced delirium. Whether this is properly called psychosis or not, the manifestations are similar in the same way that a panic attack and a heart attack look the same to a non-medical person like me. Be that as it may, my grandmother was not experiencing reality the way the rest of us were. One night shortly before she died, as we were sitting at her bedside, she recounted disparate memories and stories from across her lifespan. At times she seemed like a child and other times like an adult. It was both entertaining and bittersweet. But most amazingly, she sang old hymns like “Precious Memories.” And what is so amazing is that, while her mind was scattered in many directions, she sang every word and every note of the sacred hymns. Despite her delirium, where she could not talk or think in a linear fashion, she was able to sing a religious hymn from beginning to end. As I see it, though her mind and body were failing, her noëtic core was intact, as demonstrated by this religious sense breaking through the fog of a morphine induced delirium.
Two more anecdotal examples. One Wednesday evening a young man entered our church building and went directly to the sanctuary. He was seeking help. His speech was hard to follow, but we finally made out that he had been wandering about town for most of the day, was off of his medication, and could not figure out how to tell his caretaker where he was. Luckily, he had his phone and I was able to speak with his caretaker. Within thirty minutes the caretaker arrived to take the young man back to his group home. Given the circumstances, I could not ask about the young man’s condition, but my guess is that he was experiencing bipolar disorder.
The point of this anecdote is to share what I observed as we were waiting for the caretaker to arrive. Like the example Frankl gave of the man who calmed himself “for God’s sake,” this young man became agitated when we were not speaking directly to him. What did he do in those moments? He alternated between quoting John 3:16, “For God so loved the world …” and praying, “God have mercy on me, a sinner.” It was unmistakable and clear that he was speaking out of his inner religious sense to deal with his psychosis. He seemed to be calming himself “for God’s sake.”
Finally, there is a lady in our congregation who has a family history of Alzheimer’s disease. Not long ago, her only living relative, a brother, passed away from the effects of Alzheimer’s. Shortly thereafter, she began to show signs herself. Once a very talkative person, she suddenly became very quiet to the point of not talking at all. The extreme change was noticed by everyone. Finally, a doctor prescribed a medicine that eased her symptoms, and she has been able to engage in conversation again, but still only with a minimum of words. Recently I observed that in worship, when the congregation recites the Lord’s Prayer, she says every word—many more words than she is now able to put into a conversation.
If a person’s inner religious sense can be accessed despite psychotic issues, how much more effective can it be when ministering to people experiencing noögenic neuroses, or other existential issues? Clergy, no less than medical doctors, deal with real human hurts. Pastoral Logotherapy can be practiced in a one-on-one or group counseling setting, but it often occurs in places like hospital rooms, social gatherings, Bible studies, sermons, and in impromptu encounters. Further, a priest, rabbi, imam, shaman, or preacher is, by virtue of his or her vocation, a representative of religion, spirituality, and the transcendent. Therefore, effective implementation of Logotherapy in the pastoral setting includes helping the person find the meaning of their lives through the usual means of maieutic questioning, etc., but also with the corollary that religion or spirituality is part of the discussion. Our examination of these six theses, drawn from Frankl’s writings, undergirds the fact that accessing the inner religious or spiritual sense within the seeker is a pathway to either healing or a positive attitudinal change for living with unalterable circumstances.
Works Cited
Frankl, V. E. (1986). The Doctor and the Soul: From Psychotherapy to Logotherapy. New York: Knopf Doubleday Publishing Group.
Frankl, V. E. (2000). Man's Search for Ultimate Meaning. United States: Basic Books.
Frankl, V. E. (2004). On the Theory and Therapy of Mental Disorders: An Introduction to Logotherapy and Existential Analysis. United States: Brunner-Routledge.
Frankl, V. E., Crumbaugh, J. C. (1967). “Psychotherapy, Art, and Religion,” in Psychotherapy and Existentialism: Selected Papers on Logotherapy. United States: Simon and Schuster, pp. 165-181.
Frankl, V. E. (1978). The Unheard Cry for Meaning: Psychotherapy and Humanism. United States: Touchstone.
Frankl, V. E. (1988). The Will to Meaning: Foundations and Applications of Logotherapy. United States: Meridian.