Episode CME activity objectives:

In the context of a therapeutic alliance, apply the information given in this episode to help draw out meaning in others.

Identify who Viktor Frankl was and how his work and legacy have shaped how we understand and utilize meaning in psychiatry.

Define psychic determinism.

Recognize that meaning is idiosyncratic and unique to each individual.

Recognize the multitude of ways people can find meaning in their lives and the various ways they can express and convey this.

Summarize the various studies listed in this episode that have shown how meaning and the creation of meaning can have a positive impact.

David Puder, M.D. has no conflicts of interest to report.

In the celebrated book Man's Search for Meaning, author Viktor Frankl wrote about his intimate and horrific Holocaust experience. He found that meaning often came from the prisoners' small choices—to maintain belief in human dignity in the midst of being tortured and starved and bravely face these hardships together.

"The way in which a man accepts his fate and all the suffering it entails, the way in which he takes up his cross, gives him ample opportunity—even under the most difficult circumstances—to add a deeper meaning to his life. It may remain brave, dignified and unselfish. Or in the bitter fight for self-preservation he may forget his human dignity and become no more than an animal." - Viktor Frankl

"We who lived in concentration camps can remember the men who walked through the huts comforting others, giving away their last piece of bread. They may have been few in number, but they offer sufficient proof that everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances, to choose one's own way." - Viktor Frankl

Frankl argued that the ultimate human drive is the "will to meaning," which could be described as the meaning to be found in the present and in the future. For example, I have had patients who are suicidal, yet they would not kill themselves, despite part of them desiring death, because they would not get to see their grandkids grow up. The meaning of the future moments and being able to help their grandkids in some small way empowers them to keep going to treatment.

People's meaning keeps them going, even when other drives, like sex or desire for power, are completely gone. In this way, Frankl noted, "Focus on the future, that is on the meaning to be fulfilled by the patient in his future…I speak of a will to meaning in contrast to the pleasure principle (or, as we could speak also term it, the will to pleasure) on which Freudian psychoanalysis is centered, as well as in contrast to the will to power on which Adlerian psychology, using the term 'striving for superiority,' is focused."

This idea led to the beginning of a new type of therapy—logotherapy.

By listening to this episode, you can earn 0.75 Psychiatry CME Credits.

Link to blog.

Link to YouTube video.

Therapeutic Alliance Part 2: Meaning and Viktor Frankl's Logotherapy

Psychiatry & Psychotherapy Podcast