Man's Search for Meaning (15 page)

Ironically enough, in the same way that fear brings to pass what one is afraid of, likewise a forced intention makes impossible what one forcibly wishes. This excessive intention, or “hyper-intention,” as I call it, can be observed particularly in cases of sexual neurosis. The more a man tries to demonstrate his sexual potency or a woman her ability to experience orgasm, the less they are able to succeed. Pleasure is, and must remain, a side-effect or by-product, and is destroyed and spoiled to the degree to which it is made a goal in itself.

In addition to excessive intention as described above, excessive attention, or “hyper-reflection,” as it is called in logotherapy, may also be pathogenic (that is, lead to sickness). The following clinical report will indicate what I mean: A young woman came to me complaining of being frigid. The case history showed that in her childhood she had been sexually abused by her father. However, it had not been this traumatic experience in itself which had eventuated in her sexual neurosis, as could easily be evidenced. For it turned out that, through reading popular psychoanalytic literature, the patient had lived constantly with the fearful expectation of the toll which her traumatic experience would someday take. This anticipatory anxiety resulted both in excessive intention to confirm her femininity and excessive attention centered upon herself rather than upon her partner. This was enough to incapacitate the patient for the peak experience of sexual pleasure, since the orgasm was made an object of intention, and an object of attention as well, instead of remaining an unintended effect of unreflected dedication and surrender to the partner. After undergoing short-term logotherapy, the patient's excessive attention and intention of her ability to experience orgasm had been “dereflected,” to introduce another logotherapeutic term. When her attention was refocused toward the proper object, i.e., the partner, orgasm established itself spontaneously.
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Logotherapy bases its technique called “paradoxical intention” on the twofold fact that fear brings about that which one is afraid of, and that hyper-intention makes impossible what one wishes. In German I described paradoxical intention as early as 1939.
¹⁰
In this approach the phobic patient is invited to intend, even if only for a moment, precisely that which he fears.

Let me recall a case. A young physician consulted me because of his fear of perspiring. Whenever he expected an outbreak of perspiration, this anticipatory anxiety was enough to precipitate excessive sweating. In order to cut this circle formation I advised the patient, in the event that sweating should recur, to resolve deliberately to show people how much he could sweat. A week later he returned to report that whenever he met anyone who triggered his anticipatory anxiety, he said to himself, “I only sweated out a quart before, but now I'm going to pour at least ten quarts!” The result was that, after suffering from his phobia for four years, he was able, after a single session, to free himself permanently of it within one week.

The reader will note that this procedure consists of a reversal of the patient's attitude, inasmuch as his fear is replaced by a paradoxical wish. By this treatment, the wind is taken out of the sails of the anxiety.

Such a procedure, however, must make use of the specifically human capacity for self-detachment inherent in a sense of humor. This basic capacity to detach one from oneself is actualized whenever the logotherapeutic technique called paradoxical intention is applied. At the same time, the patient is enabled to put himself at a distance from his own neuro- sis. A statement consistent with this is found in Gordon W. Allport's book,
The Individual and His Religion
: “The neu- rotic who learns to laugh at himself may be on the way to self-management, perhaps to cure.”
¹¹
Paradoxical intention is the empirical validation and clinical application of Allport's statement.

A few more case reports may serve to clarify this method further. The following patient was a bookkeeper who had been treated by many doctors and in several clinics without any therapeutic success. When he was admitted to my hospital department, he was in extreme despair, confessing that he was close to suicide. For some years, he had suffered from a writer's cramp which had recently become so severe that he was in danger of losing his job. Therefore, only immediate short-term therapy could alleviate the situation. In starting treatment, Dr. Eva Kozdera recommended to the patient that he do just the opposite of what he usually had done; namely, instead of trying to write as neatly and legibly as possible, to write with the worst possible scrawl. He was advised to say to himself, “Now I will show people what a good scribbler I am!” And at the moment in which he deliberately tried to scribble, he was unable to do so. “I tried to scrawl but simply could not do it,” he said the next day. Within forty-eight hours the patient was in this way freed from his writer's cramp, and remained free for the observation period after he had been treated. He is a happy man again and fully able to work.

A similar case, dealing, however, with speaking rather than writing, was related to me by a colleague in the Laryngological Department of the Vienna Poliklinik Hospital. It was the most severe case of stuttering he had come across in his many years of practice. Never in his life, as far as the stutterer could remember, had he been free from his speech trouble, even for a moment, except once. This happened when he was twelve years old and had hooked a ride on a streetcar. When caught by the conductor, he thought that the only way to escape would be to elicit his sympathy, and so he tried to demonstrate that he was just a poor stuttering boy. At that moment, when he tried to stutter, he was unable to do it. Without meaning to, he had practiced paradoxical intention, though not for therapeutic purposes.

However, this presentation should not leave the impression that paradoxical intention is effective only in mono-symptomatic cases. By means of this logotherapeutic technique, my staff at the Vienna Poliklinik Hospital has succeeded in bringing relief even in obsessive-compulsive neuroses of a most severe degree and duration. I refer, for instance, to a woman sixty-five years of age who had suffered for sixty years from a washing compulsion. Dr. Eva Kozdera started logotherapeutic treatment by means of paradoxical intention, and two months later the patient was able to lead a normal life. Before admission to the Neurological Department of the Vienna Poliklinik Hospital, she had confessed, “Life was hell for me.” Handicapped by her compulsion and bacteriophobic obsession, she finally remained in bed all day unable to do any housework. It would not be accurate to say that she is now completely free of symptoms, for an obsession may come to her mind. However, she is able to “joke about it,” as she says; in short, to apply paradoxical intention.

Paradoxical intention can also be applied in cases of sleep disturbance. The fear of sleeplessness
¹²
results in a hyper- intention to fall asleep, which, in turn, incapacitates the patient to do so. To overcome this particular fear, I usually advise the patient not to try to sleep but rather to try to do just the opposite, that is, to stay awake as long as possible. In other words, the hyper-intention to fall asleep, arising from the anticipatory anxiety of not being able to do so, must be replaced by the paradoxical intention not to fall asleep, which soon will be followed by sleep.

Paradoxical intention is no panacea. Yet it lends itself as a useful tool in treating obsessive-compulsive and phobic conditions, especially in cases with underlying anticipatory anxiety. Moreover, it is a short-term therapeutic device. However, one should not conclude that such a short-term therapy necessarily results in only temporary therapeutic effects. One of “the more common illusions of Freudian orthodoxy,” to quote the late Emil A. Gutheil, “is that the durability of results corresponds to the length of therapy.”
¹³
In my files there is, for instance, the case report of a patient to whom paradoxi- cal intention was administered more than twenty years ago; the therapeutic effect proved to be, nevertheless, a permanent one.

One of the most remarkable facts is that paradoxical intention is effective regardless of the etiological basis of the case concerned. This confirms a statement once made by Edith Weisskopf-Joelson: “Although traditional psychotherapy has insisted that therapeutic practices have to be based on findings on etiology, it is possible that certain factors might cause neuroses during early childhood and that entirely different factors might relieve neuroses during adulthood.”
¹⁴

As for the actual causation of neuroses, apart from constitutional elements, whether somatic or psychic in nature, such feedback mechanisms as anticipatory anxiety seem to be a major pathogenic factor. A given symptom is responded to by a phobia, the phobia triggers the symptom, and the symptom, in turn, reinforces the phobia. A similar chain of events, however, can be observed in obsessive-compulsive cases in which the patient fights the ideas which haunt him.
¹⁵
Thereby, however, he increases their power to disturb him, since pressure precipitates counterpressure. Again the symptom is reinforced! On the other hand, as soon as the patient stops fighting his obsessions and instead tries to ridicule them by dealing with them in an ironical way—by applying paradoxical intention—
the vicious circle is cut
, the symptom diminishes and finally atrophies. In the fortunate case where there is no existential vacuum which invites and elicits the symptom, the patient will not only succeed in ridiculing his neurotic fear but finally will succeed in completely ignoring it.

As we see, anticipatory anxiety has to be counteracted by paradoxical intention; hyper-intention as well as hyper- reflection have to be counteracted by dereflection; dereflection, however, ultimately is not possible except by the patient's orientation toward his specific vocation and mission in life.
¹⁶

It is not the neurotic's self-concern, whether pity or contempt, which breaks the circle formation; the cue to cure is self-transcendence!

Every age has its own collective neurosis, and every age needs its own psychotherapy to cope with it. The existential vac- uum which is the mass neurosis of the present time can be described as a private and personal form of nihilism; for nihilism can be defined as the contention that being has no meaning. As for psychotherapy, however, it will never be able to cope with this state of affairs on a mass scale if it does not keep itself free from the impact and influence of the contemporary trends of a nihilistic philosophy; otherwise it represents a symptom of the mass neurosis rather than its possible cure. Psychotherapy would not only reflect a nihilistic philosophy but also, even though unwillingly and unwittingly, transmit to the patient what is actually a caricature rather than a true picture of man.

First of all, there is a danger inherent in the teaching of man's “nothingbutness,” the theory that man is nothing but the result of biological, psychological and sociological conditions, or the product of heredity and environment. Such a view of man makes a neurotic believe what he is prone to believe anyway, namely, that he is the pawn and victim of outer influences or inner circumstances. This neurotic fatalism is fostered and strengthened by a psychotherapy which denies that man is free.

To be sure, a human being is a finite thing, and his freedom is restricted. It is not freedom from conditions, but it
is
freedom to take a stand toward the conditions. As I once put it: “As a professor in two fields, neurology and psychiatry, I am fully aware of the extent to which man is subject to biological, psychological and sociological conditions. But in addition to being a professor in two fields I am a survivor of four camps —concentration camps, that is—and as such I also bear witness to the unexpected extent to which man is capable of defying and braving even the worst conditions conceivable.”
¹⁷

Psychoanalysis has often been blamed for its so-called pansexualism. I, for one, doubt whether this reproach has ever been legitimate. However, there is something which seems to me to be an even more erroneous and dangerous assumption, namely, that which I call “pan-determinism.” By that I mean the view of man which disregards his capacity to take a stand toward any conditions whatsoever. Man is
not
fully conditioned and determined but rather determines himself whether he gives in to conditions or stands up to them. In other words, man is ultimately self-determining. Man does not simply exist but always decides what his existence will be, what he will become in the next moment.

By the same token, every human being has the freedom to change at any instant. Therefore, we can predict his future only within the large framework of a statistical survey referring to a whole group; the individual personality, however, remains essentially unpredictable. The basis for any predictions would be represented by biological, psychological or sociological conditions. Yet one of the main features of human existence is the capacity to rise above such conditions, to grow beyond them. Man is capable of changing the world for the better if possible, and of changing himself for the better if necessary.

Let me cite the case of Dr. J. He was the only man I ever encountered in my whole life whom I would dare to call a Mephistophelean being, a satanic figure. At that time he was generally called “the mass murderer of Steinhof” (the large mental hospital in Vienna). When the Nazis started their euthanasia program, he held all the strings in his hands and was so fanatic in the job assigned to him that he tried not to let one single psychotic individual escape the gas chamber. After the war, when I came back to Vienna, I asked what had happened to Dr. J. “He had been imprisoned by the Russians in one of the isolation cells of Steinhof,” they told me. “The next day, however, the door of his cell stood open and Dr. J. was never seen again.” Later I was convinced that, like others, he had with the help of his comrades made his way to South America. More recently, however, I was consulted by a former Austrian diplomat who had been imprisoned behind the Iron Curtain for many years, first in Siberia and then in the famous Lubianka prison in Moscow. While I was examining him neurologically, he suddenly asked me whether I happened to know Dr. J. After my affrmative reply he continued: “I made his acquaintance in Lubianka. There he died, at about the age of forty, from cancer of the urinary bladder. Before he died, however, he showed himself to be the best comrade you can imagine! He gave consolation to everybody. He lived up to the highest conceivable moral standard. He was the best friend I ever met during my long years in prison!”