Doctors in search of meaning

The basic thesis of the Austrian neurologist and psychiatrist Viktor Frankl (1905-1997): human beings need a meaning for which they live. Having a meaning drives a person, gives him strength to make sacrifices for a cause or person. It also strengthens the capacity for suffering and tolerance of frustration. Having a sense of meaning does not necessarily have to be pleasant. According to Frankl's theory, happiness, for example in the form of recognition or money, is only a side effect. Therefore, if one strives only for happiness without simultaneously seeking meaning, there is a danger of losing one's grip and strength.

In conversations with colleagues, Müller-Hartburg identified questions regarding stressful situations, which she sought to answer with Frankl's theories. Of particular importance in Frankl's teaching is the ability to make decisions. Wherever there are choices, one can decide - by actively changing or passively enduring. People suffering from dementia, schizophrenia or endogenous depression have a reduced ability to make decisions. Applied to a common problem for medical professionals, namely overwork, the question might be: What are my theoretical options for changing this? Here, one can generously think through the possibilities and then consider: Which of these are realistic? What is best for me and my environment? As examples, Müller-Hartburg cited her training period and the burden of many years of on-call duties at the hospital. After a change was unthinkable and a change in the situation was not possible, she decided to make the best of it, to meet friends near the hospital or to get enough sleep whenever it was possible.

Logotherapy by Viktor Frankl for challenges faced by physicians

"A man is only fully a man when he is devoted to a cause or another human being," Frankl said. According to his theory, man can overcome the strongest instinct. For Frankl, a human being is a novelty and can for example choose to act out aggression in other ways than through violence.

According to Frankl, life retains meaning under all circumstances, because a person maintains inner freedom and can take a stand on his fate by choosing how to deal with situations. By distancing himself from his ego, a person can consciously cope with challenges that life presents. As a result, he moves from being a victim of his circumstances to being a creator of his life. In this regard, Frankl describes mental detachment as a human skill.

For Frankl, there are three ways to realize meaningfulness in life: Creational means such as achievement (a successful surgery or medical treatment), experiences (such as leisure activity, enjoyment, or doing nothing), and attitudes (the way one deals with situations).

According to Frankl, the question is not why life conditions are difficult, unfair, or threatening, but rather, "What does the life situation challenge me to do, and how do I want to and should I respond or act?" In Frankl's words, we must not ask about the meaning of life because we ourselves are being questioned. We can answer life questions only by being responsible for our own existence.

Many physicians are also confronted with the fear of making mistakes and the legal consequences of these mistakes. Here Frankls theory may help to at least distance oneself from moral responsibility. "If I am convinced that I have given a treatment to the best of my knowledge, I can also take responsibility. If I act according to the best of my medical knowledge and I am facing a lawsuit, I must not question myself. If one has indeed made a mistake, one must admit it and consider how to make up for it so that one can live better with it. In medical professions, it is especially important to know how to live with the decisions you make," says Müller-Hartburg.

Standing up for oneself in stressful situations

The lack of appreciation from superiors and patients was also frequently mentioned in the survey. Applied to this problem field, one can ask oneself: "Is my work less meaningful if my superior or patient does not appreciate it? One might ask: "What am I doing the work for?". This will make you less dependent on the approval of others. "In adversity, patients say things that have nothing to do with me, they don't need to see what I do for them, I don't depend on that," the gynecologist said.

Not being paid appropriately concerns colleagues as well. Here, one might ask, "How much money do I really have? What do I need more money for? Is the money too little or am I concerned about lack of recognition?" On the issue of work-life balance, one might ask, "Who needs me the most? What opportunities do I have to make a difference? What do I want to say about myself in ten, twenty years in this regard?"

The death of a patient as a personal failure is also a pressing issue. In this regard the question that might be asked is, "Just because a life ends, does that mean that the treatment was pointless?"

Viktor Emil Frankl (1905-1997) placed the question of meaning at the center of logotherapy and existential analysis, often referred to as the "Third Viennese School of Psychotherapy." His main focus was on depression and suicide. In his 1946 work "... Still Saying Yes to Life: A Psychologist Experiences the Concentration Camp," Frankl describes his experiences in four different concentration camps, including Auschwitz, during World War II.

The VICTOR FRANKL CENTER VIENNA in Vienna's 9th district was founded in 2004 as a center for questions concerning life's meaning and existence. It is a non-profit educational institution with a focus on public relations, which makes Frankl's meaning-oriented teachings - logotherapy and existential analysis - accessible to a broad public. The center is located at Mariannengasse 1, right next to the apartment where Viktor E. Frankl lived and worked for over 50 years. In 2015, on the initiative of the VIKTOR FRANKL ZENTRUM WIEN, the world's first Viktor Frankl Museum was opened there.

Imma Müller-Hartburg has practiced for 30 years as a specialist in gynecology and obstetrics in hospital and private practice. She has also worked as a medical director in the hospital. She has completed a five-semester training at the Viktor Frankl Center in Vienna and offers counseling in crisis situations.