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ABSTRACT

AN EMPIRICAL INVESTIGATION OF VIKTOR FRANKL'S
CONCEPT OF THE SEARCH FOR MEANING: A
PILOT STUDY WITH A SAMPLE OF
TUBERCULOSIS PATIENTS

by Rex Eugene Ballard

The purpose of this study was to investigate empiri—
cally some of the concepts of Viktor Frankl, especially
his concept of man's search for meaning, as they apply to
tuberculosis patients.

The population for this study was twelve patients
from the Ingham County Tuberculosis Hospital, which was
all of the willing, medically able to participate subjects
from that hospital and thirty—eight patients, chosen at
random from the willing, medically able to participat
subjects of the Oakland County Tuberculosis Hospital.

Two criteria measures were selected: the Berle Index
(a medical scale which gives an indication of prognosis in
tuberculosis) and the Shontz and Fink Scale (which indicates
psychosocial adjustment in the hospital situation). The
latter was scored by hospital personnel.

Seven variables were then correlated with these two

criteria measures. These variables were chosen because there

Rex Eugene Ballard

is evidence that they measure that which Frankl discusses.
They are as follows:

1. The Purpose in Life Test, which measures the con—

cepts of Frankl.

2. The Anomie Scale, measuring social isolation and

aimlessness.

3. The Normlessness Scale.

4. Do you ever ask, ”Why has this illness happened

to me?”

5. Do you ever ask, "What is the meaning and purpose

of my life?”

6. Whether the subject has found meaning and purpose

for his life.

7. Whether the subject has found a reason for the

illness happening to him.

The simple correlations indicated that the Berle Index
and the P.I.L., Anomie, Normlessness variables and the
response indicating the finding of some purpose in life
were significantly related at the .05 level of significance.
This confirmed the hypotheses that such would be the case.
The hypotheses that the Berle Index and variables A, 5, and
7 were significantly related at the .05 level, were rejected.

The simple correlations also indicated that the Shontz
and Fink Psychosocial Scale and the Anomie and the Normless—
ness variables were significantly related at the .05 level

of significance. This confirmed the hypotheses that such

 

I.)

‘9

‘Q

Rex Eugene Ballard

would be the case. The hypotheses that there would be a
significant correlation between the Shontz and Fink Scale
and the P.I.L. Test, as well as variables A, 5, and 7,
were rejected.

It is concluded that the concepts Frankl discusses
are related both to prognosis in tuberculosis and adjust-
ment to the hospital situation. However, the usual caution
is necessary in concluding a casual relationship. Clearly,
need exists for further research.

The multiple correlations of the Shontz and Fink Scale
with the seven predictor variables was .5109, with the norm-
lessness Scale being the single best predictor multiple
correlations were computed with the two criteria variables
and the predictor variables. The multiple correlation of
the Berle Index and the seven predictor variables was .7A80,
with the P.I.L. Test and the Normlessness Scale being the
two best predictors.

The subjects were asked to respond to four Open ended
questions: (1) Why do/don't you ask, ”Why has this illness
happened to me?", (2) What answers, if any, do you find to
the question, "Why has this illness happened to me?", (3)
Why do/don't you ask, "Does my life have any meaning or
purpose?" (A) What, if anything, gives meaning and purpose
to your life? The responses to these questions were placed
in categories and the number of responses in each category

was compared with the high, medium and low scores (the high

 

 

 

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Rex Eugene Ballard

end of the scale being defined as the direction of assumed
Optimal adjustment) on three variables (the P.I.L. Test,
the Anomie and Normlessness Scales) and the "Yes" and "No”
reaponses on the variables capable of being scored dicho-
tomously. The purpose of this content analysis was to
suggest possible hypotheses for further research.

The content analysis revealed the following: 52% of
the subjects did ask why the illness happened to them and
of this percentage, 76.92% found some reason, while 23.07%
did not. Of the 52% who asked why the illness happened,

22% gave a definite reason for asking, while 30% asked,
but with no stated reason for asking. Of the 48% who did
not ask why the illness happened, 12% stated no reason for
not asking.

54% of the subjects found no reason for the illness
happening, 6% found no reason but believed there was one,
18% gave punishment—associated responses, 8% thought of the
disease in terms of cause and effect, 14% felt the disease
was purposive, e.g., "to slow me down."

78% of the subjects aSked what the meaning and purpose
of their lives was, and of these, 82.05% found some meaning
and purpose, while 17.94% did not.

Of those asking the question as to what was the meaning
and purpose of their lives, 34% asked with a definite reason
for asking, and 44% asked but with no definite reason for
asking. Of the 22% who did not ask, 10% gave no reason for

110t asking, and 12% gave a reason for not asking.

Rex Eugene Ballard

Eight patients gave more than one response to the
question as to what gave meaning and purpose to their
lives. These responses had to be placed in different cate—
gories, making the total number of responses 58 and making the
percentages the percentages and of responses and not patients

22.41% of the responses indicated that the patients
found no meaning or purpose in life, 8.62% indicated no
meaning or purpose having been found, but revealing their
belief that there was such meaning if they could manage to
find it, 37.93% of the responses indicated meaning being
found in some form of accomplishment, 29.31% indicated meaning
being found in some type of experience, e.g., experiencing
the love of someone, and 1.72% indicating meaning being found
in the attitude taken toward suffering. The last three cate—
gories are those suggested by Frankl.

Attention was also drawn to statistically significant
shifts in response categories as compared with high and low
scores on the P.I.L. Test and the Anomie and Normlessness

Scales. Suggestions were made for further research.

AN EMPIRICAL INVESTIGATION OF VIKTOR FRANKL'S
CONCEPT OF THE SEARCH FOR MEANING: A
PILOT STUDY WITH A SAMPLE OF

TUBERCULOSIS PATIENTS

By

Rex Eugene Ballard

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Counseling, Personnel Service and
Educational Psychology

College of Education

1965

To:

To:

To:

To:

To:

ACKNOWLEDGMENTS

Dr. John E. Jordan for his interest, encouragement,

and guidance during this study.

My doctoral committee which included Dr. John E. Jordan,
Chairman, Dr. Donald Hamachek, Dr. Norman Kagan, and

Dr. Marian Kinget. They have given guidance and
encouragement during the progress of the study.

The staff and patients of the Ingham County Tuberculosis
Hospital, and the Oakland County Tuberculosis Hospital
who, by their generous cooperation, made this study
possible.

My parents, who early impressed upon me the values of
education.

Mary, my wife, and Douglas and Gregory, our children,

I gratefully dedicate this study.

11

REX EUGENE BALLARD

CANDIDATE FOR THE DEGREE OF

DOCTOR OF PHILOSOPHY

Final Examination: December 1, 1964 College of Education

Thesis: An Empirical Investigation of Viktor Frankl's Con—
cept of the Search for Meaning: a Pilot Study with
a Sample of Tuberculosis Patients.

Outline of Studies: Major Subject: Guidance and Personnel
Services
Minor Subject: Professional Education
and Psychology

Biographical Items:

Born: April 20, 1927, Battle Creek, Michigan

Undergraduate Studies: Northern Baptist Theological
Seminary, 1945-1946; Western Michigan College,
1946—1949, A. B. Degree, June, 1949.

Graduate Studies: Northern Baptist Theological Seminary,
1949—1952, B. D. Degree, May, 1952; Garrett Biblical
Institute, 195l; Western Michigan University, 1955;
Andover Newton Theological School, 1960—1961, S.T.M.
Degree, May, 1961; Michigan State University, 1962—
1965, Ph. D. Degree, March, 1965.

Clinical Training: (Three quarters under the auspices
of the Institute of Pastoral Care, Inc.); University
Hospital, Ann Arbor, Michigan; Boston City Hospital,
Boston, Massachusetts; Massachusetts Mental Health
Center, Boston, Massachusetts; Worcester State
Hospital, Worcester, Massachusetts.

Experience:

Pastor, Ceresco Baptist Church, Ceresco, Michigan and
North Athens Baptist Church, East LeRoy, Michigan,
1951-1957;

Pastor, Broadway Baptist Church, Bay City, Michigan,
1957-1960;

Pastor, Martin's Pond Union Baptist Church, North
Reading, Massachusetts, 196021962;

Pastor, Towar—Hart Baptist Church, East Lansing,
Michigan, 1962—1964;

Graduate Assistant, Michigan State University, 1963—
1964;

Staff Psychologist, Counseling Psychology Section,
Veterans Administration Hospital, Battle Creek,
Michigan, 1964 to present.

TABLE OF CONTENTS

ACKNOWLEDGMENTS
LIST OF TABLES
LIST OF APPENDICES
Chapter
I. THE PROBLEM

The Nature of the Problem.
Statement of the Problem .
Hypotheses. . .
Definition of Terms.

Need for the Study . .
Limitations of the Study
Organization of the Thesis

II. REVIEW OF LITERATURE

Existentialism .

Frankl' s Therapeutic Concepts
Research Related to Tuberculosis
Summary. . .
Research Related to Anomie

III. PROCEDURE AND METHODOLOGY.

Subjects

Interviewing Methods
The Experimental Tasks.
Analysis Procedures.

IV. RESULTS AND DISCUSSION.

V. SUMMARY, RECOMMENDATIONS AND IMPRESSIONS.

Summary.
Recommendations for. Further Research
Impressions

REFERENCES.

APPENDICES.

iii

Page
ii
iv

vii

H

\OCDNOUONH

11
21
36
50
51

56
56
57

58
68

72
109
109
112
113
121

126

Table

10.

LIST OF TABLES

Range of Berle scores for experimental subjects
at time of initial hospitalization.

Replication of Berle scores for experimental
subjects five years after initial hospital-
ization. . . . . .

Results of Purpose in Life Test in Crumbaugh's
and Moholick's study - . . . . .

Simple correlations.

Intermediate solution no. 1. Multiple and
partial correlation coefficients of depen—
dent variable no. 1 and independent vari—
able no. 3, with 48 degrees of freedom

Intermediate solution no. 2. Multiple and
partial correlation coefficients of depen-
dent variable no. 1 and independent varia-
bles nos. 3 and 4, with 47 degrees of
freedom. . . . . . . . . .

Intermediate solution no. 3. Multiple and
partial correlation coefficients of depen-
dent variables no. 1 and independent vari—
ables nos. 3, 4, and 5, with 46 degrees of
freedom. . . . . . . . . . .

Intermediate solution no. 4. Multiple and
partial correlation coefficients of depen-
dent variable no. 1 and independent vari-
ables nos. 3, 4, 5, and 6, with 45 degrees
of freedom. . . . . . . . . .

Intermediate solution no. 5. Multiple and
partial correlation coefficients of depen—
dent variable no. 1 and independent vari—
ables nos. 3, 4, 5, 6, and 7, with 44
degrees of freedom . . . . . .

Intermediate solution no. 6. Multiple and par—
tial correlation coefficients of dependent

variable no. 1 and independent variables nos.

3, 4, 5, 6, 7, and 8, with 43 degrees of
freedom. . . . . . . . . . .

iv

Page

61

61

65
73

76

76

77

77

78

78

11.

12.

13.

14.

15.

16.

17.

18.

19.

Final solution. Multiple and partial corre—
lation coefficients of dependent variable
no. 1 and independent variables nos. 3, 4, 5,
6, 7, 8, and 9, with 42 degrees of freedom.

Intermediate solution no. 1. Multiple and par—
tial correlation coefficients of dependent
variable no. 2 and independent variable no. 3,
with 48 degrees of freedom

Intermediate solution no. 2. Multiple and par-
tial correlation coefficients of dependent
variable no. 2 and independent variables nos.
3 and 4, with 47 degrees of freedom

Intermediate solution no. 3. Multiple and partial
correlation coefficients of dependent variable
no. 2 and independent variables nos. 3, 4, and
5, with 46 degrees of freedom .

intermediate solution no. 4. Multiple and par-
tial correlation coefficients of dependent
variable no. 2 and independent variables nos.
3, 4, 5, and 6, with 45 degrees of freedom.

Intermediate solution no. 5. Multiple and par-
tial correlation coefficients of dependent
variable no. 2 and independent variables nos.
3, 4, 5, 6, and 7, with 44 degrees of freedom

Intermediate solution no. 6. Multiple and par~
tial correlation coefficients of dependent
variable no. 2 and independent variables nos.
3, 4, 5, 6, 7, and 8, with 43 degrees of
ireedom . . . . . . . . . .

Final solution. Multiple and partial correla«
tion coefficients of dependent variable no.
2 and independent variables nos. 3, 4, 5, 6,
7, 8, and 9, with 42 degrees of freedom.

Comparison of responses to the question, "Why do/
don't you ask, 'Why has this illness happened
to me?'” with levels of scales and question-
naire items

Page

79

79

80

80

81

81

99

Table

20. Comparison of responses to the question,
"What reasons do you find for this ill—
ness having happened to you?" with levels
of scales and questionnaire items.

21. Comparison of reSponses to the question, "Why
do/don't you ask, 'What is the meaning and
purpose of my life?“'with levels of scales
and questionnaire items

22. Comparison of responses to the question, ”What
answers do you find to the question, 'What
is the meaning and purpose OI my life?'"
with levels of scales and questionnaire
items

vi

Page

100

101

102

Appendix
I.

II.

III.

IV.

VI.

The
The
The
The
The

Six

LIST OF APPENDICES

Berle Index

Shontz and Fink Scale.
Purpose in Life Test
Anomie Scale.
Normlessness Scale.

Item Questionnaire.

vii

Page
126
130
134
138
140
142

CHAPTER I

THE PROBLEM

The Nature of the Problem

 

The writings of Dr. Viktor E. Frankl have come into
the awareness of the American academic community largely
since World War II. The interest in Frankl's work is part
of the larger interest in the existential school of philos—
phy and psychology. While the work of Frankl has many
aSpects and many implications, the major focus of this study
will be on his concept of man's need to have some meaning for
his life. Frankl believes that man's most important need
is to have some meaning and purpose in life.

In reporting on the group psychotherapeutic experiences
in the prisoner of war camps he writes, "A saying from
Nietzsche could have stood as a motto for the whole psycho—
therapeutic work in the concentration camp: 'He who knows
a WHY for living, will surmount almost every HOW.'" (Frankl,
1963, p. XIII.)

There is a rather wide-spread, "common—sense" kind
of agreement that people need to have something to live
for, something which will give their lives meaning and pur—
pose. For instance, it is commonly remarked by medical
personnel that, ". . . if the patient only had the will to
live, his chances for recovery would be much better."

1

2

Statement of the Problem

 

The purpose of this present study is to investigate
Frankl's concept of man's search for meaning. Based on his
own personal eXperiences and the experiences of others in
the concentration camps, Frankl believes that when peOple
are in a crisis situation they may ask themselves why this
particular event has happened to them, in order to find some
meaning in their experiences. Frankl also suggests that if
a person finds some meaning or purpose for his life, he
will be better prepared to meet the crises of life.

This study will seek to investigate these concepts
through interviews and scale scores obtained from a group of
hospitalized tuberculosis patients. There will be two criteria
scores: a score from the Berle Index (see Appendix 1) (Holmes,
1960—61) which purports to indicate progress toward recovery
from tuberculosis, and the Shontz and Fink Scale (see Appendix
II) (Shontz and Fink, 1961) which measures adjustment in the
hospital environment. Also, each patients will be scored on
the Crumbaugh and Maholick "Purpose in Life Test” (see Appendix
III) (Crumbaugh and Maholick, 1964), a scale that is based on
Frankl's concepts. Furthermore, the patients will be scored
on Srole's Anomie Scale (see Appendix IV) (Srole, 1956) and
Dean and Reeves' Normlessness Scale (see Appendix V) (Dean
and Reeves, 1962). The rationale for administering the
Anomie and Normlessness scales is to determine if the P.I.L.
Test is measuring essentially the same factors as these

primarily socially-oriented scales.

In addition, the patients will be asked two questions:

1. Do you ever ask yourself, "Why has this
illness happened to me?"

2. Do you ever ask yourself, "Does my life
have any meaning and purpose?”

The patients will also be scored as to whether they do

or do not find a meaning for life and scored as to whether

they find a reason for the illness having happened.

After a review of literature pertinent to the present

study, a complete procedure and methodology will be pre-

sented in Chapter III.

Hypotheses

 

The following hypotheses are offered in order to

test the implications arising out of the previous discussion.

HYPOTHESIS
the .05 level of
Index and scores

HYPOTHESIS
the .05 level of
Index and scores

HYPOTHESIS
the .05 level of

Index and scores

I: There is a significant correlation at
significance between scores on the Berle

on the P.I.L. Test.

II: There is a significant correlation at
significance between scores on the Berle

on the Anomie Scale.

III: There is a significant correlation a:
significance between scores on the Berle

on the Normlessness Scale.

HYPOTHESIS IV: There is a significant correlation at
the .05 level of significance between scores on the Berle
Index and responses to the question, "Do you ever ask your—
self, 'Why has this illness happened to me?'"

HYPOTHESIS V: There is a significant correlation at
the .05 level of significance on the Berle Index and
responses on the question, "Do you ever ask yourself, 'Does
my life have any meaning and purpose?'"

HYPOTHESIS VI: There is a significant correlation at
the .05 level of significance between scores on the Berle
Index and responses indicating either success or lack of
success in finding a reason for the illness occurring.

HYPOTHESIS VII: There is a significant correlation
at the .05 level of significance between scores on the Berle
Index and responses indicating either success or lack of
success in finding some meaning and purpose in life.

HYPOTHESIS VIII: There is a significant correlation
at the .05 level of significance between scores on the
Shontz and Fink Scale and scores on the P.I. L. Test.

HYPOTHESIS IX: There is a significant correlation
at the .05 level of significance between scores on the
Shontz and Fink Scale and scores on the Anomie Scale.

HYPOTHESIS X: There is a significant correlation
at the .05 level of significance between scores on the

Shontz and Fink Scale and scores on the Normlessness Scale.

HYPOTHESIS XI: There is a significant correlation at
the .05 level of significance between scores on the Shontz
and Fink Scale and responses to the question, "Do you ever
ask yourself, 'Why has this illness happened to me?'"

HYPOTHESIS XII: There is a significant correlation
at the .05 level of significance between scores on the
Shontz and Fink Scale and responses to the question, "Do
you ever ask yourself, 'Does my life have any meaning and
purpose?'"

HYPOTHESIS XIII: There is a significant correlation
at the .05 level of significance between scores on the
Shontz and Fink Scale and responses indicating either
success or lack of success in finding a reason for the ill—
ness occurring.

HYPOTHESIS XIV: There is a significant correlation
at the .05 level of significance between scores on the
Shontz and Fink Scale and responses indicating either success
or lack of success in finding some meaning and purpose in
life.

In addition, multiple and partial correlations will
be computed between each criterion variable and the Anomie
Scale, Normlessness Scale and P.I.L. Test and the two
questions on which a "Yes" or "No” response will be obtained.
Attention will be drawn to those correlations that are signi—
ficant at the .05 level of significance. The purpose of

this statistical analysis will be to determine if a gain is

made in predicting the criterion variable by the addition

of a combination of additional experimental variables, and

if so, what is the degree of increase in predictability.
In addition to testing the above hypotheses, four

questions will be asked of the patients for the purpose

of hypothesis generation, i.e.:

1. Why do/don't you ask the question, "Why
has this illness happened to me?”

2. What answers, if any, do you find to the
question, "Why has this illness happened
to me?”

3. Why do/don't you ask, "Does my life have
any meaning or purpose?”

4. What, if anything, gives meaning and pur-
pose to your life?

The answers to these four questions will be subjected to

content analysis.

Definitions

 

The following four terms, which are used throughout
this study, are defined as follows:

Meaninglessness.--Frankl uses the word "meaninglessness"

 

in two ways: (1) The inability to see any pattern or
reason in what has happened to oneself, and (2) having no
purpose to live for which gives meaning to life. The two
uses of the word will be made clear either through context
or by specific reference to its method of use.

Anomie.—-This is interpreted as a feeling of deSpair, a

negative Weltanshauung, a generalized, pervasive sense of

 

"self—to-others distance" and "self-to—others alienation.”

Normlessness.-—This is a situation in which the social

 

norms regulating individual conduct have broken down or

are no longer effective as rules for behaviour.

 

Need for the Study

Most peOple, in the course of a lifetime, face a
number of crisis situations. Fortunately, most individuals
have the internal and external resources to meet these
crises. However, there are those individuals who feel com?
pletely, or almost completely, overwhelmed by certain life
eXperiences. There are those who must face the death of
a loved one, or the existence of an inoperable cancer in
themselves or a member of their family. There are the
inevitable limitations associated with growing old, or, for
some peOple, the severe limitations which accompany chronic
disease.

How are those in the helping professions to be of
service to such peOple and others like them? Too often
such individuals are approached with pious platitudes on
one hand, or on the other hand they are simply avoided because
of the powerful feelings of helplessness and guilt that are
created in the would—be helper by his inability to alleviate
the distress.

It is Frankl's contention that even in suffering people
can find meaning and purpose and thereby life can not only

be made endurable but fulfilling, even in the most extreme

situation. If there is even a possibility of such being the
case for even a few people, it is worth investigating. Howv
ever, there is very little research to either support or
reject Frankl's concepts. There has been a good deal of
speculation about Frankl's work, but there is a great need
for actual research.

It is the purpose of this study to take at least pre—

liminary steps in that direction.

Limitations of the Study

The limitations of the study consist primarily in
the following:

1. The small number of subjects. However, large
numbers of subjects are not feasible due to the time—con—
suming methods of gathering the data. A sample of fifty
is large enough to warrant the use of the statistical tools
employed in this study.

2. The limited statistical inferences that can be
derived from such a sample. As samples become larger and
representative, they more nearly represent the parent pOpu—
lation. However, the sample is assumed to be fairly repre-
sentative of tuberculosis patients.

3. The necessity of using instruments on which there
is not a great deal of research. However, the concepts with
which this study is primarily concerned are just now becoming
the center of research. It is hoped that this study will

add research information in this area.

4. The inability to generalize beyond the population of
tuberculosis patients. It will remain for other research
to discover if the characteristics of this pOpulation also

holds for other pOpulations.

Organization of the Thesis

This thesis is organized according to the following
plan:

Chapter I serves as an introduction to the nature of
the problem involved in this study.

Chapter II is a summarization of the most significant
research related to this study. The research has been
presented in four major divisions:

l. A review of existentialism in general.

2. A review of Viktor Frankl's writings.

3. A review of research related to the personality

characteristics of tuberculosis patients.

4. A review of the research dealing with Anomie and

Normlessness.

Chapter III is concerned with the procedure and metho—
dology of this study. It describes the sample, the inter—
view procedure and the various scales used to obtain the
measurements. The chapter concludes with an explanation of
the statistical procedures used in the analysis of the data

obtained in the study.

 

arr
«uh;

10

Chapter IV presents the results of the study in
tabular and eXplanatory form.
Chapter V presents a summary of the results with

conclusions and recommendations.

..— » on“

 

 

CHAPTER II
REVIEW OF LITERATURE

Existentialism

Since many of Viktor E. Frankl's concepts are drawn
from the existential school of philos0phy and psychology,
in seeking to understand Frankl's thinking it is helpful to
have a general knowledge of existentialism. A brief review
of the historical background and main concepts of existen-
tialism is the purpose of this section of Chapter II.

Soren Kierkegaard (1813-1855) generally is acknowledged
to be the father of existentialism per se. Friedrich Nietzche
(1844-1900), a contemporary of Kierkegaard, carried forward
the existential philosophy. Nietzche apparently was not
influenced directly by Kierkegaard, but rather responded
to the cultural conditions of his time in much the same
manner as had Kierkegaard. In spite of the fact that both
Kierkegaard and Nietzche were writing before the first World
War, it was not until after this war that their writings
became influential in EurOpe. (Barrett, 1962, p. 12.)

Following World War I, existentialism was furthered by

the writings of Martin Heidegger (1889- ), Karl Jaspers
(1883b ), Gabriel Marcel (1889- ) and J. P. Sartre
11

 

12

(190"- ). It was not until after World War II that
existentialism became really influential in this country.
(Wahl, 1949.)

No philosophical movement arises in a cultural vacuum.
In many ways, existentialism is a reaction to some of the
cultural developments in the period beginning about 1800
and continuing to the present. As William Uarrett points out,
(1962, p. 35) the existentialists believe that modern man has
entered into a secular phase of his history, and that he has
brought with him a feeling of great exuberance at the prospect
of his increased power over the world around him. In most
cases modern man's fondest dreams have been fulfilled in the
conquest of his environment. But, paradoxically, for the
first time man has found himself homeless. Science stripped
nature of its human forces and presented man with a universe
that was neutral, alien, to his human purposes in its vast—
ness and force. Before this phase set in, religion had been
a structure that encompassed man's life, providing him with
a system of images and symbols by which he could express his
own aspirations towards psychic wholeness. With the loss of
this containing framework, man became not only a dispossessed
but a fragmentary being.

As the existentialist sees it, in society as in the
spiritual world, secular goals have come to predominate;
the rational organization of the econdmy has increased human

power over nature, and politically society has become more

-~x *_ -“

v— v— ‘v— ____ ‘,

 

rational, ultilitarian, democratic, with a resulting material
wealth and progress. The men of the Enlightenment saw no

end to this triumphant expansion of reason into all areas

of social life. But here too, the existentialists believe,
reason has foundered upon its Opposite, upon the surd and
unpredictable realities: wars, economic crises and disloca—
tions, political Upheavals among the masses.

Moreover, as the existentialist sees it, man's feeling
of homelessness, Of alienation has been intensified in the
midst of a bureaucratized, impersonal mass society. He has
come to feel himself an outsider even within his own human
society. He is truly alienated: a stranger to God, to
nature, and to the gigantic social apparatus that supplies
his material wants. (Barrett, 1962, p. 36.)

From the existentialist point Of view, the worst and
final form of alienation, toward which the others tend, is
man's alienation from his own self. In a society that
requires of man only that he perform competently his own
particular social function, man becomes identified with this
function. The rest of his being is allowed to subsist as
best it can, usually to be drOpped below the surface of
consciousness and forgotten.

It is not possible to outline the works of the major
existentialist writers, but the work of Soren Kierkegaard,
the father of existentialism, is so important that it is

worthwhile to spend some time on his ideas. In much of

l4

Eflerkegaarr's writing he is reacting to the philOSOphy of
imgel. And since Hegel's philosOphy was an expression of the
times, it is necessary to try to grasp at least the essentials
of Hegel's thought.

Hegel's system of philosOphy was an essentialist
approach which had its roOts in the thinking of Plato. In
following Plato, Hegel searched for the "essence" of things.
He felt that the search for essence was especially important
because essence was immutable and unchanging. And since
Hegel was interested in finding that which gave stability
to life, this seeking after essence was especially important
to him.

In general, philosophers strive to rise above the world
of "becoming" and find a truth which is universal and eternal.
Hegel was no exceptiOn. Philosophers generally believe,
or at least hope, that they Operate solely by reason. Hegel
certainly believed this very deeply. In many ways he was .
the philosopher who carried this desire to systematize the
world and experience to its farthest point rationally.
(Barrett, 1962.) .

Hegel believed in universal reason. He felt that
thoughts and feelings have meaning solely because each thought,
each feeling, is bound to personality which itself has meaning
curly because it takes place in a history and a state, at a

specific epoch in the evolution of the Universal Idea. To

understand anything which happens in our inner life, we must

 

15

go to the totality which is self, thence to the larger totality
which is the absolute Idea.

It is against this type of philosOphy, which is called
essentialism, that Kierkegaard reacted. ”Essence" and "exis—
tence" are polar phiIOSOphical terms. Kierkegaard was an
existentialist in reaction to the essentialist phiIOSOphy
of Hegel. Essentialism,las represented by Hegel's system of
thought, was an over emphasis of the philOSOphy of ideas and
things. It was this that drew the anger of Kierkegaard.

Kierkegaard and existentialists in general have reacted
to this philosophy of ideas and things by proposing a phil-
OSOphy of man. Existentialism goes on to accuse philOSOphy
of having ignored man far too often in favor of philosophy
about the world or about products of the mind. '

The existentialists are by no means in agreement on
all subjects. But there are certain characteristics that
apply generally to all of them. According to Roberts, (1959)
the following statements are a general summary of their
thinking.

Firstly, existentialism is a protest against all forms
0f rationalism which find it easy to assume that reality can
be,grasped primarily or exclusively by intellectual means.

IF is an emphatic denial of the assumption that construction
of a logical system is the most adequate way to reach the

truth. (Roberts, 1959, p- 7.)

16

Secondly, existentialism is a protest against all
views which tend to regard man as though he were a thing,
that is, only an assortment of functions ahd reactions.
This means that in the sphere of philOSOphical theory existw
ontialism stands against mechanism and naturalism; and in
the sphere of social theory it stands against all patterns
of human organization in which mass mentality stifles the
spontaneity and.uniqueness of the individual person. (Roberts,
1959, p- 7.)

Thirdly, existentialism makes a drastic distinction
between subjective and objective truth, giving priority to
the former as against the latter. The existentialists use
the word ”subjective" in a technical sense, and not to
denote bias, prejudice or unreliability, connotations which
the word often carries. When the existentialists give the
subjective priority they are not denying that through science,
logic and common sense men are able to arrive at genuinely
objective truth. But they insist that in connection with
ultimate matters, it is impossible to lay aside the impassioned
concerns of the human individual. They are calling attention
to the fact that in the search for ultimate truth the whole
man, and not only his intellect or reason, is caught up and

involved.

The fundamental difference is that between knowing about

 

the truth in some theoretical, detached way and being_grasped

 

by the truth in a decisively personal manner. While the

lY

objective standpoint gets as far as it possibly can from the
feelings, hOpes or fears of the individual human being, the
subjective point of view puts the individual with his com-
mitments and passions in the very center of the picture.
And only by the latter approach, say the existentialists,
can a man be so grasped and changed inwardly as to deepen
and clarify his relationship to reality, even as a thinker.
(Roberts, 1959, p. 8.)

In the fourth place, existentialism regards man as
fundamentally ambiguous. This is very closely linked to
its predominant stress on freedom. It sees the human
situation as filled with contradictions and tensions which
cannot be resolved by means of exact or consistent thinking.
These contradictions are not due simply to the present
limitations of our knowledge, and they will not be overcome
by obtaining further scientific information or phiIOSOphical
explanation because they reflect the stubborn fact that man
is split, at war with himself. He is free, yes; he is
conscious of responsibility, of remorse, of guilt for what
he has done. Yet his whole life is enmeshed within a natural
and social order which profoundly and inevitably determines
him, making him what in fact he is. He is finite, but he
is capable of rising above the limits of any particular
situation through his action or his imagination. His life is
bounded in time and is moving forward toward death. Yet he

has a strange kinship with eternity because he can rise above

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the present and see its relation to the pant and the future.
Viewed from the outside, he is but an episode in the vast
process of nature. Viewed From the inside, each man is a

universe in himself.

Hence there can be no simple answers as to what man
should do with his freedom. In one sense, he must himself
create the answer by using his freedom to find out just
what he wants to become. He will not avoid this dilemma by
returning to the level of the animal which does not ask
metaphysical and religious questions. Nor can he avoid it
by accepting some ethical or religious system which purports
to give him infallible guidance as to what he should do.

For man himself hasslhand in producing these systems, and
does so for reasons which the systems cannot altogether
conceal.

All men, the existentialists believe, try to run away
from this predicament. Everything would be simple if man
could become either like animals or like God. As an animal,
or as God, man would be liberated from the agonizing tor-
ments of moral conflict and inner strife. But so long as
man remains human, he must enter into the mystery of what
it‘means to be a finite self possessing freedom. (Roberts,
1259. p- 9.)

In this stress on freedom the assumption of diametriv
cally opposed views may be undertaken by the existentialists

on specific issues, for example, in relation to theism. In

 

 

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ingirw; the problem of' [‘roodmn, one group tries to make an
atheistic acceptance of freedom and despair serve as the only
possible answer. In this group would be Heidegger and
Sartre. The other group finds that the implication of

human responsibility leads inescapably to a revival of
religious faith,euui:h1this group would be Kierkegaard and
Marcel. Thus existentialism has produced hath the most
penetrating forms of Christian faith and tne most nihilistic
types of human self—assertion. (Roberts, 1959, p. II.)

By no stretch of the imagination are many of these
concepts new. The biblical writers were constant users of
many of these ideas and such men as Socrates and Pascal
used these terms. While these men can be called the fore-
runners of existentialism, expressing an existential point
of view, they were not yet existentialists. but when the
concepts we have been discussing become central, we approach
existentialism as a philosophy. (Tillich, 1952.)

The genuinely existential thinker regards contradiction
as not merely the Beginning but also as the Ending. Thought
must not only commence here but must return to the given
ambiguity of the human situation, and do so continually.
Moreover, in the end thought cannot get beyond it.

Another point that should be made is that the word
"existential" can also refer to an attitude rather than a
content. In this sense, an existential attitude is an

attitude of involvement, in contrast to a detached attitude.

 

 

All stirwdruc, first—tmunlrexperlurmnn;Imiy he teIWKMJIBXiSv
tential, for example: falling in love, being seized by

some group loyalty, or possessing any type of moral earnest—
ness. Tillich (1952) believes that the term ”existential”
probably should be reserved for ultimate questions. For
instance, man can ask why there is a world at all, why man
exists at all, and whether our lives are at bottom meaning«
ful or meaningless. These questions can be raised in a
speculative and detached way, but whenever we come to face
them with passionate earnestness, fully aware of the solemn
risks and tremendous opportunities involved in them, we

are entering into an "existential attitude” in a narrower
and more stringent sense.

Strictly speaking, the term "existentialism” should
not be used alone. ”Existence” is a technical phiIOSOphical
term and is the polar Opposite of the term "essence."
Philos0phical ideas, for the most part, appear in pairs of
contrasting concepts, like subject and object, rational
and irrational. In the same way, existentialism refers to
its Opposite, essentialism. In relation to man, for instance,
essentialism seeks to describe man‘s essential nature.

Existentialism would describe man as he is in existence,

- finite and in conflict.

In many ways Freud was an existentialist. He described
man in conflict, in stress, in guilt, in despair. But Freud

also had a concept of what man was essentially, what healed-

21

man was like, at least in theory. In this he was an essential—
ist. Incidently, it is Freud's doctrine of essential man

with which the existentialists tend to disagree. For the

most part they admire his existential analysis of man's
existence.

Sartre would like to take existentialism to its extreme
and avoid essentialism altogether. He prOposes to do this
in his statement, "A man's essence is his existence." What
Sartre means is that man is a being of whom no essence can
be affirmed, for such an element would introduce a permanent
element, contradictory to man's power of transforming himself
indefinitely. According to Sartre, man is what he acts to
be. (Wahl, 19u9.)

But in Spite of what Sartre intended, he has made an
assertion about man's essential nature. Man's particular
nature, according to Sartre, is his power to create himself.
(Tillich, 1952.)

Existentialism analyzes existence, not as man should
be, not as he is in his essence. Existentialism is a

correective to an essentialism that becomes abstracted from

life. Existentialism cannot replace essentialism, it can

be only a corrective for an abstracted, irrelevant essentialism.

Frankl's Thergpeutic Concepts

The review of Frankl's writings will be concerned with

five general areas:

l. Frankl's concept of man.

2. His concept of psychopathology.
3. His concept of therapy.

A. Special techniques.

5. Research related to Frankl's concepts.

Concept of Man
According to Frankl, man lives in three dimensions:
the somatic, the mental and the spiritual. It is Frankl's
conviction that psychology, by and large, has ignored the
spiritual. Frankl means to denote by the word "spiritual"
that realm of man's experience which is characterized by "the
innate desire to give as much meaning as possible to one's
life, to actualize as many values as possible." (1955, P. 16.)
He accuses psychoanalysis of being almost totally con-

cerned with the pleasure principle and individual psychology

of devoting itself exclusively to the status driye. He

 

refers to the pleasureprinciple as the will—toapleasure,
and the status drive as the will-toepower, adding that he
18 p rimarily concerned with the will—to—meaning. This last
he defines as ". . . man‘s striving to fulfill as much
meaning in his existence as possible, and to realize as much
Value in his life as possible." (1959, p. 161.)

It is Frankl's belief that the will—towmeaning is the
most.human phenomenon of all. He points out that no animal
Worries about existence. Frankl is quick to recognize

that this approach very soon brings the therapist into the

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field of values. He accuses traditional psychotherapists of
taking the easy way out by saying they are "scientific" and
thus have no connection with the field of values. He does
not believe that it is possible to have a psychotherapy that
does not deal with values. Either the values are conscious
and recognized, or they are unconscious and unrecognized.
Frankl does not turn his back upon the field of values. In

fact he calls his specific therapy, logotherapy, and defines

 

the word "logos" as signifying first of all ”the spiritual”
and beyond that, ”the meaning.”

Frankl believes that three factors characterize human
existence as such:_ man's spirituality, his freedom, his
responsibility. (1955, P. XVIII)

According to Frankl, the spirituality of man is a
thing-in-itself. It cannot be explained by something not
spiritual; it is irreducible. He does not deny that man's
spiritual life may be conditioned by many things, but he
believes it may be conditioned by something without being
caused by it.

Freedom, for Frankl, means freedom in the face of
three things: (1) the instincts, (2) inherited disposition,
and (3) environment. Frankl does not mean to give the
impression that he does not believe that man has instincts,
nor that they are powerful or even that man should not accept
them. But he does believe that as man can accept his

instincts so he can, under certain circumstances, reject them.

n...

—.—-.i.

 

2H

iflan is not completely determined by his instincts, but has
at least a degree of freedom over them.

AS Frankl believes that man has n Jvnree Of freedom
over his instincts, he believes that a- ui . has a degree
of freedom over his inheritance. Ha aunt-. . vase of
identical twins. Une twin became a UJJNiJg criminal, dhile

his brother became an equally cunning criminologist.
Concerning the environment. Frankl hmiieves that it
does rmmzinake timzlnan. lira crucitil thirnt:ihuut lfiu: envirvnnnent
is what man makes of it, of the attitude which he formulates
towards it. Frankl quotes freud:
Try and subject a number oi very strongly differ—
entiated human beings to the same amount of starva-
tion. With the increase of the imperative need for
food, all individual differences will be blotted out
and, in their place, we shall see the uniform eXpression
of the one unsatisfied instinct. (1955, P. XIX.)

Of this Frankl observes:

But in the concentration camps we witnessed the con-
trary; we saw how, faced with the identical situation,
one man degenerated while another attained virtual
saintliness. (1955, p. XIX.)

Frankl feels very strongly that man is not merely a
Product of heredity and environment, but that there is a third
element: decision.

According to Frankl, man has freedom, but this is not
an absolute freedom, for man is also responsible. To what
is man responsible? Frankl would answer this question by
saying that man is first of all responsible to his conscience.

Frankl is not willing to concede that the conscience is the.

'2};

.dnn l1; nCA; COHu)letv:ly (b:tnrdhinvaii)y lit. 11h.tizwttn, iyut kids

at least a demree of freedonnrmvl’u:wmh
As Frankl believe: that man hr 4 wvmrwu of freedom
’a’l‘jf‘ l’ilf-J li’ib‘tll’l’dtfs, 1’10 b-fillaz'lup 3351.3 ."fil.‘\ ’L glf’f‘f‘tlfé
of freedom over his inheritduu~. A .»‘1 i M'» 7
identical twins. one twin oecim; l .,HU;. :..miuql, in .
his brother became an equally cunnlnm trinindlnuIJL.
Concerninn *ho “nViPUhm~?“, Fwynui M-@F~/«s inat 1t
11’2"“; ."z’ill I‘fl’i‘ii‘f; tilt) 113m. Tip "1‘4 ’1'}! 13:3..3' JIM/‘1‘. 1.3319 (11'11/l.t"‘)t:hx"lll'

L) admit mill: “Nikki; 321' it, ‘11. 1111‘: -L"l‘-l1»1.l‘l‘f .JiillLli 3H: formulate;
towards it. Franxl quotes Freud:

Try and subject a numter a! very strongly differ—
entiated human beings to the same amount of starva-
tion. With the increase of the imperative need for
food, all individual differences will be blotted out
and, in their place, we shall see the uniform expression
of the one unsatisfied instinct. (1955, p. XIX.)

Of this Frankl observes:

hut lll the (Huncerdiratiwni canumS'no wiiniesseui the annu—
trary; we saw how, faced with the identical situation,
one man demenerated while another attained virtual
saintllness. (1955, p. All.)

Frankl feels very strongly that man is not merely a
gmwduct of heredity and environment, but that there is a third
element: decision.

According to Frankl, man has freedom, but this is not
an absolute freedom,fkn~rmm1is also responsible. To what

hsnuuu responsible? Frankl would answer this question by

Saying triat man is first of all responsible to his conscience.

“finkl :15: not willing to concede that the conscience is the

 

vvvvw

 

 

 

25

were product of parental prohibitions, mediated by the id,

ego and superego. He feels that conscienbe, like man's
spirituality, is an irreducible thingvin—itself.

However, in the last analysis, Frankl believes that
man cannot be responsible to himself alone. Behind his

conscience stand an extra—human authority. Frankl feels

, I

that we make a mistake if we look upon religion as something.

emerging from the realm of the id, thus tracing it back

again to instinctual drives. And while Frankl does not

explicitly define his concept of God, he feels that man

can be responsible only to an entity higher than himself.
Frankl very strongly believes that, as he puts it:,

When we present man as an automaton of reflexes, as
a mind machine, as a bundle of instincts, as a pawn of
drives and reactions, as a mere product of instinct,
heredity and environment, we feed the nihilism to
which modern man is, in any case, prone. (1958, p. XXI.)

To this Frankl adds his own testimony: '

I became acquainted with the last stage of that . .
corruption in my second concentration camp, Auschwitz.
The gas chambers of Auschwitz were the ultimate conse-
quence of the theory that man is nothing but the
product of heredity and environment~90r, as the Nazi
liked to say, of "Blood and Soil." I am absolutely
convinced that the gas chambers of Auschwitz, Treblinka,
and Maidanek were ultimately prepared not in some>
Ministry or other in Berlin, but rather at the desks

.and in the lecture halls of nihilistic scientists and
philosophers. (1958, p. XXI.)

Frankl accuses the psychoanalysts of being largely
unconscious of their image of man, and he feels that they,

of all people, should be aware of the philosophical assumptions

on which they are operating.

 

 

26

Furiduirmormr, Frwunii hciiw:ucs tduat Elli tax) ofteui the
psychoanalyst, when he deals with man, has taken as a
starting point what is really a caricature of man and not
a true image. Too frequently, according to Frankl, the
psychologist sees man as "nothing but” a being who is
"driven," or Just satisfies the conflicting claims of Id

and Superego drives by compromise. (195", p. 36.)

Concept of Sickness

Frankl believes that individuals face emotional prob-
lems that are psychogenic in origin as well as problems that
are somatic in their beginnings. In fact, Frankl has done
some experimental work in drug therapy and uses drugs for
some individuals who are his patients. He has reached the
conclusion that some psychological problems can be solved "
by either drugs or by an "uncovering" type of approach.
However, it is Frankl's opinion that many of the people
coming to psychiatrists today for help are suffering from no
clinically defined syndrome. Rather, these people are
seeking help because they find no personal meaning for their
lives. .

Frankl feels that there is a wide-spread existential
vacuum in our time. He feels that this vacuum has been
created by a twofold loss that man has had to undergo since

he became a truly human being. As Frankl sees it, at the

beginning of human history man lost some of the basic

 

27

animal instincts, which left him with an uncertainty as to

how to conduct himself. In addition, there has been in recent
times a loss in the power of tradition which formerly
buttressed man's behaviour. No instinct tells man what to

do and no tradition tells him what he ought to do. From
Frankl's viewpoint, man is more and more governed by what
Others want him to do, thus increasingly he falls prey to
conformism. (1963, p. 168.)

Frankl is convinced that this existential vacuum has
some unfortunate consequences for man. The most wide—
spread result of man's living in this existential vacuum
is a state of boredom. Frankl goes so far as to say that
boredom today is bringing more peOple to psychiatrists than
is any actual distress. He believes that the problems of
boredom will grow increasingly great as automation produces
more and more leisure time for greater numbers of workers.
Frankl suggests that some cases of suicide, alcoholism and
Juvenile delinquency can be understood in part in terms of
an existential vacuum underlying them., (1963, p. 170.)

However, there are other consequences of living in an
existential vacuum. One such is a frustration which plays
a large role in the creation of a neurosis, which Frankl
calls a noogenic neurosis. The word "noogenic" comes from
the Greek term "noos," meaning mind. According to Frankl,
noogenic neuroses do not emerge from conflicts between the
drives and instincts, but rather from conflicts between various

\

values and from existential frustration.

‘—

 

28

According to Frankl, not every coniilct is necessarily
neurotic; some amount of conflictjesnormalanuihealthy. Frankl
is by no means willing to concede that one's search for a
meaning to his existence, or even his doubt of it, in every
case is derived from, or results in, any disease. Existen-
tial frustration is in itself neither pathological nor patho—
genic but how an individual is able to solve, or unable to

solve, the problems of existential frustration may lead to

pathology.

.1..- ~00—
, _1-_#- _....-.-—-"’

Concept of Therapy

Frankl feels that there are many individuals who will
be helped by psychotherapy in the traditional sense of the
term. But he also feels there are those cases that will
be aided only when they can be helped to find some meaning
in life, in spite of the existential conflicts and ambiguities

of life. Logotherapy regards its assignment as that of

 

assisting the patient to find meaning in his life. As Frankl
phrases it:

Logotherapy deviates from psychoanalysis insofar
as it considers man as a being whose main concern
consists in fulfilling a meaning and in actualizing
values, rather than in the mere gratification and
satisfaction of drives and instincts, the mere
reconciliation of the conflicting claims of id, ego
and superego, or mere adaptation and adjustments to
the society and environment. (1963, p. 16H.)

Frankl does not feel that it is the role of the

I

logotherapist to impose his own values or Judgments on the

patient. He sees the therapist's role as: ‘

 

29

widening and broadening the visual iield of the
patient so that the whole spectrum of moaning and
values becomes conscious and visible to him. (1963, p. 17H.)

Frankl believes that it is a mistake to ask in abstract
terms, "What is the meaning of life?” Such a question can
never be answered. What matters is not the meaning of life
in general but rather the specific meaning of life. Every—
one has his own specific vocation or mission in life.

Frankl feels that in many cases the iogotherapist
actually has to help the patient reverse the question of the
meaning of life. He feels that ultimately, man should not
ask what the meaning of life is, but rather must recognize
that it is he who is asked. Frankl is of the opinion that
each man is questioned by life, and he can answer only by
answering for his own life. Logotherapy sees in responsible-
ness, in terms of responding, the very essence of human
existence.

In saying that man is responsible, responsible for
actualizing the potential meaning of his life, Frankl stresses
that the true meaning of life is to be found in the world
rather than within a man or his own psyche. (1960, p. 13.)

Frankl believes that the polarity of self—world is a real
one and that to ignore either pole would destroy the whole. In
other words, values are really to be found in the universe.
They are not mere projections of the psychic life of man.

According to logotherapy, meaning can be discovered in

life in three different ways: (1) by doing a deed, (2) by exv

periencing a value, and (3) by suffering. (Frankl, l963,p.l76.)

 

30

Many people limuirmeaning in iiie tiuwnnyi the accom—
plishment of Specific deeds. The architect finds meaning
for life in the construction of buildings, the doctor by
bringing healing to his patients.

Another way of finding meaning, according to Frankl,
is by experiencing a value. By this he means experiencing
something such as a work of nature or cuiture——a beautiful
sunset or a master painting——or by eXperiencing someone,
through love.

Finally, Frankl believes that man can find meaning
in life, even through suffering. He believes that whenever
one is confronted with an inescapable, unavoidable situation,
whenever one has to face a fate that cannot be changed,
such as an incurable disease or an inOperable cancer, Just~
then is given to one a last chance to actualize the highest
value, to fulfill the deepest meaning, the meaning of '
suffering. For, Frankl believes, what matters above all
is the attitude we take towards suffering, the manner in
which we take suffering upon ourselves.

Frankl insists that it
. . .must be understood that suffering, to be mean?
. ingful, must be real, and not due to a masochistic
desire to suffer. Masochism would be subject to a
i more traditional uncovering type of approach. But
when suffering is unavoidable, then logotherapy can
be of value. (1963, p. 180.)
Frankl states:
It is one of the basic tenets of logotherapy that

man's main concern is not to gain pleasure or to
avoid pain, but rather to see a meaning in his life.

31

That is why man is even ready to suffer, on the condi-
tion, to be sure, that his suffering has a meaning.
(1963, p- 179.)

Frankl believes that patients never really despair
because of any suffering in itself. instead, he feels,
their despair stems in each instance from a doubt as to
whether suffering is meaningful.

Man is ready and willing to shoulder any suffering
as soon and as long as he can see a meaning in it.
(1962, p. 27).

As Frankl sees it:

Frequently it will be the aim of existential
analysis to clarify the difference between meaningful
and meaningless suffering, and to analyze suffering
in the life of an individual regarding his capacity I
for experiencing meaningful suffering. (1953, p. 13.)

Frankl disagrees with those existentialists who say

that existence has no meaning. Rather, he would say that
what we are called on to endure is not the meaninglessness
of life, but rather to bear our incapacity to grasp its
unconditional meaningfulness in rational terms. '
Frankl is willing to concede that the methods of
logotherapy may increase a person's tension. He is not
willing to concede that the goal of therapy is to create
an individual who feels no tension or anxiety.

'Frankl feels that the maxim of psychology might well

I
be the statement of Goethe:

If we take people as they are, we make them worse.
If we treat them as if they were what they ought to
be we help them to become what they are capable of
becoming. (1956, p. 56.)

 

 

{Lidi'i’d' La]. ‘l.‘r.-chniq'ir_.: of I..'_)I':"‘_{i~ilfgl mpg/y
Frankl, as most existentialtherapzsts,does not place a great
deal of reliance upon special techniques. He feels that

the crucial agency in psychotherapy is not so much the method
as the relationship between the patient and his doctor.
This human relationship between two persons is what
seems to be the most significant aspect of the
psychotherapeutic process. (1960, p. 5%0)
However, there is one technique that Frankl relies
on in certain situations, mainly those cases where the
patient is troubled by obsessive, compulsive and phobic
conditions. He calls this special technique, "Paradoxical
Intention." (1960, p. 521.) This procedure is based on
the fact that a certain amount of pathogenesis in phobias
and obsessive-compulsive neuroses is due to the increase
of anxieties and compulsions that is caused by the endeavor
to avoid or fight them. Paradoxical Intention consists in
a reversal of the patient's attitude toward his symptom,‘
and, according to Frankl, enables him to detach himself from
his neurosis.

Frankl gives the following report to illustrate how

he uses the technique.

A young physician came to our clinic because of a
severe hidrOphobia. He had for a long time been
troubled by disturbances of the autonomic nervous
system. One day he happened to meet his chief on
the street and, as the young man extended his hand in
greeting, he noticed that he was perspiring more than
usually. The next time he was in a similar situation

he expected to perspire again and this anticipatory
anxiety precipatory excessive sweating. it was a

 

33

vicious circle; hyperhidrosis provoked hidrOphobia and
hidrOphobia, in turn, produced hyperhidrosis. We
advised our patient, in the event that his anticipatory
anxiety should recur, to resolve deliberately to show
the people whom he confronted at the time how much he
could really sweat. A week later he returned to report
that whenever he met anyone who triggered his antici—
patory anxiety, he said to himself, "I only sweated
out a liter before, but now I'm going to pour out at
least ten liters!" What was the result of this para-
doxical resolution? After suffering from his phobia
for four years, he was quickly able, after only one
session to free himself of it for good by this new
procedure. (1960, p. 522.)

Research Relevant to Frankl's Concepts

There is relatively little research, as yet, on
Frankl's concepts. One such study is by Theodore A. Kotchen.
(1960) Kotchen devised a questionnaire of thirty items, i
based on seven concepts found in the existential literature
(Frankl's cencepts among them): uniqueness, responsibility,
self-affirmation, courage, transcendence, faith-commitment,
wor1d_view, which is purported to measure the existential
concept of mental health.

The questionnaire was given verbally to five sample
groups of thirty men each: locked-ward mental patients,
parole mental patients, chronic physical patients, the man-
in-the-street, and college undergraduates.

The first four groups were matched for age and educa-
tion. They were, on the average, forty years old and none
had been to college. The fifth group was composed of

- students at Harvard Summer School (1959).

 

 

5A

Moan total aOUILn for math group is as follows:
locked—ward mental patients, 16.8; parole patients, 17.9;
chronic physical patients, 20.9; man-in-the—street, 23.1;
undergraduates, 24.7. Thus the results supported the
hypothesis of the study: the live gloops oi subjects
responded to the questionnaire of existential mental health
in the same order with which they fell on the basis of
Operational-pragmatic criteria of mental health.

In another study by Crumbaugh and Maholick (1964) an
approach somewhat similar to Kotchen's was followed. An
attitude scale was Specially designed to evoke responses
believed related to the degree which the individual exper-
ienced "purpose in life," as defined by Franklu

A sample of 225 subjects comprised five sub-popula-

tions as follows:

Group I — 30 non—patients, graduate students.

Group II — 75 non-patients, undergraduate students.

Group III - 49 out-patients of Georgia psychiatrists.

Group IV - 50 out-patients of a Georgia out-patient
psychiatric clinic.

Group V - 21 hospitalized alcoholic patients.

The Purpose in Life Test was given to all five groups.
The Frankl Questionnaire and the Allport—Vernon-Lindzey
Scale of Values was given to Groups II, III, V, while the
M.M.P.I. was given to Group IV. Group IV was evaluated by
the therapist after the first session as to how he felt the

patient would reSpond.

'l'ht realitz. ahww that Lm'r'rz is 7i i.i.j’,li.il ;w.'-;r.:,::‘... t’lif=<;i'.:_mi:.':
tion between patients and non«patients, and a progressive
decline in mean scores irom Group i through Group V.

The total score on the Frankl Questionnaire correlated
.68 (Pearson product—moment, N equals 136) With the total
score of the P.I.L., showing that the P.I.L. is measuring
to a substantial degree what Frankl's Questionnaire is
measuring.

Of the six value scales on the Allport-Vernon-Lindzey
Scale, none discriminated adequately between patients and
non-patients. There was little relationship between any
of the A.V.L. Scales and the P.I.L.

On the M.M.P.I., only the K (Validity) and D (Depres-
sion) scores showed any substantial relationship to the
P.I.L. (respectively .39 and -.30, Pearson product N equals
M5). Since the K scale is a measure of defensiveness, the
indication is that subjects who have a high degree of "pur-
pose in life" tend to have adequate defenses; they also
tend to be less depressed than others.

The authors feel that their results make it possible
for them to conclude that their questionnaire (a) measures
what Frankl describes as "purpose in life," (b) identifies
something different from the usual neuroses, and (c) iden-
tifies characteristics of psychOpathological as distinguished

from "normal" groups.

 

 

 

Honourch “elated iv ishggsslagla

There is a great deal oi research concerned with tuber»
culosis and for this reason it was necessary to limit the
review of literature. The only research reviewed was that
which had to do with the personality characteristics of
tuberculosis patients or with psychological or social con—
commitants of the disease. The literature from 1953 to
the present was included in this study.

Derner (1953) attempted to discover some of the psycho—
logical factors arising from tuberculosis. A sample of 32
patients was chosen. They were within the age range of l8
to 40, able to read and write English, and were hospitalized
between two months and two years; they were a first
admission for tuberculosis treatment, and not in serious
condition.

The method of investigation included interviews,
psychometric tests, rating scales and proJectlve techniques.
The patients were given an intelligence test, the Rorschach,
the M.M.P.I., the Psychosomatic Attitude Pictures and a
Happiness Scale.

The findings in summary are:

1. There was no unique tuberculosis personality
demonstrated in this study but there was a wide variety of

disturbed behaviour.

2. There was traumatic reaction to the diagnosis of

‘tuberculosis and the effect of the disease was all-perVasive

 

 

Jr: the ifliinklruj of true pati(x1ts lrwnn the tiymz of ttmrtllamv
nosis. The effect is especially reflected in his projec—
tions and his dreams.

3. The most frequent emotion. were fear, apprehen—
sion, and depression. Most patients were optimistic about
their prognosis but they did not show spesnphthisiga. All
patients had some degree of depression related to the
disease from time to time during the course of the disease.

u. The most frequent thought oi the patients was
related to the desire to leave the hospital and return to
active living. Most patients were realistic but not
pessimistic about their handicapped physical health.

5. The range and distribution of their self-estimates
of happiness were typical of a healthy normal population.

6. The Rorschach Test, as usually clinically inter-
preted, indicated low productivity. There was low affectiw
vity, emotional impoverishment, and impoverished intellec-
tual productivity. There was introversion and some
emphasis on body-oriented ideas.

Charen (1956, p. 273) studied the regressive behaViour
changes in tuberculosis patients. Paper-and—pencil tests,
the Rorschach and the Blacky Tests were administered to
determine if the patient's interest became narrow, if he
became dominating, intolerant and selfish, if he became

dependent and insecure, and if he became hypochondriacal.

38

Twenty—five male veteran patients, sick with pulmonary
tuberculosis, with an average hospital stay of eight months,
were matched for age, education, color and occupational
level with 25 recovered tuberculosis patients with an average
hospital stay of twelve months; and secondly with a group
of 25 non—tuberculosis patients hospitalized less than two
months for surgery.

In none of the tests was there evidence of changes
in personality structure in any of the research groups to
which the term regression could be applied. Tuberculosis
patients on the average apparently accept hospital condi-
tions of bedrest, dependency, reliance upon others, and
social frustration with patterns of behaviour which are
adult and not childlike.

Vital (1954) sought to investigate the hypothesis that
personality components are related to the clinical course
of tuberculosis.

Two matched groups of male veteran pulmonary tubers
culosis patients, one whose course was declining and the
other improving, were compared for the purpose of testing
differential predictions of defensiveness. The observed
data confirmed the expectation that the declining group
would be characterized by greater defensiveness concerning
dependence, anxiety, activity level, self—esteem, and pro—
ductivity in a goal setting task. The group did not differ

on hostility. The declining group was less cautious than the

39

improving group, in both its overall goal setting behaviour
and also following a failure experience during goal setting
behavior and the declining group was more responsible than
the improving group. The latter two findings were contrary
to expectation.

When normal groups were compared with the present
sample of tuberculosis patients on measures of self—esteem
and goal setting behaviour, the declining group tended more
nearly to resemble the normal group in its performance on
these measures.

The findings of the study relate heightened defensive—
ness and tension states to poor recovery from tuberculosis.

Rorabaugh and Guthrie (1953) administered the
Minnesota Multiphasic Personality Inventory to fifty tubers
culosis patients on admission to the hospital, to thirty“
five patients who received medical discharges and to thirty—
five patients who left the hospital against medical advice.

The group of admission subjects scored significantly
higher on all scales of the M.M.P.I. than did normal sub“
Jects. On item analysis, however, they did not show as
much deviation from theinormal group as did a group of sick
persons visiting a private physician for a variety of
reasons. Assuming face validity for these items, there is
indication that the deviation which the admission group

showed was a direct result of this physical condition.

HO

Platt (1953) studied the adaptive aspects of hospitav
lized veterans. The subjects were 51 tuberculosis patients
and a control group of 30 non—tuberculosis patients. Tests
were administered and findings summarized in terms of the
outstanding characteristics of the group and severity of
illness of the patients.

Responses of the tuberculosis patients were reported
in mean score values and standard deviations. Comparisons
were made with those of the normative and control groups
through the "plus" test to determine measurable personality
differences.

Hypotheses of a unique tuberculosis personality are
not borne out by the findings which point to situational
reactions related to the disease and hospitalization. With
few exceptions, when comparisons were made with responses
0f the non-tuberculosis groups, all groups showed about the
same characteristic degree of temperamental strengths
and weaknesses and expressed about the same degree of
aggression and defensiveness in their adjustment.

Page (1949) administered the M.M.P.I. to a group of
hospitalized tuberculosis patients. In comparison with a
normal group, these subjects scored generally higher on the
neurotic scales with a lesser elevation on the psychotic
scales. For comparison with a group of patients hospitalized
for reasons other than tuberculosis, the hospitalized patients

showed the same general form as those of the tuberculosis

Al

subjects but the elevations were not quite so high. Item
analysis of the M.M.P.I., contrasting tuberculosis subjects
with normal controls, yielded 106 items significant at the

5 per cent level of confidence. Assuming face validity, these
items indicated that tuberculosis subjects were more worried,
had many health complaints, and suffered more from feelings

of inadequacy and dependency and social ineptness than did

the normal controls.

Hand (1952) sought to study the personality character—
istics of tuberculosis patients. For a period of several
months, consecutive patients admitted to the Veterans Adminis-
tration Hospital, Sunmount, N.Y., for treatment of tuberculosis
were given the individual form of the M.M.P.I.

A definite attempt was made to administer the inventory
shortly after each patient's admission, so that the general
circumstances would be comparable and so that a long period
of hospitalization, characteristic of tuberculosis therapy,
would not become an additional and perhaps complicating factor.
When cases of inactive tuberculosis or non—tuberculosis
pulmonary anomalies were eliminated, the score of 88 patients
with active pulmonary tuberculosis remained.

The results of the study showed that the tuberculosis
group showed personality characteristics, based on M.M.P.I.
scores, different from those of other groups. These charac-
teristics were high Hypochondriasis, Depression, Hysteria,
Psychasthenia, Schizophrenia and Validity. Low Femininity

also distinguished the tuberculous from the non—disabled group.

A2

When M.M.P.I. scores for different diagnosis groups
in tuberculosis were compared, few distinguishing signs
resulted.

Discharge groups, however, were distinguished from
each other by two scales, Psychopathic Deviate and Hypomania.

Research by Muldoon (1957) was planned to study some
psychological concommitants of tuberculosis and hospitili—
zation. The variables included in the study were defensive—
ness, dependency, anxiety, repression and rigidity. Subjects
for the study were selected on the basis of rigorous criteria
so that they would be as similar as practically possible
in terms of age, education, and sex. It was hOped that a
rigid selection would prevent the results from being masked
by extraneous variables which an uncritical selection might
introduce.

The subjects were eighty young, white, hospitalized
males who were divided into four groups of twenty patients
each. Two of the groups were tuberculous, two were not
tuberculous. One tuberculous group and one non—tuberculous
group were made up of patients who had been in the hospital
less than three months. The two remaining groups, one
tuberculous and one non—tuberculous, had been in the hospital
more than eleven months.

The data were analyzed by analysis of variance technique,
which permitted the effects of illness and hospitalization to

be studied independently. It also permitted the observation

43

of any possible interaction effect of illness and hospitaliv
zation. The five variables were used in a regression
analysis to determine the relative contribution of each to
the differentiation between tuberculous and non—tuberculous
subjects.

The following conclusions were drawn from the results:

1. There is no evidence of any effect of hospitali—
zation on the psychological variables included in this
study.

2. The tuberculous subjects are significantly more
dependent and anxious and less defensive than non-tuber-
culous subjects.

3. The observed differences in the psychological
variables between the tuberculous and non-tuberculous
subjects are attributable to a more fundamental difference
in dependency: the tuberculous patients are significantly
more dependent than the non—tuberculous patients.

4. A basic dependency conflict is a possible contri—
buting factor to the development oi tuberculosis.

Goldberg (1954) sought to apply some of the central
constructs of modern self—theory to a problem in psychoso-
matic medicine. The specific hypotheses tested were that
progress toward recovery from pulmonary tuberculosis is
positively related to degree of self—acceptance, and that
patients who make good progress toward recovery from pulmonary

tuberculosis have different kinds of self-conceptual attitudes

44

from those who make poor progress toward recovery from pul-
monary tuberculosis.

Two measures of self-acceptance were used. One was
the correlation between a Q sort of 76 statements made to
describe the patient's self and a similar sort made to
describe his ideal self. The other was the patient's score
on the Berger Self-acceptance Scale. The patient's first
Q sort was used as a measure of his self—concept.

The patients were tested shortly after their admission
to the hospital and after a period of several months their
progress was rated on a seven-point scale by the hospital
physicians. For the test of the first hypothesis 56
patients were separated into three progress groups on the
basis of the physicians' ratings. A multiple analysis of
covariance was done for each of the self-acceptance
measures using progress ratings and extent of disease on
admission to the hospital as criteria of classification,
and partialling out the effect of age and intelligence on
the self-acceptance scores. The only significant result was
found with the scores from the Berger Scale, and it showed
that significantly lower self-acceptance scores were made
by the group that had made the best progress. A similar
trend was observed for the self-acceptance measures based on
the Q sorts, but it was not significant.

Two groups of patients differing significantly in progress

ratings were selected to test the second hypothesis. There

45

were five patients in the poor progress group and four
patients in the good progress group. The groups were
equated for age, intelligence, and marital status. All

the intercorrelations of the self sorts of the nine
patients were computed and the resulting matrix factorized
by the method of centroid factor extraction. Two factors
were extracted but the progress groups were not differenti—
ated by their loadings on the factors.

In was concluded that there is a significant relation—
ship between progress toward recovery from pulmonary tuber-
culosis and self—acceptance. However, the meaning of the
relationship is obscure and requires further study. It was
also concluded that there is no significant relationship
between progress toward recovery from pulmonary tuberculosis
and self concept.

Moran, Fairweather, Morton and McGaugh (1955) studied
the use of demographic characteristics in predicting
response to hospitalization for tuberculosis.

The criterion for selection of subjects is based on a
simple stay-response or quit-response dichotomy. Stay—
response: the patient entered with active disease and
stayed until discharged by his physician as having received
adequate treatment. Quit-response: the patient entered
with active disease and left the hospital against the advice
of his physician. Both groups entered ill, both groups

began a treatment program, one group stuck it out, the other

46

quit in midstream. The present study seeks to predict only
one or the other of these two final responses.

Data for this study were derived from the record folders
of discharged patients. The clinical folder contains an
account of his medical treatment history and certain demo-
graphic data, e.g., age, race, occupation.

Forty such items of information available in the
records were selected to serve several purposes, one of which
involves prediction of final responses to hospitalization.
Information on these items was abstracted from the clinical
records of all patients discharged from the tuberculosis
service at the V. A. Hospital at Houston, Texas, from
March 1949 through December 1952.

There was a total sample of 268 discharges. Of the
22 information items taken from the folder, 9 served to
differentiate significantly the groups. Items significant
at least beyond the .05 level were: age on admission,
service—connected disability, pension, duration of illness,
chronic vs. fresh disease, number of previous hospitaliza—
tions, type of any previous hospital discharges, permanent
address, psychiatric diagnosis in addition to tuberculosis,
and occupation.

Holmes, Joffe, Ketcham and Sheey conducted an eXperi—
ment to evaluate the relationship between psychosocial

assets and treatment failure or success in tuberculosis.

47

The instrument used to measure assets was the Berle
Index. Patients were interviewed and scored at the time
of their hospital admission and the results of the study
were compared with a follow—up study on the same patients
five years after hospital admission, and with a three year
follow-up of 669 discharged patients and a one-year study
of 137 readmitted patients.

A comparison of the results of the three studies
showed that patients in the predictive study who showed
treatment failure and that characteristics of these treat-
ment failures and of patients with low predictive scores
were related to the characteristics of both relapsed-read-
mitted patients. Those characteristics of male sex, alcoho-
lism, non-tuberculer illness and against medical advice dis-
charge found in the treatment failures of all three studies
were significantly lacking in those patients with high
Berle scores.

There was a striking validation of the hypothesis that
the quality and quantity of psychosocial assets provide a
basis for making a prognosis.

Thurston and Calden (1954) designed a study to answer
the following question: are patients who leave the hospital
irregularly less intelligent than those who remain to

receive a medically sanctioned discharge?

48

The SS in this study were 182 male tuberculosis
patients admitted to the V.A. Hospital, Madison, Wisconsin,
during a one year period. All subjects given a short—
form Wechsler—Bellevue during their second month of hospitali—
zation.

The irregular discharge group consisted of the first
fifty Ss in the sample who obtained regular, medically
approved discharges.

Analysis of the W—B Test results indicates that the
tuberculous patient group, as a whole, is of average intell-
igence (mean Full I.Q. equals 107.59).

A comparison of the mean I.Q. scores and subtest scores
of the 50 regularly discharged patients and 50 irregularly
discharged patients reveals no statistically significant
differences. These results suggest that on a group basis,
there is little difference in intelligence between patients
receiving regular and irregular discharges.

Calden, Dupertuis, Hokanson and Lewis (1960) studied
105 tuberculosis patients, 62 in a slow recovery group and
“3 in a fast recovery group by means of the Minnesota
Multiphasic Personality Inventory and the Madison Sentence
Completion Form.

The results of this eXploratory study suggest that
tuberculosis patients who show a non«rapid rate of recovery
during the early stage of hospital treatment can be distin-

guished from the slower recoverers on the basis of age,

49

acuteness of illness, stage of treatment and body type. The
fast recoverers tend to be younger, are more acutely ill, are
in the initial phases of treatment,and havebody builds
classified as mesomorphic or ectomorphic rather than endo—
morphic. Although fast and slow recoverers do not differ
significantly in regard to race, extent of illness (far—
advanced, moderate, or minimal involvement of infected

living tissue), or duration of illness, a number of person“
ality, attitudinal and word-behaviour factors distinguished
the two groups.

The rapid recoverers, in contrast to the slow recoverers,
are inclined to be more enthusiastic, more confident and
Optimistic about the future, more socially outgoing, more
overly aggressive, and less preoccupied with their physical
ailments or emotional problems.

Slow recoverers are more depressed, hypochondriacal,
self—preoccupied and socially withdrawn.

The results give credence to old folk notions that hOpe
and faith in recovery are assets in the treatment of physical
illnesses, while despair and depression seem to prolong
the disease.

Cohen (1954) studied the ability of the Rorschach
technique, singly, to predict two years beforehand the medical
progress rate of 45 young, male, hOSpitalized pulmonary
tuberculous patients being treated early in their illness.

Rate of medical progress was defined as the degree to which

50

a patient's medical progress conforms to his expected pror
gress based on the patient's over—all medical history.
None of 33 Rorschach scoring variables, nor the Harrower—
Erickson technique of evaluating neurotic signs on this test
nor the anxiety and hostility variables of Elizur's Rorschach
Content Test were found to predict reliably the rate of
medical progress.

Degree of medical progress was not significantly related
to age, length of hospitalization, intelligence, or severity

of the tuberculous process.

Masai

The research findings are not entirely consistent as
they relate to factors involved in tuberculosis. However,
certain characteristics are evident.

The existence of a tuberculosis ”personality” is not
borne out by the research, but there are characteristic
situational reactions to the disease and hospitalization.
Among these are feelings of fear, apprehension and depression.
Marked regression is not apparent but conilict over dependency
feelings is evident. There is evidence that certain scores
of the M.M.P.I. distinguish tuberculosis patients from
normals.

It is clear from the research that social and emotional

factors do differentiate improving groups from declining

51

groups. Such factors as male sex, alcoholism, againstwmedicalo
advice discharge, tension level, defensiveness and self
acceptance, are relevant.

It is evident from this review of research that there
is no information on the effectcflThaving some meaning or

purpose in life as seen in relation to prognosis.

Research Related to Anomie

 

The term anomie or anomia originated in religious philo—
sophy about the end of the sixteenth century, and had approxi—
mately its current meaning reflecting planlessness, uncertainty
and doubt. Durkheim introduced the term into the social
solences in 1893, and later used it as an explanatory concept
in his theory of suiCide.

Davol and Reimanis (1959) have reviewed the chronological
theoretical develOpment of anomie. According to these
authors, Durkheim defined anomie as normlessness in a society,
resulting from society's failure to curb man's "inborn
impulses."

Merton makes a clear break with Durkheim's concept of
anomie. For Merton, anomie is a result of dissociation
between the culturally prescribed aspiration of pecuniary
success and the socially structured avenues for realizing
this aspiration.

Riesman defined the adjective anomie as "virtually

synonymous with maladjusted" and classified the anomie

52

individual as lacking the capacity to conform to the
behavioural norms of society.

Thus we see that the different authors emphasize
different aspects of anomie. One group refers to it as any
situation which threatens the social structure and its
values, as indicated by widespread social disorganization
in segments of the society; another group uses the term to
apply to an individual's perception of the social order as
lacking meaningfulness or usefulness, his withdrawal from
society, or his perception of constant conflict between the
basic goals in life.

There has not been a great deal of empirical research
on the concept of anomie, but the following are some of
the more relevant studies.

In 1951, Srole (1956) designed a measure of psycho—
logical anomie and in administering this scale, found that
anomie was related positively to prejudice; with anomie
held constant, authoritarianism related very slightly to
prejudice. Srole concluded that authoritarianism is not
related to prejudice independently of the psycho—social
factors measured by the Anomie Scale. Srole also found
that at low education levels, anomie and status, rather
than authoritarianism, were related independently to pre—
judice; but at college level, authoritarianism, rather than

anomie and status, was related independently to prejudice.

53

Following the implication of Srole's data that authorie
tarianism may be related to prejudice only because of socio—
economic components, Roberts and Rokeach attempted to replicate
the study. They also found that anomie and authoritarianism
were equally correlated with prejudice. However, when
anomie was held constant, correlations of authoritarianism
and ethnocentricism drOpped only slightly; but when authori—
tarianism was held constant, the correlation of anomie with
ethnocentricism decreased considerably; when education was
held constant, anomie was not related to socio—economic
level.

Bell (1959) attempted to relate measures of social isola—
tion and class structure to anomie, using the Srole Scale.

The questions comprising the Anomie Scale were asked of the
respondents in each of the four census tracts in a large

west coast city. In each of these four neighborhoods, probab—
ility area samples were selected. The respondents were men
aged twenty-one or over, and the total response rate was in
excess of 85%. A total of 701 interViews vwrs obtained.

Bell found a positive relationship between anomie and
age, but negative relationships between anomie and economic
status, as well as anomie and informal and formal group parti-
cipation. Not only were these determinates of high anomie
found important when individual members of a community were
considered, but a significant relationship also existed between
anomie and the economic character of the neighborhood pepula—

tion as a unit.

5H

Reimans and Davol (1959) investigated what demographic
and psychological factors contributed to high anomie scores
in an institutional domiciliary population. They found a
high negative relationship between educational level and
anomie scores. In addition, measures of the desire for
social affiliation and the maintenance of contacts with close
friends and relatives were found to be important negative
correlates of anomie.

A major finding was that age per se and actual social

——-._

 

participation were not related to anomie when other variables,
such as education and desire for soCial affiliation, were
statistically controlled. But a combination of these
Variables plus length of stay at the domiciliary, number of
letters received, and number of Visits made or received,
produced, regardless of arithmetic sign, a multiple corre—
1ation coefficient of .679, accounting for almost half of the
variance of the anomie score.

Dean and Reeves (1962) used a normlessness scale, of
their own construction, to measure anomie in a Catholic and
Protestant sample.

A sample of 160 women was drawn from a Catholic college
and 160 from a Protestant college. The selection of the
sample held the variables of age, sex, and educational level
constant. The findings indicate that Catholic college women
have significantly lower normlessness score at the .01 level

of confidence than do Protestant women.

It is evident that there are contradictory findings
among the various research studies. However, certain relation—
ships stand out when all the empirical work is reviewed: (a)
negative relationships between anomie and education, soc:o«
economic status, and indicators of social interest; and (b)
a positive relationship between anomie and the authoritar«

ianism—ethnocentrism syndrome.

CHAPTER III

PROCEDURE AND METHODOLOGY OF THE STUDY

It is evident from a review of the literature that while
there is a great deal of research on tuberculosis, there is
no research related directly to the relation of a patient's
having meaning and purpose in life and his progress toward
recovery from that disease.

Two research studies deal with the concept of meaning,
that of Kotchen, (1956) and Crumbaugh and Maholick, (1964).
However, they are concerned with preliminary steps toward
establishing the existence of a noogenic neurosis rather
than relating lack of meaning and purpose to progress toward
recovery from tuberculosis.

There is research on anomie and normlessness, but again
it is not related to meaninglessness or tuberculosis.

1t is the purpose of this chapter to describe the prov
cedure and methodology of studying the relationships of the

above variables.

Elem
The subjects were fifty pulmonary tuberculosis patients.
Twelve were patients of the Ingham County Tuberculosis
Hospital and thirty-eight were patients of the Oakland County

Tuberculosis Sanatorium.

56

57

All of the willing patients of the Ingham County
Tuberculosis Hospital, able to cOOperate, were interviewed.
There were twelve such patients. The remainder of the
fifty subjects were those who were willing to c00perate,
chosen at random, from a group of patients who were con—
sidered by the hospital staff to be medically able to

cooperate, at the Oakland County Tuberculosis Sanatorium.

Interviewing Methods

 

The author approached each patient, introducing himself
as a graduate student, stating that he was interested in
discussing with them some or their ideas and feelings con«
cerning their illness.

Following this brief introduction, the interviewer
sought to create an atmosphere in which the patient would
feel as free as possible to express himself. As much as
possible the first part of the interView was conducted along
non—directive lines.

In many cases the patients answered most of the infor—
mation items contained in the Berle Index without being
directly questioned. Those questions on the Berle Index
that had not been answered spontaneously were then asked
directly of the patient. The minimum time spent in this
initial interview was one and one—half hours. Some inter—

views were three hours in length.

58

During the last part of this interview, the patients
were asked to respond to the author's sixwitem questionnaire.
They were then given the P.I.L. Test, the Anomie Scale and
the Normlessness Scale. In some cases, it was possible to
leave the scales with the patient and have the patient com—
plete them at his leisure. In other cases, because of low
motivational level on the part of the patient and the length
of the scales, it was necessary to administer them personally.

The Berle Index was evaluated and scored before the
Anomie, P.I.L., and Normlessness Scales and the questionnaires
were scored, to minimize possible bias in scoring the Berle
Index, which requires a degree of subjective evaluation.

The Shontz and Fink Psychosocial Adjustment Scale was
rated by a social worker for the patients at the Oakland
County Sanatorium and the head nurse rated the patients at
the Ingham County Hospital. The social worker had eleven
years of experience with tuberculosis patients and the head

nurse had nine years' experience.

The Experimental Tasks

 

This study consists of two criteria variables: the
Berle Index (see Appendix I) and the Shontz and Fink Psycho—
social Adjustment Scale (see Appendix 2). Correlated
with these two criteria scales are seven variables: the
Purpose in Life Scale (see Appendix 3); The Anomie Scale

(See appendix A); The Normlessness Scale (see Appendix 5);

59

and four items obtained from the questionnaire constructed
for this study (see Appendix 6).

The following paragraphs are concerned with the
development of the instruments used in this study and with
their validity and reliability. In each case material that
is pertinent to understanding the instrument, its past use

and future possibilities, is included.

The Berle Index

 

The Berle Index was originally constructed as a guide

stress” disea' , i.e., migraine, hyper—

U:
(D
(It

to prognosis in

'\
u

e I952) The records of

F l

U ,1
(D

tension, asthma, ulcers, .r

(1‘
(

739 patients With "stress" diseases treated by eighteen
phySicians in the medical outpatient department of a

university hospital were studied and analyzed to determine
which factors could be correlated with the degree of change

observed in these patients in the course of treatment

11f

(D
(D

m

directed chiefly at the patient' adjustment to hi

V
L

(‘f
if"
“

'orrflated with improvement

(I’.
II

(7"

situation. Various fact
were assembled into a scale for use as a clinical guide to
prognosis in individual patients. This scale was then
applied to a grOup of 209 patients with asthma, migraine
headaches, and hypertension, whose clinical course had
already been evaluated. It was found that the patients
scoring below 60% were in the unimproved group, those scoring
between 65% and 75% were considered symptomatically improved

and those scoring over 80% were considered basically improved.

60

Homes, Joffe, Ketcham and Sheehy used inns Berle Index
with a population of tuberculosis patients. The subjects
for the study consisted of 41 patients. There were 25
males and 16 females, of which 34 were white and 7 non—white
and who varied in age from 18 to 63. They were chosen at
random by selecting every fifth consecutive previously
untreated first admission to Firland Sanatorium. The only
additional criteria were their ability to read and write,
the established diagnosis of pulmonary tuberculosis, and that
they were not too critically ill.

Treatment failure was defined as unrelenting chronicity
of the tuberculosis following admission, or relapse of the
disease following discharge from the hospital.

Total Berle scores, of which 90 is maximum, for the 41
experimental subjects at time of admission to the hospital
ranged from 16 to 58 with average of 38. Percentage scores
ranged from 18 to 66, with an average of 42 per cent.

The failure to respond to treatment as evidenced by
chronicity of illness or relapse was significantly related in
the predictive study to low Berle scores, whereas none of the
patients with medium or high Berle scores was a treatment
failure. Relapse or chronic disease occurred in 5 patients or
12% of the 91 patients in the predictive study, and all five
were in the low Berle score group. The test score for A of
these patients was 27 points (31%) and for one patient, 16

pcflnts (18%). A standard error of the difference was computed

61

and the observed difference was statistically significant

at the .05 level.

TABLE l.——Range of Berle scores for experimental subjects
at time of initial hospitalization.

A

 

Number Treatment
Points Per cent of Patients Failure
47 — 58 (High) 52 — 66 9 O
30 — AU (Medium) 34 — 50 17 0
l6 - 28 (Low) 18 — 33 15 5
(12%)

 

A replication of the Berle test five years after the
original hospitalization showed that the capacity for change
and improvement in adjustment was significantly influenced
by the amount of psychosocial liabilities. Thirty—five
patients or 85% of the patient group had scores with 6 points
Of the original tests, and were, therefore, in the same
Berle percentage group. (See Table 2.)

TABLE 2.——Replication of Berle scores for eXperimental sub—
jects five years after initial hospitalization-

 

 

 

1958
High Medium Low
52 - 66% 34 — 50% 18 — 33%
High 100 ——- -__
Medium 12 82 6

1953 Low -—— 20 8O

 

62

Although the estimation of assets in the second Berle
test was made on the basis of the patient's adjustment and
satisfaction in the period since hospitalization, the results
were the same as those based on his entire life adjustment
at admission. The low scored items in the original Berle
were equally low in the second Berle test. Patients lost
additional points in the second Berle for "age up to forty
years," "surgical treatment for symptoms," and "duration of
illness less than five years."

Shontz and Fink Psychosocial
Adjustment Scale

 

 

The other criteria measure is the Shontz and Fink
Psychosocial Adjustment Scale. This instrument provides a
quantified description of a patient as he is perceived by
the worker. Items of the scale were formulated from psycho-
social factors found in patient records that seemed to
have some relation to rehabilitation and to adjustment to
disability. The items were then put into a Q-sort. The
authors report that this Q—sort was then used on 20 hemiplegic
patients and on 20 patients admitted for treatment of
fractures only. The authors point out that it seemed reason-
able to suppose that this group of fracture patients was,
generally speaking, less disabled than the group of hemiplegics,
and it seemed reasonable to expect that their long-range home
adjustment would be better than that of the hemiplegic group.

Analysis of the data established that this was indeed the case

63

since the differences in psychosocial adjustment were in the
expected direction and were significant at the .001 level
of probability.

In the case of this Q-sort, the minimum requirement
at the .01 level of statistical significance is a Pearson
product-moment correlation coefficient of about .42.

Preliminary tests of the Q—sort, with individual
patients rated by several judges independently, yielded
reliability values exceedingifluaminimum statistical require—
ment in every case in which the necessary rating conditions
were met (i.e., when the persons providing the descriptions
had at least two years'experience working directly with the
chronically ill population, and when adequate interview
data were made available to the raters). Agreement among
experienced judges under these conditions tended to fall
around a median of about .60.

The instrument was used as formulated by the authors,
with the exception oftfluaminor changes made in wording Area
II, as indicated in Appendix, (See Appendix 2) to make the

scale applicable to the current situation.

The Purpose in Life Test

 

The first independent variable is the score on the
Purpose in Life Test. The P.I.L. Test is an attitude scale
especially designed to evoke responses believed related to
the degree to which the individual experienced "purpose in

life." According to the authors, the a priori basis of the

 

6A

items was a background in the literature of existentialism,

particularly in logotherapy, and a "guess” as to what type

 

of material would discriminate patients from non—patients.
A pilot study was performed, using 25 such items; on the
basis of the results, half were discarded and new items sub—
stituted. Twenty—two then stood up in item analysis and
these were utilized in the present test.

The test was given to 225 subjects, as follows:
Group I, 30 "high purpose" non-patients, composed of six
Junior League females and 2A Harvard summer school graduate
students (1A males and 16 females); Group II, 75 under—grad—
uate college students, non-patients (AA males and 31 females);
Group III, out-patients of various co-Operating psychiatrists
in private practice in Georgia, a total of A9 (25 male and 2A
female) cases of mixed diagnosis; Group IV, out-patients of
the Bradley Center, Inc., (a privately endowed non—profit
out-patient psychiatric clinic), a total of 50 (22 male and

28 female) cases of mixed diagnosis; Group V, hospitalized

patients, all alcoholics, a total of 21 (1A males and 7 females;.

Ages ranged from 17 to over 50, all groups except the under—
graduate college students being fairly well mixed, but with
averages near 30.

As shown in Table 3, there is a significant discrimin—
ation between patients and non-patients. This is consistent

with predictions from the orientation of content validigy.

65

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66

An item analysis (Pearson r's between the total score
and the score on each item, N equals 225) revealed a correla—
tion range of from —.06 (Item 19) to .82 (Item 9), 17 items
being above .50 and 20 above .A0. The reliability of the
P.I.L. revised total score, determined by the odd—even
method (Pearson r, N equals 225) is .81, Spearman—Brown
corrected to .90.

A partial "concurrent" validation of the P.I.L. revised
total score against one type of criterion, the ratings assigned
by patient's therapist of each P.I.L. item as the therapists
thought the patients should have rated themselves in order to
be accurate, yield an r of .27 (Pearson product—moment, N

equals 39).

Anomie Scale

 

The second independent variable is the score on the
Anomie Scale. Srole formulated a five item scale which,
according to him, measures the socio-psychological concept of
anomie. There is some indication that what Srole's scale
is measuring is a feeling of despair. McDill administered the
Anomie Scale, the Authoritarian Scale and the Prejudice Scale
to a sample of 266 subjects. A factor analysis of the three
scales indicated an underlying factor that was identified as

a negative Weltanschuung.

 

Srole administered his scale to 701 men, age 21 or over.

The Cornell scaling technique was applied. The coefficient of

67

reproducibility for this sample is .65. Scaling of the items
resulted in two trichotomies and three dichotomies, the scale

ranging from a possible low of zero to a possible high of ten.

The Normlessness Scale

 

The third independent variable is the score on the
Normlessness Scale. Dean and Reeves develOped a three part,
2A item alienation scale of which the Normlessness Scale is
a part. The test was scored by the Likert method, the range
of possible scores being 0 - 2A, with the higher score indi-
cating a higher degree of normlessness. Validation was
attempted by submitting the items with one—page descriptions
of the three component types to seven sociologists at the Ohio
State University. The judges were instructed to decide
whether or not each item referred specifically and only to
normlessness. For retention of an item, agreement on specific
placement was required from at least five of the seven judges.
When this procedure had been completed, the usual "D P” test
was applied to determine which of the "valid" items were to
be retained. The scale was tested for reliability by the
"split-half" method, and was found to be .78 (N 38A) when
corrected for attenuation by the Spearman-Brown prOphecy form—

ula.

Author's Questionnaire

 

In addition to the foregoing scales which were adminis—
tered to the patients, the subjects were asked to respond to

the author's six item questionnaire (see Appendix 6).

68

The questions were individually administered. Items
one and four, to which a "Yes" or "No" response is given,
were designed to give some indication as to how many subjects
consciously asked themselves why the illness had happened
to them and what was the meaning and purpose of their lives.

Items two and five, which are open-ended and require
a narrative answer, were designed with the intention of
determining the reasons, as the patients saw them, for asking
or not asking "why" as to the reason for their illness and
the meaning and purpose of their lives. These questions,
as items three and six, were asked for the purpose of
hypothesis generation.

Items three and six seek to explore the content of the
subjects' answers as to why they feel they became ill and

what gives meaning and purpose to their lives.

Analysis Procedures

 

Each of the two criteria measures, the Berle Index
and the Shontz and Fink Scale, was correlated with the
following variables by means of the Pearson product—moment
correlation, the P.I.L. Test, the Anomie Scale and the
Normlessness Scale. (The statistical computations were
performed by the M.S.U. 3600 computer using the AES Program
Description 12, Dec. 27, 1963.)

The following formula was used: riJ = S . ij

69.

The four questionnaire items were correlated with the criteria
by means of the point biserial correlation.

The simple correlation coefficients were tested for
significance by the use of Table V.A. of R. A. Fisher,
Statistical Methods for Research Workers. (Edwards, 1960,

p. 502.)

Multiple and first order partial correlation coeffi—
cients were computed for each criterion variable and the
predictor variables, starting with one predictor variable
and adding predictors, one at a time, until the full multiple
correlation was obtained. The following formula was used to

obtain the multiple correlation coefficients:

R2 = SSR R = ‘/R2

TSSAM
and the partial correlation coefficients were found by:

tbi

ryi. . . .l. . .(i—l)(i+l). . . . K = DF + tbi2

While formal hypotheses were not stated for the multiple and
partial correlations, attention was drawn to those that are
significant at the .05 level of significance.

The Open-ended questions, items 2,3,5, and 6, on the
author's questionnaire, were analyzed by means of content
analysis. The answers to each item were examined and placed
in categories, on the basis of being logically related in
some fashion. The content analysis was accomplished by

recording all of the responses on index cards, with the name

70

of the patient on the reverse side of the card so that the
author would not be aware of whose response he was sorting at
the time. As a further step toward objectivity, the cate-
gories were not formed and the sorting was not done until
several weeks after the actual interviewing was completed.
The answers to items 2 and 5 were placed in four categories,
and items 3 and 6 were placed in five categories.

The subjects were placed in one of three levels on the
basis of their responses to the three predictor variables,
the P.I.L. Test and the Anomie and Normlessness Scales,
being placed in the high, medium or low level, depending on
whether their score fell into the upper, middle or lower one—
third of the responses given on each scale. A scale was
defined as high or low, in terms of assumed Optimal adjust—
ment, not in terms of scoring values. Subjects were also
placed in categories on the basis of the nYes".or "No" responses
to Items 1 and 2 of the questionnaire and Items 3 and A of
the questionnaire as to the subjects haVing found, or not
having found, a reason for their illness' having happened
and finding a meaning in life.

Percentages were computed for the number of responses
falling in the high, medium and low levels of the tests for
the total sample. Percentages of the scores falling in the
high, medium, and low levels for each category were also
computed. Using the percentage of scores in the high and low

levels of the test for all subjects as the eXpected number

71

for the relevant categories, x2 tests of significance were

computed using the formula:

X = N o T—
1

Attention was drawn to those high and low categories

that show a significant variation at the .05 level.

CHAPTER IV

RESULTS AND DISCUSSION

The research data was subjected to statistical analysis

as described in Chapter III. Table A gives the simple

correlations. The variables have been assigned numbers as

follows:

1.

Berle Index

Shontz and Fink Psychosocial Adjustment Scale
Purpose in Life Test

Anomie Scale

Normlessness Scale

”Do you ever ask yourself, 'Why did this illness
happen to me?'"

"Do you ever ask yourself, 'What is the meaning
and purpose of my life?'"

Whether the subject has found meaning and purpose
for his life.

Whether the subject finds a reason why the illness
happened to him.

An inspection of the correlations, as shown in Table A,

with those correlations indicated that are significant at

the .05 level of significance, shows that the following hypo—

theses are supported:

72

73

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HYPOTHESIS
the .05 level of
Index and scores

HYPOTHESIS
the .05 level of
Index and scores

HYPOTHESIS
at the .05 level
Index and scores

HYPOTHESIS

the .05 level of

7A

I: There is a significant correlation at
significance between scores on the Berle
on the P.I.L. Test.

II: There is a significant correlation at
significance between scores on the Berle
on the Anomie Scale.

III: There is a significant correlation

of significance between scores on the Berle
on the Normlessness Scale.

VI: There is a significant correlation at

significance between scores on the Berle

Index and responses indicating either success or lack of

success in finding a meaning in life.

HYPOTHESIS

at the .05 level

IX: There is a significant correlation

of significance between scores on the

Shontz and Fink Scale and scores on the Anomie Scale.

HYPOTHESIS

at the .05 level

X: There is a significant correlation

of significance between scores on the

Shontz and Fink Scale and scores on the Normlessness Scale.

The following hypotheses are rejected,

lacking the

required .05 level of significance:

HYPOTHESIX

the

Index and responses to the question,

self the question,

IV: There is significant correlation at

.05 level of significance between scores on the Berle

"Do you ever ask your-

'Why has this illness happened to me?'"

75

HYPOTHESIS V: There is a significant.correlation at
the .05 level of significance on the Berle Index and responses
on the question, "Do you ever ask yourself, 'Does my life
have any meaning and purpose?'"

HYPOTHESIS VII: There is a significant correlation at
the .05 level of significance between scores on the Berle
Index and responses indicating either success or lack of
success in finding some meaning and purpose in life.

HYPOTHESIS VIII: There is a significant correlation
at the .05 level of significance between scores on the
Shontz and Fink Scale and scores on the P.I.L. Test.

HYPOTHESIS XI: There is a significant correlation
at the .05 level of significance between scores on the Shontz
and Fink Scale and responses to the question, "Do you ever
ask yourself, 'Why has this illness happened to me?'"

HYPOTHESIS XII: There is a significant correlation at
the .05 level of significance between scores on the Shontz
and Fink Scale and responses to the question, "Do you ever
ask yourself, 'Does my life have any meaning and purpose?'"

HYPOTHESIS XIII: There is a significant correlation
at the .05 level of significance between scores on the Shontz
and Fink Scale and responses indicating either success or
lack of success in finding a reason for the illness occurring.

HYPOTHESIS XIV: There is a significant correlation at

the .05 level of significance between scores on the Shontz

76

and Fink Scale and responses indicating either success or

lack of success in finding some meaning and purpose in life.
Tables 5 through 18 present the multiple and partial

correlation coefficients, with those indicated that are

significant at the .05 level of significance.

TABLE 5.--Intermediate solution no. 1. multiple and partial

correlation coefficients of dependent variable no. 1 and
independent variable no. 3, with A8 degrees of freedom.

 

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients
R = .6181* 3 .61807*

 

*Statistically significant at .05 level, two—tailed.

TABLE 6.——Intermediate solution no. 2. multiple and

partial correlation coefficients of dependent variable

no. 1 and independent variables nos. 3 and A, with A7
degrees of freedom.

 

 

 

Multiple Correlation Partial Correlation

 

Coefficient Var. Coefficients
R = .6510* 3 .57678*
A -.26020

 

*Statistically significant at .05 level, two-tailed.

77

TABLE 7.—-Intermediate solution no. 3. multiple and partial
correlation coefficients of dependent variable no. 1 and
independent variables nos. 3, A, and 5, with A6 degrees of

 

 

freedom.
Multiple Correlation Partial Correlation
Coefficient Var. Coefficients
R = .7186* 3 .53A7A*
A .03782
5 -.A007l*

 

*Statistically significant at .05 level, two—tailed.‘

TABLE 8.-—Intermediate solution no. A. multiple and partial

correlation coefficients of dependent variable no. 1 and

independent variables nos. 3, A, 5, and 6, with A5 degrees
of freedom.

 

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients
R = .7209* 3 .53908*
A .01A8A
5 -.35OA9*
6 —.08302

 

*Statistically significant at .05 level, two-tailed.

78

TABLE 9.—-Intermediate solution no. 5. multiple and partial

correlation coefficients of dependent variable no. 1 and

independent variables nos. 3, A, 5, 6, and 7, with AA degrees
of freedom.

 

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients
R = .7255* 3 .5A788*
A -.00212
5 -.35891*
6 —.ll67A
7 .11803

 

*Statistically significant at the..05 level, twovtailed.

TABLE 10.-—Intermediate solution no. 6. multiple and partial

correlation coefficients of dependent variable no. 1 and in—

dependent variables nos. 3, A, 5, 6, 7, and 8, with A3 degrees
of freedom.

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients

 

.A9272*

.00A36
—.3202A*
-.09A5A

.14691
-.iA668

R = .7325*

oowoxtnzw

 

*Statistically significant at .05 level, two—tailed.

79

TABLE ll.--Final solution. multiple and partial correlation

coefficients of dependent variable no. 1 and independent

variables nos. 3, A, 5, 6, 7, 8, and 9, with A2 degrees of
freedom.

L
fi‘

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients

 

.52686*
.0022u
—.31655*
-.21209
.1A682
—.1A960
.22259

R = .7A80*

\OCIDNOUTL'UO

 

*Statistically significant at .05 level, two—tailed.

TABLE l2.-—Intermediate solution no. 1. multiple and partial
correlation coefficients of dependent variable no. 2 and in—
dependent variable no.“3, with A8 degrees of freedom.

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficient

 

R = .1267 3 .12667

 

80

TABLE 13.-—Intermediate solution no. 2. multiple and partial
correlation coefficients of dependent variable no. 2 and
independent variables nos. 3 and A, with A7 degrees of freedom.

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients
R = .2912* 3 .05019
A -.26A33

 

*Statistically significant at .05 level, two—tailed.

TABLE lA.——Intermediate solution no. 3. multiple and partial
correlation coefficients of dependent variable no. 2 and in—
dependent variables nos. 3, A, and 5, with A6 degrees of

 

 

freedom.
Multiple Correlation Partial Correlation
Coefficient Var. Coefficients
R = .3879* 3 -.02086
A -.05260
5 —.26796

 

*Statistically significant at .05 level, two-tailed.

81

TABLE 15.v—Intermediate solution no. A. multiple and partial
correlation coefficients of dependent variable no. 2 and
independent variables nos. 3, A, 5, and 6, with A5 degrees of

 

 

 

freedom.
Multiple Correlation Partial Correlation
Coefficient Var. Coefficients
R = .A637* 3 —.06850
A .02215
5 -.352A0*
6 .275A8

 

*Statistically significant at .05 level, two-tailed.

TABLE l6.-—Intermediate solution no. 5. multiple and partial

correlation coefficients of dependent variable no. 2 and

independent variables nos. 3, A, 5, 6, and 7 with AA degrees
of freedom.

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients

“H”...—

—.o86u3
.03u64
.3u746*
.28823
—.08851

R = .A702*

woman;
I

 

*Statistically significant at .05 level, two-tailed.

82

TABLE l7.——Intermediate solution no. 6. multiple and partial

correlation coefficients of dependent variable no. 2 and in—

dependent variables nos. 3, A, 5, 6, 7, and 8, with A3 degrees
of freedom.

 

 

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients

 

-.0578u
.03180

—-35179*
.27693

—.10032
.06556

R = .A738*

mflmkfitw

 

*Statistically significant at .05 level, two—tailed.

TABLE 18.--Final solution. multiple and partial correlation

coefficients of dependent variable no. 2 and independent

variables nos. 3, A, 5, 6, 7, 8, and 9 with A2 degrees of
freedom.

 

Multiple Correlation Partial Correlation
Coefficient Var. Coefficients

 

R = .5109* —.OOOS2
.O3OAl
—.3A885*
.09622
—.106A5
.06792

.217OA

\DCDNIOUT-tw

 

*Statistically significant at .05 level, two-tailed.

83

An inspection of Tables 5 through 11 shows that the
multiple correlation coefficient for dependent variable
number 1, the Berle Index, is significant for the final
solution as well as all of the intermediates solutions. An
inspection of Tables 5 through 11 also shows that in all of
the intermediate solutions, as well as the final solution,
the partial correlation coefficients for variables 3, the
P.I.L. Test, and 5, the Normlessness Scale, are significant.

An inspection of Tables 12 through 18 indicates that
the multiple correlation coefficients for dependent variable
number 2, the Shontz and Fink Psychosocial Adjustment Scale,
is significant for the intermediate solutions numbered 2, 3,
A, 5, 6, and the final solution. A similar inspection of
Tables 12 through 18 reveals that the partial correlation
coefficients are significant for the independent variable
number 5, the Normlessness Scale, for intermediate solutions
A, 5, 6, and the final solutions.

In predicting the dependent variable number 1, the
Berle Index, the variables 3 and 5, the P.I.L. Test and the
Normlessness Scale make the greatest contribution to the
multiple correlation coefficient.

In predicting the dependent variable number 2, the
Shontz and Fink Psychosocial Adjustment Scale, variable 5,
the Normlessness Scale, makes the greatest contribution to

the multiple correlation.

8A-

Four of the items.on the author's questionnaire, Item
2, "Do you ever ask, 'Why has this illness happened to me?'";
Item A, "Do you ever ask, 'What is the-meaning and purpose of
my life?'"; Item 5, "Have you found a meaning or purpose for
your life?" and Item 6, "Do you find a reason for this illness
happening?" were subjected to content analysis.

Responses to item A, were placed in four categories
as follows:

CATEGORY I: Those who ask the question, "Why has this
illness happened to me?" with a reason for asking the
question:

1. "It is easier if I know."

2. "I-have to ask 'why' about everything."

3. "It was necessary for me to know."

A. "I need to know."

5. "I just had to have a reason."

5. "I see others who apparently never have anything
happen to them, and I wonder, 'Why me?!"

7. "Because I think there must be come reason why we
are here."

8. "It is human to."
9. "There must be a reason."

10. "Because I have a curious mind, there are many
unanswered 'whys' in this world."

11. "Because, I want to know if it is because of
something I did."

CATEGORY II.

85

Those who ask the question,

"Why has this

illness happened to me?" but who have no reason for asking the

question:

12.

13.
1A.

CATEGORY III.

"Just do."

"I don't know why I do, I just do."
"Can't help it."

"I just don't know, I just do."
"It just comes into my mind."
"Can't help it."

"I must."

"You just can't help it."
"Can't help it."

"Can't really say."

"Just do."

"Couldn't say."

"Can't help it."

"It is impossible not to ask."

Those who do not ask the question, "Why

did this illness happen to me?" and who give no reason for

not asking:

I.
2.

.1:-

mm

"I don't know."

"Just never thought of it."
"Never occurs to me."

"Just never thought of it."
"Never thought about it."

"Just never thought about it."

86

CATEGORY IV. Those who do not ask the question, "Why

did this illness happen to me?" and who give a reason,

either expressed or implied, for not asking.

I.

U'l-lt'w

10.

ll.

l2.

13.

1A.

15.
l6.

l7.
18.

"What's the use?"

"No point in asking such a question."

"Don't think I could find any answer."

"I don't see that anyone is to blame for it."'
"Because it just don't make no sense [gig] if it
happens, it happens."

"Because I know."

"No point in it, if it did, it.did."

"No, because I don't see much point in it. What
is mean to be, is meant to be."

"No use."

"Because I know, I.am being punished."

"I don't think anyone is to blame, I don't blame
anyone."

"Life is cause and effect, no reason to ask."
"If it happens, it happens. It doesn't seem like
a profitable question to ask."

"No reason to ask. It's the Lord's will."

"Just don't see any point in it."

"Never entered my mind. Why should God pick me
out for this?"

"What will be, will be."

"Because then I would just be feeling sorry for

myself. Better not think about it."

87

Responses to Item 3, "What reasons do you find to the
question, 'Why has this illness happened to me?'" were placed
in five categories, as follows:

CATEGORY I: Those who do not find an answer to the
question, "Why did this illness happen to me?", but believe
there is one.

1. "Well, I feel there must be a reason, but I don't

what it is."

2. "I don't always find the answer, but I very
firmly believe there is one."

3. "Don't find any, yet I think there is one; makes
me feel that things do happen for a purpose."

CATEGORY III: Those who give some sort of punishment-
associated responses to the question, "Why has this illness
happened to me?"

1. "I have asked this over and over, 'Why?‘ I became
very bitter after my mother's death. I felt God
was punishing me. I still don't know, but I don't
feel so bitter."

2. "I used to think God was punishing me, but I
couldn't see why. What would a seventeen year old
do to deserve this? Now I know, Satan is causing
it, God is not punishing me at all. This makes me
feel much better."

3. "None really, I don't really think God is punishing
me. I have always taken care of myself, more than

others, then this! I guess, 'What will be, will be.'"

88

"I try not to think of it too much, it just seems
like it gets me down. I don't suppose I have
lived the best life, but still not the worst, but
I just don't get an answer."

"Maybe punishment for something I did and Christ
is trying to bring me back."

"I used to think God was punishing me, but I
don't anymore."

"You mean do I feel persecuted? No."

"I don't think anyone is to blame, I don't blame
anyone."

Responded that she didn't ask, ". . . because

I know, I am being punished."

CATEGORY IV: Those who responded to the question, "W

has this illness happened to me?" by giving an answer which

took account of cause and effect in terms of violation of

health rules.

1.

"Overwork, lack of exercise, didn't take care

of myself."

"Didn't take care of myself, didn't go to the
doctor."

"Because of my nerves and my working conditions.”
"Too active, went from hot rooms right out doors

for gym."

CATEGORY V: Those who feel they know the reason that

the illness happened.

}-.-'
66L)

89

1. "Some good will come of it, it will make me more
sensitive to others' suffering. It may help me
help them."

2. "I think it was to slow me down."

3. "It was a 'yellow light' warning me to slow down."

A. "Well, I don't really know, except that each person
has suffering to do and perhaps it will make me
more aware of others' needs."

5. "My daughter was ill, they thought she had cancer,
but then it was proven not to be cancer. I'm
glad I am suffering, not her."

6. "Sin, not my personal sin, but sin in the world.
You are tested and tried and it is up to the
individual to meet those tests, to meet Satan's
attacks."

7. "Fate, no other reason, no other answer."

The responses to questionnaire Item 5, "Why do/don't
you ask, 'What is the meaning and purpose of my life?'" were
divided into the same four categories as was item number two.

CATEGORY I: Those who ask what is the meaning and
purpose of life for a stated reason.

1. "I have to know."

2. "Because I believe the Lord has left me here for

a purpose and I should find it."

3. "It is the most important thing a man can ask."

ll.

12.

13.

1A.

15.

16.
17.

O\O(I)NC\U1

90

"Because everyone wonders; one hopes to find an
answer to give them the courage to go on."

"I have to ask, 'Why?' about everything."

"I need some meaning."

"It is important for me to know."

"Because it would be ofgreattmlp to me if I knew."
"Because a person has to have some purpose."

"It's human to ask. One can't exist without some
purpose, some meaning."

"Because you have failed at something, it causes
you to question the meaning of your life."

"I feel like we are put here for a purpose and
should justify our existence."

"I feel that it is a person's duty to seek to find
out."

"I need to know, I couldn't stand a purposeless
existence."

”It is of tremendous importance to me.”

"If you don't ask, you won't find out."

"It was necessary for me to know."

CATEGORY II: Those who ask the question of the meaning

and purpose of their lives, but state no reason for so doing.

1.
2.

"Can't help it."
"It's human to."
"I can't help it."

"I don't know Why I do, I just do."

91

"Fate."
"I can't help it."

"You just can't help it."

(DNOU‘I

"Can't help asking."
9. "Never thought about why I ask."
10. "I don't know, just part of life."
11. "I just do."
12. "Can't help it."
13. "One can't help but ask, it's human."
1A. "A person just can't help asking it."
15. "A person can't really help it."
16. "When I have nothing to do, it just comes, but I
try not to let it."
17. "Can't hardly help it."
18. "Just do."
19. "Don't know, just do."
20. "I don't know, I just do."
21. "I don't know."
22. "I just do."
CATEGORY III: Those who don't ask what is the meaning
and purpose of their lives and give no reason for not asking.

I. "I don't know."

2. "I don't know, I don't really think about such things.’

3. "Just never have."
A. "Never been asked."

5. "Never occurs to me."

92

CATEGORY IV: Those who don't ask what is the meaning

and purpose of their lives and give a reason for not asking.

1. "Because I have such meaning."
2. "Because I know there is no use to."
3. "Sometimes, if you ask questions you don't like

the answers you get."

A. "Wouldn't find any, so why ask."

5. "Foolish question."

6. "No point in it, never got many of the things I

wanted."

The responses to questionnaire item number six, "What
do you find that gives meaning and purpose to your life?"
were placed in the following five categories. (There is a
total of 58 responses to this question instead of 50, because
eight subjects gave responses which had to be placed in two
categories.)

CATEGORY I: Those who find no meaning or purpose.
There were thirteen subjects who gave this response.

CATEGORY II. Those who find no meaning or purpose,
but believe there is one.

1. "I think everybody is put here for a purpose.

There must be some meaning, but I don't know what
it is."

2. "I don't know, but I do believe that we all have

some purpose for being here, if you didn't, you

would just give up."

93

"Well, I feel that it must have some meaning, some
purpose, but I don't know what it is."

"Nothing really, although I do think there is a
purpose for everyone being here."

"Nothing really, though I think we are all put here

for a purpose, must be."

CATEGORY III: Those who find meaning and purpose in

life through some form of accomplishment: (that portion of

the answer which is in parentheses is included in the following

category.

The placing of an item, e.g., concerning the family,

in categories four or five was made on the basis of whether

or not a subject found meaning in doing something for the

family or just said that his family gave meaning to his life.)

1.

"Getting well, not being a burden to others,
helping others."

"My writing, it means nearly everything to me, it
is something that will live after me."

"Ability to know you can accomplish."

"To meet the challenge of the day, to do the besy
I can, to learn new things."

"My family; getting my children raised to the
point that they are self-sufficient."

"My work; it gives me pleasure and it is a means

of helping others."

10.

11.
12.

13.

1A.

15.

l6.

l7.
l8.

19.

9A

"Helping others, making society a better place to
live."

"Trying to help others less fortunate than myself,
trying to help them find the true way," (meaning
Christianity).

"The vindication of God's name."

"I have raised a large family. They are all a
credit to themselves. That gives meaning to my
life."

"Make people happy."

"Doing craftwork, helping my children, raising
them to be what they should be."

"To do what my parents taught me, they taught me
good rules of life.”

"Since I am a Roman Catholic, to save my soul,

and provide for my family."

"My family, if I can raise them, so they are happy,
I will be fulfilled."

"To get well, (enjoy life). Nothing really beyond
this."

"People: serve and (know them)."

"To do good, to my children, to everybody. (I look
at every new day and say 'It's new, thank God;' I
am happy to be alive.)"

"To try to help my fellowman, to do good for him,
to pray for him; very important to me (to give

thanks)."

95

20. "Helping my husband in business: (children and
family)."
21. "People, (experiencing life), but most of all,

my career."
22. "(My family), getting ahead, building a new house."
CATEGORY IV: Those who find the meaning or purpose
of their lives through some type of experience.

1. "My family."

2. "Well, no really great purpose, but while I have
been here, people where I worked have sent cards,
letters, verses, etc., and it has given some meaning
to my life."

"My family means a great deal to me."

A. "Thankful I have my family and boy."

5. "Being a Christian."

6. "'Life' gives meaning and purpose to life. To
enjoy beauty and nature."

7. "My family; husband and children."

8. "My church, this is the big thing now."

9. "Family, being with them, life in general."

10-17. Those answers in category III which are in
parentheses.
CATEGORY V: Those who find meaning and purpose in life
through the attitude they take toward suffering.
l. "I just believe that a person has so much suffering

in this life and must learn to bear it with dignity."

96

Discussion

 

An examination of Table A shows that the P.I.L. Test
correlates significantly with variables A, the Anomie Scale;
5, the Normlessness Scale, and 8, the response as to whether
the subject has found something which gives meaning and
purpose to his life.

The correlation of the P.I.L. Test with the Anomie
Scale is statistically significant, being -.280379. How—
ever, the correlation is low enough to indicate that even
though the two measures are related, they are not highly
related. This correlation would indicate that the scales
are by no means measuring precisely the same things.

The correlation of the P.I.L. Test with the Normless—
ness Scale is also significant, being -.369A1A. And while
the correlation of the P.I.L. Test and the Normlessness
Scale is higher than that of the P.I.L. Test and the Anomie
Scale, it is still low enough to suggest that there is a
substantial difference in what the two measures are recording.

The correlation of the P.I.L. Test with the indication
of the subjects' having found some meaning and purpose in
life is understandably higher, being -.A81A87. That the
correlation is not even higher probably is an indication that
the subjects do not define meaning and purpose in the same way
as the authors of the P.I.L. Test.

Frankl suggests that often peOple do not find meaning

in life because they seek to find the meaning or the purpose

97

of life, instead of asking, "What meanings or purposes can
my life have?" This observation would eXplain partially why
some of the subjects said they had found no meaning or pur«
pose in life, and yet scored rather highly on the P.I.L. Test.
Crumbaugh and Maholick, (l96A) the authors of the P.I.L.
Test, correlated their test with the M.M.P.I. and the Allport,
Vernon, Lindzey Scale of Values, and concluded that there
was little relationship between any of the A-V—L Scales and
the P.I.L. Test, and that only the K (Validity) and D (Depres—
sion) scores of the M.M.P.I. showed any substantial relation—
ship to the P.I.L. Test. They explained the correlations of
the K and D Scales by saying, "Since the K Scale is a measure
of defensiveness, the indication is that subjects who have
a high degree of 'purpose in life' tend to have adequate
defenses; they also tend to be less depressed than others."
The results of this study would indicate that while
"purpose in life" may not be significantly related to some
of the characteristics measured by the scales more commonly
used in clinical work, "purpose in life" is related to some
of the variables studied by sociologists and social psycholo—
gists. However, the relationships are so low, at least in
this study, that further investigation of the concept of meaning
would seem to be a fruitful endeavor. It would seem that
Frankl's contention that today we have a new neurosis, one
marked by lack of purpose and meaning, is worth further investi—

gation.

98

It will be noticed that there is a —.51 correlation with
the Berle Index and the individual's indication of having
found some meaning and purpose in life. This is a relatively
high correlation of a single question with a full scale.

After the open—ended questions were categorized, the
appropriate categories were compared with the scales and
dichotomous questions. The compariSons were made in the
following manner: the scales were divided into high, medium
and low responses; high being defined as the upper one-
third and low, the lower third. (The high end of the scale
being defined as in the direction of assumed optional adjust-
ment.) The categories were also compared with those who
responded "Yes" or "No" on the questions capable of being
scored dichotomously. These divisions were called levels.
The percentage of the total scores falling in each level of
each test and the "Yes" or "No" categories of the dichotomous
questions were computed.

Also, the percentages of the total scores falling in
any given category were computed for each level of the test,
to give some idea of the shift in responses in any category
on the different levels of the tests considered. Tables 19
through 22 present this data.

It will be noted from Table 19 that 52% of the subjects
did ask why the illness had happened to them and of this
percentage, 76.92% found some reason while 23.07% did not. Cm

the 52% who asked why the illness happened to them 22% have a

99

TABLE l9.e—Comparison of responses to question, ”Why do/don't
you ask, 'Why has this illness happened to me?'" with levels
of scales and questionnaire items.

 

 

 

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Do you ask,
"Why has this Yes 26 52 100% 100% 0 0
illness hap—
pened to me?" No 2A A8 0 0 100 100

Purpose in High i6 32 27.27% 20.00% 16.67% 50.00%“
Life Test
Med 23 46 63.63% 53.33% 50.00% 27 77%

Low 11 22 9.09%* 26.66% 33.33% 22.22%

High 23 A6 A5.A5% A0.00% 50.00% 50.

O
O
N

O\.
O\
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Anomie Med 13 26 A5.A5% 26.66% 16.66% 16.

LOW 14 28 9.09%* 33-33% 33:33% 33-33%

High 21 A2 81.81%* 33.33% 33.33% 27.77%

Normlessness Med 21 A2 18.18% A0.26% 50.00% 55.55%

Low 8 16 0* 26.66% 16.66% 16.66%
# 50 11 15 6 18
Total in % 22% 30% 12% 36%
each cat-
gory

 

*Statistically significant at the .05 level.

TABLE 20.--Comparison of responses to the question,

100

"What

reasons do you find for this illness having happened to
you?" with levels of scales and questionnaire items.

 

 

 

 

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happening?
High 16 32 37.03% 0 33.33% 0 A2.85%*
Purpose in Med 23 A6 33.33% 66.66% 55.55% 100% A2.85%
Life Test
Low 11 22 29.62% 33.33% 11.11% 0 lA.28%
High 23 A6 51.85% 66.66% 22.22%* 25% 57.1A%
Anomie Med 13 26 lA.8l% 33 33% AA.AA% 75% lA.28%
Low 1A 28 33.33% 0 33.33% 0 28.57%
High 21 A2 A0.7A% 33.33% 11.11%* 50% 85 71%*
Normlessness Med 21 A2 A8.lA% 66.66% AA.AA% 50% 0
Low 8 16 11.11% 0 AA.AA%* 0 lA.28%
Total in # 50 27 3 9 A 7
each cate— % 5A% 6% 18% 8% 1A%
gory
*Statistically significant at the .05 level.

101

TABLE 2l.«—Comparison of responses to question,
don't you ask, "What is the meaning and purpose of my life?"

"Why do/

with levels of scales and questionnaire items.

 

 

 

 

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High 16 32 A7.05% 22.72% 60% O.*
Purpose in Med 23 A6 A7.05% 5A.5A% 20% 33.33%
Life Test
Low 11 22 5.88%*22.72% 20% 66.66%*
High 23 A6 52.90% 5A.5A% 20% 16.66%*
Anomie Med 13 26 35.29% 18.18% AO% 16.66%
Low 1A 28 11.76%*27.27% AO% 66.66%*
High 21 A2 58.82% AO.90% AO% O.*
Normlessness Med 21 A2 35.29% A5.A5% 20% 66.66%
Low 8 16 5.88% 13.63% A0% 33.33%*
Total in # 50 17 22 5 6
each cate—
gory % 3A% AA% 10% 12%
*Statistically significant at the .05 level.

102

 

 

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103

definite reason for asking, while 30% asked, but with no stated
reason for asking. Of the A8% who did not ask why the illness
happened to them, 12% stated no reason for not asking, while
36% stated a definite reason for not asking.

Table 20 shows the relative frequency with which various
answers were given to the questions of why the illness happened.
It will be observed that 5A% of the subjects found no reason
at all for the illness happening, 6% found no reason but
believed there was one, 18% of the subjects in some manner
associated punishment with the answers they gave, 8% thought
of the disease purely in terms of cause and effect, while
lA% felt the disease was present for a purpose, e.g., "to
slow me down."

It will be noted from Table 21 that 78% of the subjects
did ask themselves what the meaning and purpose of their
lives was and of these, 82.05% found such meaning and purpose,
while l7.9A% did not.

Of those asking the question as to what was the meaning
and purpose of their lives, 3A% asked with a definite reason
for asking, and AA% asked but with no definite reason. Of
the 22% who did not ask the question, 10% gave no reason for
not asking, and 12% gave a reason for not asking.

Table 22 gives the percentage of responses to the
question, "What do you find that gives meaning and purpose to
your life?" (Since eight subjects gave two responses, and

those responses had to be placed in two categories, the total

10A

number of responses to this question is 58, in comparison to
the 50 responses to the other questions.) 22.Al% of the
responses fall into the category of finding no meaning and
purpose in life, 8.62% responses fall into the "no meaning
and purpose but believe there is such a meaning and purpose”
category, 37.93% of the reSponses were in the category,
"meaning and purpose in some form of accomplishment," 29.31%
of the responses were in the category of "meaning in some
type of experience," and 1.72% of the responses were in the
category, "meaning in the attitude taken toward suffering."

An examination of Table 19 would give cautious confir—
mation to Frankl's belief that some peOple do look at their
life situation and ask, "Why?" 0f the 52% who did ask 'why,'
22% of these asked for a specific reason and in 8 of these
cases, the implication seemed to be that they sought some
pattern in their life experience that would help them deal
with their experiences.

An hypothesis could be formed and tested as to the
relative anxiety levels of the groups who do and do not ask
why the illness happened to them. Is it perhaps more
anxiety—provoking to look at one's life situation and ask,
”Why?" than to see one's life situation as totally or almost
totally the result of cause and effect relationships?

It will be noticed from Table 20 that 60% of the
subjects found no answer to the question, ”Why did this

illness happen?" Hypotheses could be stated about self,

105

ideal—self incongruence in such situations. Is there a corre«
lation between how one views one's self and how one views

the world? Do those whohave a congruent view of themselves
arrive at congruent answers concerning their environment?

An examination of Table 21 would confirm, for this
sample, Frankl's belief that peOple do ask what is the
meaning and purpose of their lives, with 78% giving a posi—
tive answer. Again, hypotheses could be formed and tested
in regard to the anxiety levels of those who ask, or fail to
ask, the meaning of their lives. Also, hypotheses could be
formed regarding other personality and behavioural conse—
quences of these patterns.

An examination of Table 22 would indicate that finding
meaning in life through the attitude one takes toward
suffering is not a prominent occurenceix1this sample, while
finding meaning through accomplishment and experience of
values is common.

Hypotheses could be tested concerning the relative
frustration levels of those who find meaning and purpose in
life through accomplishment and those who find meaning and
purpose through some form of experience. It would be hypothe—
sized that in this sample of subjects whose activities are
severely restricted by their disease, those who find the
meaning in their lives through accomplishment would be rela—
tively more frustrated than those who can find meaning in

more passive ways. Also, our society tends to be an activity

106

oriented society, and it would be hypothesized that many
individuals are frustrated and feel worthlesss when they can
no longer actively accomplish.

A number of hypotheses could be formulated on the
basis of the shift in percentage of responses in each category
of answers as the different levels of the tests are considered.
(All changes in percentages commented on are statistically
at the .05 level, using the formula X2 = N (pip;pi)2 for
the X2 test of significance for percentages, using the per—
centage of the total sample in the specified level as the
expected percentage.) Only the high and low categories are
compared in this study.

An inspection of Table 19 shows that those who score
in the low level of the P.I.L. Test, Anomie and Normlessness
Scales have fewer responses in the ”Ask with a reason” cate—
gory, which would be expected theoretically. It will also
be noted that high scorers on the Normlessness Scale have
more than the expected number of responses in the ”Ask with
a reason" category, which also may be reasonably expected.

In addition, it will be noted that the high scorers on
the P.I.L. Test have more responses than would be eXpected
in the "Don't ask, with a reason for not asking" category.
A number of hypotheses could be formed and tested concerning
this phenomenon. One such hypothesis might be that people
who have high purpose in life suffer from fewer guilt feelings

and thus are not concerned with the question of why the illness

happened to them.

107

An examination of Table 20 reveals shifts in response
percentages which are significant. The response shifts are
in the direction expected theoretically. Those who are highly
unanomic have fewer responses in the "Punishment-associated
responses," as do the highly non-normless. Those who are
normless have more responses in these categories than would
be expected.

Those who have both a high purpose in life and a high
score on having norms, have more than the expected number
of responses in the "For a known purpose” category.

Table 21 reveals that the significant shifts in
responses are in the theoretically expected directions. Those
with low scores on purpose in life and high scores on anomic
responses have fewer than the expected number of responses in
the "Ask, with a reason for asking” category.

Those with high scores on purpose in life, who are
unanomicanuihave low scores on normlessness, have fewer than
the expected number of responses in the "Don't ask, with a
reason for not asking” category. And conversely, those
who scored at the other extreme on these scales had more than
the expected number of responses in the same category.

An examination of Table 22 shows that those having high
purpose in life, unanomic and non—normless, have lower than
expected scores in the "Nothing” category. Conversely, those
with low scores on these same scales had more responses than

might be eXpected in this category.

108

Highscorers on the P.I.L. Test have more than the
expected number of responses in the "Accomplishment" category.
Those with low scores on the P.I.L. Test and low scores on
the Normlessness Scale had fewer than the expected number of
responses in the "Accomplishment" category.

It will be observed that those having scores which
indicated that they had many norms, had more responses than
would be eXpected in the "Experience a value" category.

Hypotheses could be formed and tested in larger
samples to see if this relationship holds true. If it does,
it could have important implications for helping peOple who
face situations which preclude finding meaning through

accomplishment.

CHAPTER V

SUMMARY, RECOMMENDATIONS AND IMPRESSIONS

Summary
The purpose of this study has been to investigate

empirically some of the concepts of Viktor Frankl, especially
his concept of man's search for meaning, as they apply to
tuberculosis patients.

The population used for this study was fifty tubercu—
losis patients of the Ingham County Tuberculosis Hospital
and the Oakland County Tuberculosis Sanitarium. All of the
medically able, willing subjects were interviewed at the
Ingham County Hospital. There were twelve such patients.
At the Oakland County Hospital, a sample was chosen at random
from among those who were medically able and willing to
cooperate in order to complete the sample of fifty.

Two criteria measures were selected: the Berle Index
(a medical scale which gives an indication of prognosis) and
the Shontz and Fink Scale (which indicates psychosocial
adjustment in the hospital situation). The latter was
scored by hospital personnel.

Seven variables were then correlated with these two

criteria measures. These variables were chosen because

109

1334i: 53% .Ifll... F .r. bill. EN. alive-a.“

110

they appear to measure that which Frankl discusses in his
writings. They are as follows:
1. The Purpose in Life Test, which measures the
concepts of Frankl.
2. The Anomie Scale, measuring social isolation.

3. The Normlessness Scale.

A. "Do you ever ask, 'Why has this illness happened
to me?'"
5. "Do you ever ask, 'What is the meaning and

purpose of my life?'"

6. Whether the subject has found meaning and purpose

for his life.

7. Whether the subject has found a reason why the

illness happened to him.

The simple correlations indicated that the Berle Index
and the P.I.L., Anomie, Normlessness variables and the
question indicating the finding of some purpose in life were
significantly related at the .05 level of significance.

This confirmed the hypotheses that such would be the case.
The hypotheses that the Berle Index and variables A, 5, and
7 were significantly related at the .05 level, were rejected.

The simple correlations also indicated that the Shontz
and Fink Psychosocial Scale and the Anomie and Normlessness
variables were significantly related at the .05 level of
significance. This confirmed the hypotheses that such would

be the case. The hypotheses that there would be a significant

111

correlation between the Shontz and Pink Scale and the P.I.L.
Test as well as variables A, 5, 6, and 7, were rejected.

It is concluded that the concepts Frankl discusses are
related both to prognosis in tuberculosis and adjustment to
the hospital situation, with some of the tested variables
being related more closely than others, as indicated. How—
ever, the usual caution is necessary in concluding a causal
relationship. Clearly, need exists for further research in
this area.

Multiple correlations were computed with the two criteria
variables and the predictor variables. The multiple corre-
lation of the Berle Index and the seven predictor variables
was .7A80, with the P.I.L. Test and the Normlessness Scale
being the two best predictors.

The multiple correlation of the Shontz and Pink Scale
with the seven predictor variables was .5109, with the Norm-
lessness Scale being the single best predictor.

The responses to the four open—ended questions were
placed in categories and the number of responses in each
category was compared with the high, medium and low scores on
three variables (the P.I.L. Test, the Anomie and Normlessness
Scales) and the "Yes" and "No" responses on the variables
capable of being scored dichotomously. The purpose of this
content analysis was to suggest possible hypotheses for further

research. Such tentative hypotheses were proposed.

112

It was discovered that 52% of the subjects did ask the
question, "Why has this illness happened to me?" 78% of the
subjects asked, "What is the meaning and purpose of my life?"

The results revealed that A0% of the subjects did find
some reason for the illness happening. Further it was found
that 6A% had some meaning and purpose for their lives.

As to the content of what the subjects see as giving
meaning to life, 37.93% of the responses indicated meaning
being found in some form of accomplishment; 29.93% of the
responses indicated meaning being found through some form of
experience, e.g. love of family; while only 1.72% of the
responses fell into the category of finding meaning in the
attitude toward suffering. These last three categories are
the ones suggested by Frankl.

Most of the variations in the different categories for
the various levels of the scales and questions were in the

theoretically expected direction.

Recommendations for Further Research

This research is exploratory in nature and much addi—
tional research is needed to obtain more definite conclusions
'as to the validity of Frankl's concepts.

Frankl's concept of the search for meaning needs to be
studied in relation to criteria other than prognosis in tuber-
<3ulosis and hospital psychosocial adjustment. Such criteria
ass job satisfaction, marital success and self—ideal self con-

ggruence are possibilities.

113

Also, it should be remembered that Frankl is saying not
only that people do search for meaning in life, but also that
those who do not seek such meaning may be helped to do so.

He suggests, too, that in some situations individuals will
be better able to c0pe with life stress if they can find such
meaning.

It is recommended that there be further research based
not on description, as this research has been, but rather on
an experimental situation in which peOple who have low measured
purpose in life are treated according to Frankl's concepts of
logotherapy.

Research by Rogers (195A) and others, has shown that
individuals can be helped to redefine their perception of
themselves in a way which seems to be helpful to the indivi—
duals. Investigation of the possibility of redefining the
external situation would seem to be helpful, especially in
the situations where a person finds little meaning in the
external situation. For instance, when a person is actually
dying of a chronic disease, is it possible to help him redefine
the situation in such a way that he can find meaning, even
in this extreme situation, and thus be enabled to meet this

crisis with courage and dignity?

Impressions
The author is aware of the paradox involved in this

stuxdy, in that it is an "essential" analysis of "existential"

11A

material. To deal with the subject only on this level would
seem to be inadequate, therefore this section of the study
will depart from the formal presentation of the previous
chapters and deal in a more personal way with the thoughts

and reactions of the patients, as well as those of the author.

There was the sixty-one year old woman patient who, in
addition to her current tuberculosis diagnosis, recently had
suffered from cancer which subsequently had been removed
surgically with apparent success. During our visits she
described her feelings of fear and loneliness at the time of
her hospitalization for cancer, and during her current
hospitalization. During the course of the conversations, she
admitted that life held little meaning for her. She described
at length how all of her life she had helped other peOple
during their times of hardship,enuihow she had derived great
satisfaction from this. But now, she felt, this was all past
and with it, the greater part of her life's meaning.

She was then asked if she felt that those peOple whom
she had helped had, in turn, helped her. She replied, "Yes,
of course they did.” It was then pointed out to her that
perhaps even now she could be a means of others finding
meaning in life as they helped her. It was suggested to her
that while this was a far different manner of finding meaning
in life than she had known in the past, nevertheless it was a

very possible way.

Hgflaufifiw . nvmfflvaigg

115

It was even more interesting to know that several months
after the author had finished his research at the hospital,
the staff reported that the patient discussed these concepts
in a patient group meeting, and seemed to have consolidated
them into her philosophy and behaviour.

Another patient, a forty—eight year old Negro woman,
after considerable interview time, asked, "Do you think sick-
ness is sent because of our being punished for our sins?"

After seeking to understand what prompted the question,
and feeling that it was not pathologically motivated, she was
informed by the author that he did not believe sickness to
be sent as punishment. Rather, whatever the reason for ill—
ness, it does afford an Opportunity to become a better person,
depending upon the manner in which one reacts to misfortune.

She replied that she had never thought of it exactly
in this way before, but had spent almost all of her time in
thinking about why she was being punished. The latter response
was a fairly typical reply from those patients who spoke of
their illness in terms of punishment.

Since this study was not designed to be of an eXperi—
Inental nature, it is not possible to determine the depth of
this insight, or if it proved effective in changing the thinking
or behaviour of the patient. However, it is an observation
xwhich might serve as an hypothesis for testing.

Another reaction was obtained from a seventy-year old

rnan who in addition to his hospitalization for tuberculosis,

1331. .....I.w.ulq|.w Lilli..:........Vuxg-JQ
. _

116

had cancer of the face. One eye had already been destroyed
by the disease, as well as the larger part of his nose.

When asked about the meaning of his life and whether
he ever asked why this sickness had happened to him, he
refused to discuss either subject. He became agitated when
the subjects were approached and immediately steered the
conversation toward such banal subjects as the weather, time
for meals, temperature of the room, etc. He seemed desperately
anxious for someone to be near him and listen to him, but
at the same time was very reluctant to discuss anything in
which there might be deep personal involvement.

It is the author's observation that some individuals
are able to deal with such obvious threats to their existence
on a conscious level, but that many cannot, and therefore
deal with the matter on an unconscious level by denial. It
would seem that Frankl's concepts would not be applicable to
a patient of this type. Rather, the greatest value would
lie in simply being with the patient, as another human being,
and allowing him to speak at whatever level he wished.

Another patient, a fifty—five year old man, was willing
and seemingly interested in discussing the ideas of meaning
and purpose, but it seemed to remain at a very "intellectual”
level. The patient had had a traumatic childhood, spending a
Iiumber of years in an orphanage. Subsequently he had drifted
to "skid row." He had had several admissions to tuberculosis

liospitals, having Spent a total of about ten years in such

117

institutions. He was very willing to indicate that one of
the main reasons for his failure to recover from tuberculosis
was his not caring for himself properly. He drank, did not
eat what he should, and lived with men whom he knew to have
active tuberculosis.

He admitted frankly that he had no purpose and found
no meaning in life, but he felt that if he could find such
meaning, it would be of value to him. Repeatedly, he said
that one of these days he would have to find such meaning.
He made the same comment concerning employment.

This patient gave the impression of one who had been
involved in a life-long pattern of self-destruction, with
no insight into this pattern and little or no motivation for
change. And while the patient talked about reaching for
meaning, the author had the feeling that this was in the form
of intellectualizing and socializing. It would seem that
the concepts of Frankl would be of relatively little value
in dealing with him. However, at this stage, probably any
other technique also would have been without merit.

There was the fifty-seven year old male patient who,
although crippled as a child and thus handicapped in making
a living, had managed to support himself by repairing electric
motors.

He had been admitted to the hospital nearly at the point
of death. According to the staff, he was on the critical list

for months after his admittance. At the time of interviewing,

118

the patient had recovered satisfactorily and was expecting to
be discharged in a few weeks. Although he had never heard
of Frankl, he had applied many of Frankl's concepts.

The patient reported that to him the most important
thing in life was to have some meaning. He had discovered
this meaning, he said, primarily through his religious con—
victions. He went on to give concrete examples of how he
had applied these convictions during the time when he was most
critically ill. For example, he had come to dislike a certain
nurse whom he felt had been unnecessarily rough and curt
with him when he was so near death. He reported how, at
first, he felt like he wanted to get even with her but
then began to see how this attitude was hurting only himself.
He came to view this situation as a means of putting into
practice some of his abstract concepts. The patient felt
that he succeeded in doing this and that his former "enemy"
was now his friend.

A forty—nine year old female patient, who has since
died (not primarily of tuberculosis but of an apparently
previously undiagnosed ailment), repeatedly refused to con—
sider the question, ”Do you ever ask, 'Why has this illness
liappened to me?'" She said that there was no use in consid—
ering it; she knew the reason, which was that she was being
gaunished. She seemed to be very eager to talk with someone,
:relating freely many of her life eXperiences, but was very

resistive to any interpretation of the cause of her illness

1 hiflm fig” Tharp s it!» (Vi

119

other than that of punishment. In this case, it seemed that
the need to feel punished was so great that any direct appli-
cation of Frankl's concepts was not possible, at least on a
short term basis.

The descriptions of the foregoing situations are im-
pressionistic and are largely subjective. However, to be con-
sistent with the existential approach, it would be appropri—
ate for the author to report some of his even more personal
and subjective experiences.

The author has experienced various emotions as he has
been allowed to share the inner world of feelings and experi—
ences of the subjects of this study. The inner world of these
people has generated feelings of fascination, awe, apprecia-
tion and, at times, fear and deep sorrow at the realization
of tragic situations which apparently were insoluble in any
objective sense.

It has caused the author again to ask himself what it
is which gives meaning and purpose to his own life, and to
try to assess his major life responsibilities.

The author has become aware of the deep conflicts in
psychopathology but the subjects of the study, not so much in
terms of traditional psychopathology but rather in terms of the
innumerable choices which life places before us all, and the
inevitable necessity of reacting to the tragid and unavoidable.

He has also taken cognizance of the great resources, the
sources of strength and the courage which so many ”common”

people possess in the face of illness and hardship.

120

He has become aware again of the paradox that is man,

of man's greatness and misery.

REFERENCES

 

121

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I

Bell, W. "Anomie, Social Isolation, and the Class Structure,‘
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Berle, B. B., Pinsky, R. H., Wolf, S. and Wolff, H. G. ”A
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Edwards, A. L. Statistical Methods for the Behavioural
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APPENDIX I

THE BERLE INDEX

 

126

127

Name

 

Objective Data
(To be obtained from patient)

Age, up to A0 years

Not divorced or seperated

Third generation American, white, gentile

High school education completed

Both parents living at home until patient
was twelve years old

No surgical treatment for symptoms

No previous formal psychiatric care

Steady employment

Duration of present illness less
that five years

Total
Patient's Interpretation
(To be obtained from patient)
Previous good health
Some religious education

Emotional support from both parents

Congenial siblings

Emotional support from spouse

Sexual compatibility with spouse
No serious sexual problem
Spouse adequate economic provider*

Children not rejected

Maximum
Score

2
2
2

|\)l\)

20

R)

Actual
Score

 

128

No housing problem

Occupational satisfaction

Congenial working conditions

Moderately adequate salary

Goals - Does he have any goals

Total (females)
*Not scored for males (males)

Evidence from past performance:
Not exaggerated sensitivity
to traumatic situation

 

Good interpersonal relationships
(including sexual)

Evidence that activities, achievements,
and other life experiences have afforded
satisfaction.

Evidence from personality structure:
Moderate flexibility

 

Minimal and short-lived hostility

Capacity to face and solve personal problems

Active participation in the give and take of
daily affairs

Maximum Actual
Score Score
2

30
28

10

 

 

A

129

Maximum
- Score
Moderate orderliness and reliability

Good judgment and evidence of adequate
discrimination regarding human
values and goals

Prevailing attitudes of the patient toward
illness and his problems at the time
of his stgy at the hospital: 10

Recognition of failure of present
patterns of adjustment and willing-
ness to adOpt others.

Willingness to consider possibility that
life stress, attitudes, and
feeling states are relevant to the
illness

Confidence in physician, hospital, and
its methods

Capacity and willingness to assume
responsibility in treatment

Extent to which a specific aspect of the
life‘ situation was a factor in pre—
cipitating the patient's illness: 10

 

Extent to which this specific feature is
modifiable with regard to the involved
person, other persons, and circumstances.

Total A0

Grand Total 116

Actual
Score

 

APPENDIX II

THE SHONTZ AND FINK SCALE

130

 

131

Patient

 

Area I MOTIVATION
DIMENSIONS:

a. Copperativeness (Check one)

 

1. Overly meticulous in obedience to medical require-
ments

2. Reasonably cooperative in carrying out medical
procedures

3. Thwarts purposes of medical care

b. Comprehension of illness (Check one)

 

1. Preoccupied with the facts of his illness
2. Comprehends physical condition realistically
3. Misinterprets reality of his illness

0. Activity level (Check one)

 

l. Avoids any form of exertion (by desire rather than

necessity)
2. Moderately active, considering his disability
3. Constantly busy with unproductive activities

d. Self appraisal of capacities (Check one)

 

l. Thinks he can do anything
2. Appraises his condition realistically
3. Devaluates his own abilities

132

Area II SOCIAL ADJUSTMENTl

DIMENSIONS

a. Dominance (Check one)

 

l. Seeks to dominate those about him
2. Treats others as equals
3. Allows others to make all decisions for him

6 I ll

Acceptance (Check one)

 

1. Allows himself to be overprotected by others
__ 2. Is accepted by others for what he really is
__ 3. Does things that cause others to resent him

0. Dependence on others (Check one)

 

 

1. Clings to others for help
2. Maintains mature social relationships
3. Isolates self from others

d. Affective relations (Check one)

 

1. Overly devoted to those around him
2. Expresses appropriate feelings for those around him
3. Always fighting with those around him

‘1‘

1Area II was changed from the following original scale to

adapt it to the current testing situation.

a. Dominance

 

1. "Rules the roost" at home
2. Family treats him as equal
3. Other members of the family make all decisions for him

b. Acceptance

 

l. Overprotected at home
2. Is accepted by family for what he really is
3. Family resents his presence

c. Dependence on others

 

1. Clings to others for help
2. Maintains mature social relationships
3. Isolates self from others

Affective relations

 

l. Overly devoted to family
2. Expresses apprOpriate feelings for family
3. Always fighting with family members

133

Area III PERSONAL ADJUSTMENT
DIMENSIONS:

a.

Acceptance of disabilipy (Check one)

 

1. "Uses" disability for selfish ends

2 Lives as well as possible within the physical
limits of disability

3. Denies disability

Emotionality (Check one)

 

l. Constantly tense
2. Emotional reactions are appropriate
3. Apathetic

Intellectual organization (Check one)

 

1. Has set ideas he won't give up
2. Adaptable in his thinking
3. Intellectually chaotic and unpredictable

Reactions to Frustration (Blame Placement) (Check one)
1. Blames others whenever something goes wrong

2. Accepts necessary misfortunes
3. Always sees himself at fault

 

APPENDIX III

THE PURPOSE IN LIFE TEST

 

13A

135

Name

 

For each of the following statements, circle the
number that would be most nearly true for you. Note that the
numbers always extend from one extreme feeling to its Opposite

kind of feeling. "Neutral" implies no judgment either way. Try

 

to use this rating as little as possible.

1. I am usually:

1 2 3 A 5 6 7
completely (neutral) exuberant
bored Enthusiastic
2. Life to me seems:
7 6 5 A 3 2 1
always (neutral) completely
exciting routine
3. In life I have:
1 2 3 A 5 6 7
no goals or (neutral) very clear
aims at all goals and aims
A. My personal existence is:
1 2 3 A 5 6 7
utterly meaningless, (neutral) very purposeful
without purpose and meaningful

5. Every day is:

7 6 5 A 3 2 1
constantly new (neutral) exactly the
and different same

6. If I could choose, I would:

1 2 3 A 5 6 7
prefer never to (neutral) like nine more
have been born lives just like

this one

7. After retiring, I would:

7 6 5 A 3 2 1
do some of the (neutral) loaf completely
exciting things the rest of my

I always wanted to life

 

 

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10.

11.

12.

13.

1A.

15.

136

In achieving life goals I have:

1 2 3 A 5 6 7
made no progress (neutral) progressed to
whatever complete ful—
fillment
My life is:
1 2 3 A 5 6 7
empty, filled (neutral) running over
only with despair with exciting

good things

If I should die today, I would feel that my life has been:

1 2 3 A 5 6 7
very worthwhile (neutral) completely
worthless

In thinking of my life, I:

1 2 3 A 5 6 7
Often wonder (neutral) always see a
why I exist reason for be—

ing here
As I view the worldixirelation to my life, the world:

7 6 5 A 3 .2 .1
completely con— (neutral) fits meaning-
fuses me fully with my

life
I am a:

l 2 3 A 5 6 7
very irres— (neutral) very respon-
ponsible sible person
person

Concerning man's freedom to make his own choices, I believe
man is:

7 6 5 A 3 2 .1
absolutely free (neutral) completely bound
to make all by limitations of
life choices heredity and

environment

With regard to death, I am:

7 6 5 4 3 . 2 1
prepared and (neutral) unprepared and
unafraid frightened

 

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16.

17.

18.

19.

20.

21.

22.

137

With regard to suicide, I have:

1 2 3 A 5 6 7
though of it (neutral) never given
seriously as it a second
a way out thought

In achieving success in life, the importance of material
possessions is to me:

7 6 5 A 3 2 1
negligible (neutral) very great

I regard my ability to find a meaning, purpose, or
mission in life as:

7 6 5 A 3 2 1

very great (neutral) practically
none

In my life literature:

1 2 3 A 5 6 7
means nothing (neutral) is a source of
to me deep satisfac-

tion

My life is:

7 6 5 A 3 2 1
in my hands (neutral) out of my hands
and I am in and controlled by
control of it external factors

Facing my daily tasks is:
7 6

5 A 3 2 i
a source of pleasure (neutral) a painful and
and satisfaction boring exper—
ience

I have discovered:

1 2 3 4 5 6 7
no mission or (neutral) clear—cut
purpose in life goals and a

satisfying life

purpose

 

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3.
I
2 V.
D. I

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APPENDIX IV

ANOMIE SCALE

138

 

 

an h .‘n. E . first Lowbrvfiuura .3 erIJLS'IlI’.

Name

139

 

In spite of what some peOple say, the lot of the average

man is getting worse. (Check one)

Strongly agree and Agree

Undecided, Disagree, and Strongly disagree
It's hardly fair to bring children into the world with
the way things look for the future. (Check one)

Strongly agree

Undecided, Disagree, and Strongly disagree
Nowadays a person has to live pretty much for today and
let tomorrow take care of itself. (Check one)

Strongly agree, Agree, and Undecided

Disagree

Strongly disagree
These days a person doesn't really know who he can
count on. (Check one)

__ .Strongly agree and Agree
Undecided, Disagree and Strongly disagree

There's little use writing to public officials because they

aren't really interested in the problems of the average
man. (Check one)

Strongly agree and Agree

Undecided and Disagree

Strongly disagree

 

APPENDIX V

NORMLESSNESS SCALE

1A0

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All .I' :4: III... In"; x

._

Name

1A1

 

The end often justifies the mean. (Check one)

Strongly agree
Agree

Disagree

Strongly disagree

—-—
—
—-

PeOple's ideas change so much that I wonder if we'll
ever have anything to depend on. (Check one)

Strongly agree
Agree

Disagree

Strongly disagree

~—

Everything is relative, and there just aren't any definite
rules to live by (Check one)

Strongly agree
Agree

Disagree

Strongly disagree

I often wonder what the meaning of life really is. (Check one)

Strongly agree
Agree

Disagree

Strongly disagree

The only thing that one can be sure of today is that he
can be sure of nothing. (Check one)

Strongly agree

Agree

Disagree
__ Strongly disagree
With so many religions abroad, one doesn't really know
which one to believe. (Check one)

Strongly agree
Agree

Disagree

Strongly disagree

 

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. , :

APPENDIX VI

SIX ITEM QUESTIONNAIRE

1A2

Name

1.

1A3

 

Do you ever ask yourself, "Why has this illness happened
to me?"

 

Why do/don't you ask, "Why has this illness happened to me?"

What answers, if any, do you find to the question, "Why
has this illness happened to me?"

:

 

 

_

1AA

Do you ever ask yourself, "Does my life have any meaning
or purpose?"

Why do/don't you ask, "Does my life have any meaning or
purpose?"

What, if anything, gives meaning and purpose to your
life?

 

UV 711....

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