This narrative is the personal experience of a psychiatrist and neurologist who, by studying his circumstances in a Nazi concentration camp, arrived at a life-changing understanding of the meaning behind suffering. This realisation came about in really horrendous circumstances which the author graphically describes as ‘an unrelenting struggle for daily bread and for life itself’; a situation where ‘there was neither time nor desire to consider moral or ethical issues’ (pages 18-19). He describes a situation where ‘beatings occurred on the slightest provocation, sometimes for no reason at all’ (page 36). He argued that people who are able to survive such horrible circumstances are most likely to be those who have ‘lost all scruples in their fight for existence’ and ‘were prepared to use every means, honest and otherwise, even brutal force, theft, and betrayal of friends, in order to save themselves’ (page 19). Yet, it is on the background of this despairing and desperate scenario that the author discovered that ‘life holds potential meaning under any conditions, even the most miserable ones’ (page 12). Indeed he stresses that ‘it is just such exceptionally difficult external situation which gives man the opportunity to grow spiritually beyond himself’ (page 80).
The book’s key premise is that ‘if there is a meaning in life at all, then there must be a meaning in suffering’ (page 76). From this foundation, the author extracted his fundamental principle that there is ‘a genuine inner achievement‘ or ‘spiritual freedom‘ in the dignity with which people bear their suffering, and it is this dignity that ‘makes life meaningful and purposeful‘ (pages 75-76). He insists that there is always an honourable way to endure suffering even in the most ‘utterly desolate’ of situations (page 49). He propounds a universal principle that difficult times provide people with the chance of achieving something through their suffering’ (page 77). He used his camp experience to illustrate this ‘uniquely human potential… to transform a personal tragedy into a triumph, to turn one’s predicament into a human achievement‘. He argues that ‘suffering ceases to be suffering at the moment it finds a meaning’ (pages 116-117). The book demonstrated, in clear prose, how people may achieve a meaningful and optimistic life in spite of the tragic triad of pain, guilt, and death (page 139). His delicate, detailed, and extensive exploration of this theme is absolutely essential reading.
The author describes several strategies he employed to survive the vagaries of concentration camp life. He referred, for example, to using humour as a weapon ‘in the fight for self-preservation’ because humour ‘can afford an aloofness and an ability to rise above any situation’ (page 54). He describes how applying the right attitude to any situation can mitigate the suffering associated with it (pages 82-87). Specifically, he said ‘apathy could be overcome, irritability suppressed’, and ‘the vestige of spiritual freedom’ preserved even in the most terrible conditions (page 74). Another strategy is what the author calls ‘the intensification of inner life’ whereby inner strength not only protects from ‘the emptiness, desolation, and spiritual poverty‘ of miserable conditions, but even enables the sufferer to appreciate ‘the beauty of art and nature as never before’ (page 50). He tackled the eternal question of the attainment of happiness, arguing that real happiness may be attained, not by pursuing it directly, but ‘…as the unintended side-effect of one’s dedication to a cause greater than oneself, or as the by-product of one’s surrender to a person other than oneself’ (page 12).
He author developed logotherapy, his model of psychotherapy, based on his profound personal experience. This method is based on the principles that ‘human life, under any circumstances, never ceases to have meaning’, and ‘the hopelessness of our struggle did not detract from its dignity and its meaning’. Logotherapy is based on the fundamental principle that ‘the striving to find a meaning in one’s life is the primary motivational force in man’ (pages 90 and 104). He presented many excellent cases studies of how the technique works in practice. He passionately argued that the principles of logotherapy can redress the existential vacuum that is plaguing man and sweeping the twentieth century, a situation which he said is responsible for various maladies afflicting man, from depression to suicide, from aggression to addiction, from rampant sexual libido to the unhealthy pursuit of wealth and power. The author characterises this desolate state of man’s affairs, worse today than when he wrote the book, as a situation in which ‘no instinct tells him what he has to do, and no tradition tells him what he ought to do’ (pages 111-113).
The book covers a surprisingly diverse range of subjects. For example, it discussed psychological concepts relevant to deprivation such as the delusion of reprieve from death (page 23), the regression to primitive mental states (page 40), and the depersonalization that follows liberation (page 95). The author reviewed topics such as cultural hibernation (page 45), psychological hygiene (page 97), self-actualization (page 114), paradoxical intention (pages 126-127), collective guilt (page 150), achievement orientation (page 152), nihilism and learned meaninglessness (page 152).
The author’s profession as a neurologist and psychologist no doubt enabled him to derive profound meanings from what is doubtlessly horrendous suffering in awful circumstances. It is an excellent book although the second part was rather repetitive and threatened to detract from the excellent first part. The author’s keen observational skill was evident throughout the book, and this facilitated the deep insights he gained into human behaviour, and the profound lessons he imparted on how best to comport oneself when faced with the most distressful of circumstances. The book lists attitudes and skills which are essential to maintaining a reasonable degree of tranquility, dignity, and humanity throughout times of adversity. These lessons are critical to healthcare where patients frequently search for meaning behind their painful, chronic or terminal illnesses.
Suffering is the currency of medicine, and the task of relieving it falls on health care providers. This book brings a deep perspective to suffering, drawing meaning that patients and their doctors may learn from. An appreciation of the meaning in suffering will no doubt alleviate the internal conflicts that plague patients with chronic and terminal illnesses. It is an excellent book and I highly recommend it to all doctors.
Publisher, Place, Year: Rider Books, London, 1959
Number of Chapters: 3
Number of Pages: 154