Searching for Meaning with Victor Frankl and Walker Percy

Essay Searching for Meaning with Victor Frankl and Walker Percy The Linacre Quarterly 1-11 ª Catholic Medical Association 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0024363920948316 journals.sagepub.com/home/lqr Ethan M. Schimmoeller, MA1,2 and Timothy W. Rothhaar, MA3 Abstract Patients present to physicians searching for more than scientific names to call their maladies. They rather enter examination rooms with value-laden narratives of illness, suffering, hopes, and worries. One potentially helpful paradigm, inspired in part by existentialism, is to see patients on a search for meaning. This perspective is particularly important in the seemingly meaningless ruins of modernity. Here, we will summarize Victor Frankl’s account of logotherapy found in his much-circulated book Man’s Search for Meaning and assess the limitations imposed by his religious agnosticism. At best he can offer patients a finite, impersonal meaning this side of the grave. Following Kierkegaard’s depiction of the religious sphere of existence, American novelist Walker Percy will be shown to supplement logotherapy with a theological mooring. The spiritual crisis of the modern world is treatable only by Christian faith supplying ultimate meaning. Taken together, Frankl and Percy show how Catholic physicians can be guides in their patients’ personal searches for meaning. This paradigm may prove chiefly beneficial in goals of care conversations, encountering “aesthetic” patients living only for pleasure, and engaging patients amidst tragedy-ridden circumstances. Although only Christian faith will ultimately satisfy the search for meaning, we first of all need encouragement to take responsibility for seeking meaning, and confidence that even the most hopeless situation can become meaningful. Summary: Victor Frankl’s Man’s Search for Meaning can enlighten clinical encounters for physicians to see patients on a search for meaning, particularly amidst suffering and tragedy in a post-modern world lacking transcendence. As shown in Walker Percy’s literature, however, ultimate meaning can only be found in Christian faith where the Word became flesh and continues to dwell among us. Keywords Christian existentialism, Meaning in medicine, Nihilism, Victor Frankl, Walker Percy Introduction Patients present to physicians searching for more than laboratory values and scientific names to call their maladies. Although they expect these, as well as an ethical physician, these are usually background assumptions; they are rarely objective questions. Rather, patients enter the examination room with value-laden narratives of illness, suffering, hopes, and worries. Although a musician’s chronic joint pain and stiffness may be caused by cartilage degeneration, osteoarthritis means he will not be able to play piano in the same manner any longer. A 1 The University of Cincinnati College of Medicine, Cincinnati, OH, USA 2 Center for Bioethics, The Ohio State University, Columbus, OH, USA 3 Department of Philosophy, Marquette University, Milwaukee, WI, USA Corresponding Author: Ethan M. Schimmoeller, The University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870, 3230 Eden Avenue, Cincinnati, OH 45267, USA. Email: [email protected] 2 diagnosis of ALS means not only muscle fiber fibrillations and motor neuron loss but a slow and certain deterioration of mobility unto death. One potentially helpful paradigm, inspired in part by existentialism, is to see patients as fundamentally on a search for meaning. Our historic context doubts meaning, increasing the urgency of a search. Postmodernity can be broadly understood as a critique of modernity’s confidence in rational moral systems, social progress, and scientifically mastering nature. Each of these is called into question by suspicion toward truth or transcendent values, rejecting trust in traditional guides like law and religion. One can consider the bloodshed of the twentieth century over secular ideologies. The tortured prisoner of Auschwitz challenges modernity’s self-assured path, as well as medicine’s integrity (Pellegrino 1997). Despite a strong education in ethics, innumerable physicians carried out National Socialist eugenics policies in euthanizing disabled children and the mentally ill, performing terrifying experiments in concentration camps, and executing the final solution (Proctor 1984; Grodin 2010; Crum 1982). The suffering can be explained in no simple manner. The evil seems senseless, and power appears the fundamental organizing force in the universe (Weil 1952, 240–41). Where can meaning be found? (Camus 1955). Packaged with this skepticism, the postmodern west has largely given up on man’s spiritual dimension or circumscribed it. In its wake, we are left with what has been variously called an “existential vacuum” or “despair” manifested today primarily as boredom. “Morality, bioethics, the state, and the meaning of life are all approached as if everything came from nowhere, were going nowhere, and for no enduring and ultimate purpose” (Engelhardt 2017, 11). Consequently, pleasure, health, and security have replaced liberty, fraternity, and equality as the cardinal values of the west, elevating the material importance of the body as a vessel for pleasure (Juvin 2010). Already we are accustomed to the radical contingency and materialism of postmodernity, however, and often fail to notice it or its novelty. Indeed, we can overlook medicine’s collusion in palliating and concealing despair by failing to appreciate patients on a search for meaning (Schimmoeller 2019). Here, we present Kierkegaard’s spheres of existence—the aesthetic, ethical, and religious—as a lens to understand Victor Frankl’s account of logotherapy, the latter predicated upon man’s search for meaning. We will assess the philosophical limitations of Frankl’s religious agnosticism and look to American novelist Walker Percy to supplement the account. We will conclude by identifying several The Linacre Quarterly XX(X) key opportunities to inform clinical practice with Percy and Frankl’s accounts, especially cultivating sensitivity to the patient’s search for meaning in the midst of suffering. Kierkegaard’s Spheres of Existence Danish philosopher Søren Kierkegaard (1813–1855) asserts that there are three stages on life’s way or three “spheres” of existence. They are the most basic ways of living one’s life regardless of one’s circumstances, culminating in conversion to Christianity and its religious categories. The spheres are the aesthetic, the ethical, and the religious. Before we discuss them, we must first note the importance of despair for Kierkegaard to help make sense of its relation to suffering and faith. The culmination of the discussion on despair is in his book The Sickness unto Death, written late in Kierkegaard’s (1980) career after his work on the spheres. For Kierkegaard, despair—a major theme in logotherapy—is a misuse of freedom related to oneself. A full explanation of what Kierkegaard means by despair, selfhood, and their relationship is not possible here, so a brief overview will suffice for the purposes of their use in this article. The first type, unconscious despair, means that one is unaware of having a self. One cannot begin to actualize one’s freedom in any meaningful way. An example is only looking out for oneself without concern for others. The second type is despair in not willing to be oneself. Persons in this state might spend their life in the pursuit of fleeting pleasures, but the underlying reason is because such persons do not want to be themselves; this is a flight from self. The third type, in despair to will to be oneself, is using freedom to choose things one wants to have meaning but do not. An example is falling in love with a celebrity, only to waste one’s life savings in pursuit of unrequited affection. It becomes one’s personal cause because it gives one direction, but the cause is ultimately unfruitful. Now, Frankl admits that one chooses meaning for oneself, but as we will see in the third section, that meaning fits one of three categories. The point of the third kind of despair is not so much that meaning cannot come from anywhere, but that people trick themselves into “seeing” meaning that really is not there, and so they dedicate themselves to things unworthy of their energies. Typically, the three spheres—at least the first two—function as one of the kinds of despair. The first sphere usually functions as unconscious despair or in despair not to will to be oneself, the second Schimmoeller and Rothhaar sphere usually as in despair to will to be oneself. The termination of the despairing self is found in faith (the last sphere), which is what we will argue in the fifth and sixth sections, wherein one uses one’s freedom for a divinely meaningful end. In this sense, Kierkegaard intertwines the psychological with the theological (understood as a spiritual relationship with God), something Frankl does not do, but which we think would avoid despair in all its forms. To reach faith, one moves through these spheres as a process of moving through despair, which begins with the aesthetic sphere. The aesthetic is a synonym for hedonism, and it is completely self-oriented. It is predicated on living one’s life for pleasure and avoiding pain. It excludes intimate relationships to the benefit of one’s happiness. Other people are useful only insofar as they give one pleasure or are the cause of pleasure. A light conversation on the tastiness of grapes, actually tasting grapes, or sexual intercourse in a vineyard is satisfactory enough to prevent one pursuing further developments like friendship lest they interfere with the immediacy of one’s delight. The aesthete lives for the moment because it is exciting, and aestheticism is predicated on avoiding boredom because “boredom . . . is the root of all evil” (Kierkegaard 1987a, 291). To avoid boredom, on top of seeking thrills, the aesthete lives a life of fantasy and imagination, wishing away all one’s cares in the form of immediate gratification. The aesthete does not work hard for anything but only toils away at living in the moment for the moment. Nothing else matters except for the moment of satisfaction. Once obtained, it immediately subsides, and the process starts over again. Kierkegaard describes it as “crop rotation”: “One is weary of living in the country and moves to the city; one is weary of one’s native land and goes abroad; one is [weary of Europe] and goes to America etc.” (pp. 291–92). Farmers must conserve the soil’s nutrients, so different crops are planted in the same spaces year after year. It avoids erosion and increases crop yield, too. The aesthete rotates pleasures as a farmer rotates crops. When becoming bored with the same routine, the aesthete’s mood changes, and he moves on to another pleasure. Tired of the city? Move to the country. And so on. Doing whatever one wants when one wants it, the aesthete lives a life of the mind in fantastical settings, always imagining a more intense pleasure and the anticipation of its satisfaction. One becomes a slave to one’s passions and so begins the transition into the ethical sphere with commitment. The ethical sphere is the life of obligation. It is characterized by committing oneself to a cause, law, institution, or other type of universal accord. The 3 ethical is oriented toward other people, be it a group like the sick or elderly or a single person as in Kierkegaard’s example of marriage. “The first thing I have to do is to orient myself . . . in the defining characteristics of what a marriage is. Obviously, the real constituting element, the substance, is [self-giving] love or, if you want to give it more specific emphasis, erotic love” (Kierkegaard 1987b, 32). To the aesthete, marriage is the end of fantasy, or at least enticing fantasy, because it locks one into a permanent position. Yes, sexuality is a thing, but it is limited to one person. The goods of various pleasures are cutoff in the responsibility required in marriage. For the person in the ethical sphere, marriage is tied to the law of loving one person romantically and self-sacrificially for the rest of one’s life. It is also immediately tied to the commandment forbidding adultery. All marriages must obey these laws, and the action of loving one’s spouse takes priority over everything else. It is the task one is required to fulfill according to the demands of the institution. The task to be fulfilled is everything for the ethical person. Unlike the aesthete who lives in anticipation, the ethicist lives every moment as the moment to live out one’s commitment to fulfill the objective moral norm. One has control of one’s passions and is not whisked away by every fleeting feeling or thought. One does not need a change of pace or scenery to be happy or what one thinks is happy. As a universal law, the ethical sphere calls all people to act the same. Whereas the aesthete acts only according to desire, the ethicist acts the same way always, without passion. In Belfast or Berlin, one is faithful to one’s wife. All ethicists are. Or are they? What happens when the ethicist fails in the task, rather, the realization of it? It is then that the conversion process to the religious sphere begins. The aesthete and the ethicist’s ways of life are filled with suffering, albeit, unredeemed suffering. The aesthete is too self-centered to know any better until reaching unmitigated boredom, and the ethicist is too self-reliant. One depends on oneself in such a way that one thinks one can fulfill this obligation without issue. What is really happening in the ethical sphere is the individual, like Frankl’s client striving for meaning, is striving for a unified life, a life with purpose. This striving, however, is in vain because, as a finite creature, the ethicist cannot fulfill the infinite demands of the ethical obligation. One inevitably falters; hence, the ethicist is guilty of breaking his own rule. To escape guilt, he must transition into the religious where we meet one of Kierkegaard’s most popular images, the knight of faith. Kierkegaard frames the religious sphere under Genesis 22’s story of Abraham’s binding of Isaac. 4 Abraham is told by God to take his son Isaac to Mt. Moriah and make him a sacrifice unto the Lord. Traveling there, Isaac asks his father what they will use for the sacrifice, to which Abraham responds that the Lord will provide. Abraham is torn over what he has been asked. He cannot make rational sense of it nor is murder permitted as per natural law. Upon arrival, Isaac sets up the altar and wood when Abraham binds him hand and foot. Abraham is just about to bring his dagger into Isaac’s throat when an angel appears and speaks to Abraham that the Lord is pleased with his obedience in faith, and he no longer needs to sacrifice Isaac. For a reward, he will make his descendants “as numerous as the stars.” Abraham unbinds him, and the two go on their way. Abraham is the “knight of faith,” one who has entered the religious sphere, because he believes a paradox. First, that God will make him the father of many nations through Isaac’s seed. Second, that Isaac will die before it is fulfilled. How can these coexist? The answer is that in sacrificing Isaac, Abraham believes he will get him back through God’s power to raise the dead. He does not comprehend how that works; he simply takes God at His word. Kierkegaard sees in this story the summation of the religious sphere. It is characterized by true, though not necessarily tranquil, faith. Unlike the ethicist who depends on an impersonal universal law to live life, Abraham—the knight of faith—depends solely on God. In his human understanding, obedience comes through lived religious categories: faith, salvation, conversion, repentance, redemption, and mercy. These are things inaccessible to the ethicist in the same way as they are to the aesthete: both types are tied to nature, and nature is insufficient to fulfill the demands of faith. The ethicist, specifically, thinks one can “actualize [the religious] through positive action,” but that is impossible because it cannot reach the level of dedication the religious requires: surrender to God (Evans 1987, 181). Action by and for oneself, or even another person, toward fulfilling a task is limited because it is rooted in a finite will. It loses meaning because the meaning fades into nothing, whether from fulfillment or exhaustion in attempted fulfillment. One needs an eternal source to have infinite meaning. Deferring to God, one opens oneself to the unknown, albeit a personal unknown, a relationship. Most relationships involve some form of suffering. Marriages go through hard times, children frustrate us, colleagues ignore us, and even good friends insult us. All through these we remain constant that good will come from these setbacks. Couples recover, children develop character, colleagues The Linacre Quarterly XX(X) praise us, and friends celebrate our victories. The suffering is mitigated with promises of a better tomorrow. That suffering also, for Kierkegaard, characterizes a relationship with God. As with Abraham, He pulls us out of our comfort zones and commands us to change our lives. We resist, perhaps like the ethicist, because we do not see the good that will come of it. Yet that is what makes the religious an entirely separate lifestyle: the meaning that comes from faith in God is greater than the meaning that comes from ourselves or our laws. Faith is personal but super (beyond) personal, beyond nature, because its meaning is beyond this world. Only when one rests in God will one find the ultimate meaning of suffering in one’s life, be it in relationship, tragedy, love, hate, or one’s deathbed. In the clinic or elsewhere, suffering is closely bound up with the search for meaning and the call of God. Victor Frankl’s Logotherapy Victor Frankl (1905–1997) was an Austrian, Jewish psychiatrist best known for his book, Man’s Search for Meaning. In it, he recounts both his personal experience within Nazi concentration camps and his theory of logotherapy.1 Although he had begun outlining his ideas prior to his arrest by the SS, Frankl found Auschwitz to be a remarkable testing ground for his theory. He saw that when man has a “why” to live for, he can bear almost any “how” (Frankl 2006, 76–77). The death camps solidified the foundation for his later psychiatric practice in assisting patients to find meaning in their lives regardless of external circumstances. In presenting his theory, we will focus primarily on its philosophical basis and then offer an evaluation. Logotherapy is a psychotherapeutic technique predicated upon the “meaning of human existence as well as on man’s search for such a meaning” (pp. 98–99). The name comes from interpreting the Greek logos as synonymous with meaning such that man’s search for meaning is a search for logos. This search—what Frankl also calls “the will to meaning”—constitutes man’s fundamental orientation, prior to all other projects. Man’s search for meaning is the primary motivation in his life and not a “secondary rationalization” of instinctual drives. This meaning is unique and specific in that it must and can be fulfilled by him alone; only then does it achieve a significance which will satisfy his own will to meaning. There are some authors who Schimmoeller and Rothhaar contend that meanings and values are “nothing but defense mechanisms, reaction formations and sublimations.” But as for myself, I would not be willing to live merely for the sake of my “defense mechanisms,” nor would I be ready to die merely for the sake of my “reaction formations.” Man, however, is able to live and even to die for the sake of his ideals and values! (p. 99) This statement requires a good deal of unpacking, but, for a start, we can note Frankl’s insistence to contrast his theory with reductive anthropologies like Freud’s pleasure principle or Adler’s “striving for superiority.” Although “man is that being who invented the gas chambers of Auschwitz,” he is also “that being who entered those gas chambers upright, with the Lord’s Prayer or the Shema Yisrael on his lips,” reflecting the dark and light sides of man’s dignity and responsibility (p. 134). No animal could design gas chambers or suffer them with a head lifted high. Logotherapy is, fittingly, built around man’s responsibility to use his freedom in accord with logos. Frankl’s anthropology defends man’s spiritual dimension by centering his being on the noös, another Greek term literally meaning “mind,” though not in a modern sense of strictly discursive rationality or consciousness (p. 100). The Austrian psychiatrist specifically characterizes this dimension of human existence as superior to the psychological. As the properly human faculty, noös is closer to what we mean by “spirit,” though not in a strictly religious sense (Frankl 2010).2 When the search for meaning goes unfulfilled, however, “existential frustration” sets in. Frankl provides the story of an American diplomat in Vienna sent to him for therapy to illustrate it. This official had grown disenchanted with his work due to personal reservations about executing American foreign policy in postwar Europe. In therapy, Frankl determined that the patient’s will to meaning had been frustrated by his vocation, and thus, he truly desired another kind of work. With Frankl’s encouragement, the diplomat left his position and quickly found contentment in another occupation. The internal conflict he had felt over his vocation and the “worthwhileness of his life [was] an existential distress,” but not a mental disease (Frankl 2006, 100–102). It was a sign of his human search for meaning. That said, however, existential frustrations can fester into “noogenic neuroses,” analogous to psychogenic neuroses. These noogenic neuroses call for logotherapy, not medication or psychoanalysis, in order to restore one’s “noö-dynamics,” the existential tension between a meaning that is to be fulfilled and the 5 man who has to fulfill it (p. 105). The logotherapist accordingly helps patients step into and live in a noological dimension, acknowledging that proper noodynamics with some necessary tension is integral to human flourishing. Logotherapy thus aims to assist patients in finding meaning in their lives. To the question of the meaning of life, though, there is no general or abstract answer. What matters, for Frankl, is the particular meaning in a particular patient’s life embedded within particular circumstances; he seeks the hidden logos latent within one’s own existence (p. 103). Indeed, “ultimately, man should not ask what the meaning of his life is, but rather he must recognize that it is he who is asked.” Therefore, responsibleness lies at the essence of man’s existence, expressed in a categorical imperative, “Live as if you were living already for the second time and as if you had acted the first time as wrongly as you are about to act now!” (p. 109). The patient must determine, in the end, to what or whom he ought to be responsible, while the logotherapist helps discover and seek it, maintaining commitment to it responsibly. Although meaning is always particular, it can be found in three typical modes, each beckoning man to transcend himself (pp. 111-15). The first, work and success, was illustrated in the American diplomat stationed in Vienna, and only lasts as long as one can advance in one’s career. The second includes love and experiences of beauty in nature and art (pp. 39–41). Love enables one to grasp the core of another person’s personality in a manner more fundamental than sex or other relations, and Frankl’s thoughts of his wife sustained him throughout camp life (pp. 37–39). In love, one also helps bring potentialities in the other to fulfillment. The third, suffering, allows one to testify to the uniquely human capability to turn hopeless predicaments into achievements. Man alone of all creatures on the earth is not destined to be entirely determined by circumstance but can show determination to transcend suffering. Although Frankl says one should endure suffering only if it is necessary, and, consequently, it should not be sought, his framework ensures that meaning can always be found in life, even without any knowledge of what could come next. It matters that the individual is able to find meaning (in suffering) here and now to continue living moment to moment. This is of great importance, for a life whose meaning relies on happenstance “would not be worth living at all.” From these foundations, Frankl identifies a widespread crisis of meaning in the contemporary, postmodern west, which he calls “the existential 6 The Linacre Quarterly XX(X) vacuum.” Man has always been tasked with a certain level of responsibility to utilize his freedom properly; however, something changed in the twentieth century, introducing an existential rupture. He no longer knows what to do with his freedom in a post-traditional, technological society, in part because his noös is ignored and thus existentially unoccupied. The traditions which buttressed [man’s] behavior are now rapidly diminishing. No instinct tells him what he has to do, and no tradition tells him what he ought to do; sometimes he does not even know what he wishes to do. Instead, he either wishes to do what other people do (conformism) or he does what other people wish him to do (totalitarianism) . . . The existential vacuum manifests itself mainly in a state of boredom. (p. 106) People turn to all sorts of substitutes to compensate for the loss of meaning and direction, especially when they are ignorant of the possibilities of a search in the first place, and often become aesthetes. Frankl considers this existential vacuum a powerful explanatory heuristic to understand, at least in part, the phenomena as widespread as depression, addiction, aggression, and the “Sunday neurosis,” the latter being where the slowed pace of a weekend away from work and daily concerns reveals one’s interior vacuity and malaise. Desires for sex, power, and money spontaneously inflate to fill the void, and the possibility of meaning fades away altogether. Frankl goes so far as to call this crisis “the mass neurosis of the present time,” and “a private and personal form of nihilism” (p. 129). The postmodern man denying or unaware of his spiritual nature is radically finite and subject to futility. Which Logos? Whose Spirituality? There is much to like in logotherapy, especially as a response to forms of postmodern malaise. First, meaning does exist in the world, and we can discover it in our own lives. Man bears an intrinsic, quite fundamental, desire to search for logos, and we remain existentially dissatisfied until we discover meaning. Second, Frankl espouses a more profound anthropology than is typically accessible in modernity: man is more than a dualism of matter and psyche. Higher than the animals and lower than the angels, man is an embodied, spiritual creature called to transcend material pleasures by seeking the logos within the world. Our identity and calling are not exhaustible by the explanations of mechanistic science, whether biological or psychological (Smith 1984; Bishop 2011). Third, meaning can truly only be found by transcending oneself in a reality beyond oneself. Logotherapy wisely teaches men to take responsibility for life by engaging their particular circumstances of work, love, or suffering, that is, finding meaning in the present moment to actualize one’s humanity. Each provides opportunities to transcend the self in ethical and supra-ethical commitments, testifying to the spiritual dignity of the human person in the process. Logotherapy has an undeniably religious, almost Christian, ring to it, bearing some resemblance, for example, to Gaudium et Spes (1965): “man cannot fully find himself, except through a sincere gift of himself” (§24). Overall, Frankl offers an enlightening lens to make sense of the postmodern west and lead people out of some of its regnant deceptions. However, logotherapy has limitations worth attending to. First, it is unclear to what extent Frankl’s logos is given, and whether it shows itself. Is the meaning sought by each person the same thing or simply a family of loosely related noological goods? This question is problematic from a Christian theological perspective in that it would question which logos he attempts to ground human flourishing within and whether it is capable of alleviating or solving the big human questions of suffering and finitude in a lasting manner. In other words, Victor Frankl cannot name the logos, and it appears something finite and impersonal. On the one hand, we can appreciate his semi-apophatic approach to meaning found within the depths of each person’s life. Logotherapy acknowledges a pregnant mystery at hand near the core of what it means to be human. Frankl’s agnosticism, however, leaves him vulnerable to generic forms of spirituality isolated from organized religion. At best, he can say “discover your personal logos for a flourishing life.” The Oxford Textbook of Palliative Care, for example, identifies Frankl’s theory as justification for its generic spirituality, rounding out the biopsycho-social model with a spiritual dimension (McClement and Chochinov 2010). Spirituality for religious people usually entails “a sense of connectedness to a God, whereas within the secular realm, it often invokes a search for significance and meaning,” as displayed in logotherapy (Cherny 2010, 45). Thus, the textbook utilizes Frankl’s theory to advance a vision of spirituality divorced from traditional religious contexts, and instantiated, for example, in a pan-religious chaplaincy ignoring the particularities and differences between Christians, Schimmoeller and Rothhaar Muslims, Hindus, and secularists (Harper and Rudnick 2010; Tollefsen 1998; Delkeskamp-Hayes 1998). Operationalizing this model further entails gazing upon and assessing the spirit in an abstracted way more proper to the human sciences than to religion (Bishop 2013). Although we can question whether Frankl would approve of identifying oneself as spiritual-but-not-religious, his agnosticism over which particular logos to seek can lead to an indeterminate spirituality (Frankl 2010, 67–72). The English translation of Man’s Search for Meaning, at the very least, cannot easily do justice to Frankl’s noological dimension by relating it to a spiritual dimension. Frankl’s religious indifference is not a problem for logotherapy. People find meaning whether Frankl is a believer or not. The problem is how this indifference affects the application of his theory. We argue it ultimately stays in the ethical sphere where personal causes (and their meanings) are terminated upon completion or else never completed at all. The lack of completion or termination are themselves forms of despair because, without meaning, one cannot bear living. Completing a cause, and so on, only means the further search for another meaning. Yet, meaning is somehow present in all these things, and so it seems there is an overarching “Meaning” that makes all meaning possible. Kierkegaard locates it in the religious sphere. The realization that there is a larger context to one’s life, suffering, work, and relationships is the spiritual equivalent to Frankl’s project, but it does not reach the level of Kierkegaard’s religious sphere. With Kierkegaard’s combining the psychological and spiritual realms, Frankl’s psychology is now open to another “level” of meaning outside oneself and others. From here, Kierkegaard’s spheres of existence question whether logotherapy may adequately accomplish its own stated goals. Kierkegaard is clear that only the religious sphere in the particularity of Christian faith, lived in theological categories, can adequately provide meaning to a life. Deferring to God, one opens oneself to a personal and infinite meaning in the Logos, the second person of the trinity. Abraham, the knight of faith, did not seek a finite, impersonal, nameless meaning as in logotherapy nor was he simply “[bearing] his incapacity to grasp [life’s] unconditional meaningfulness in rational terms” (Frankl 2006, 118). Abraham exercised faith. He trusted in the God who had personally called him in the midst of a dynamic relationship to sacrifice his son Isaac on Mt. Moriah, believing the paradox that God would make him the father of many nations through Isaac’s seed. Frankl does 7 admit that the noological dimension, though higher than the psychological, is subordinate to the theological and accordingly does not intend psychiatrists trained in his theory to displace clergy (Frankl 2000, 16; Frankl 2010, 78–81). The meaning that comes from faith in God is greater than the meaning that comes from our engagement in work, love, and suffering. Being above nature, faith supplies infinite, personal meaning flowing from a divine source eternally beyond this world.3 We know that “only” Jesus Christ “fully reveals man to man himself and makes his supreme calling clear” (Gaudium et Spes, §22). In the beginning was the Logos, and the Logos was with God, and the Logos was God; He became flesh in order to give man power to become children of God while sustaining all creation in being (John 1). This Logos is named, infinite, and personal, all the while utterly accessible to all who seek Him in faith and thus relativizes any finite, impersonal meaning. For Frankl, making sense of life here and now is of the utmost importance for living well and fully, but there is a “beyond” that Frankl overlooks, presumably due to his religious beliefs (e.g., unbelief in an afterlife). The meaning of life is not Frankl’s target, rather, it is a concrete meaning in the present moment. We do not see a problem here in principle. The issue we take is that with either the unfulfillment of that meaning or its termination (for any reason), the search for a new meaning must start all over again. This is a cause for despair in the third form where the spiritual and psychological overlap. One might argue that Frankl’s point is to never stop searching for meaning, but our contention is that there can be a stopping point—and thus an end to despair—in the religious sphere, as we will now show in Percy’s novel. To summarize, logotherapy can be a helpful first step to healing the malaise of modernity and a useful paradigm for Catholic physicians to see patients on their own searches for meaning. However, it cannot supply ultimate meaning. Victor Frankl’s project thus seems incomplete absent a theological mooring.4 Walker Percy and the Difference of (Traditional) Christianity Walker Percy (1916–1990) excels where Frankl falters. Percy was an American physician-turned-writer known for treating philosophical and religious matters in fiction and essays (Allsopp 1993; Howard 2006). After recovering from tuberculosis—contracted from cadavers during his pathology 8 internship—he traded the scalpel for the writer’s pen, and converted to Catholicism, in no small part due to reading Kierkegaard during his convalescence. 5 Although physicians and medical topics often appear in his writing, he primarily regarded himself as a literary pathologist of modern culture, utilizing medicine to speak to more foundational issues (see Love in the Ruins 1999; Lantos and Elliott 1999, 4). Percy was concerned with spiritual suicide at heart—despair, made explicit to him by Kierkegaard—resembling Victor Frankl’s concern with meaning and the current “existential vacuum” (Desmond 2005).6 However, the novelist’s theological mooring gave him a stronger platform to map postmodern man’s search for meaning, making him a prime example for physicians encountering patients on their own searches. Binx Bolling, the protagonist of Percy’s (1961) The Moviegoer, awakens one day to find his “peaceful existence” in a fictional New Orleans suburb suddenly “complicated” (p. 7). Something has ruptured this aesthete’s usual plots to seduce his secretaries, fixation on expanding profit margins, and innumerable hours spent on entertainment at the movies. He has abruptly become aware of the possibility of a search, though he struggles to name it, recalling a similar experience from his service in the Korean war. In the Orient, he was shot in the shoulder and came to himself under a chindolea bush. It did not hurt, oddly enough, and what ought to have been the worst of times became the best. “Six inches from my nose a dung beetle was scratching around under leaves. As I watched, there awoke in me an immense curiosity. I was onto something.” This time, however, he would not let it go. Something more was possible. Was he searching for God? He does not know, though considering “98% of Americans believe in God” and the remaining 2% are atheists or agnostics, this would make him dead last in settling the issue. Have the 98% found what he seeks or are they also unaware of the possibility of a search? All Binx knows is “the search is what anyone would undertake if he were not sunk in the everydayness of his own life” (p. 9). Indeed, “not to be onto something is to be in despair” (p. 10). He embarks upon a weeklong existential search around Mardi Gras, culminating in his thirtieth birthday on Ash Wednesday and engages in many conversations and philosophical monologues along the way. The search redirects Binx’s attention away from the aesthetical. He does not, however, take the ethical life too seriously. His aunt’s moralizing taunts rooted in her hollow ethical vision are not desirable to him. She was as stuck in despair as an The Linacre Quarterly XX(X) aesthete. As Kierkegaard says, no one can really live up to the unsympathetic demands of the ethical life; hence, despair sets in. It is incapable of providing a “why” for living and can be more a distraction from the search than anything. Binx Bolling’s search ends in the religious sphere on Ash Wednesday, although certainly not in triumphant fashion. He renounces the aesthetic and ethical spheres, while taking up commitments in marrying Kate and entering medical school. He loves her despite her neurotic, volatile moods and substance problems, which they discuss as believers leave the church across the street with ashes on their foreheads. The former aesthete gives up the movies altogether in exchange for a serene Catholic faith. The novel concludes at the funeral for Binx’s younger brother. On his deathbed, he had updated Binx: he had at last overcome a capital sin with prayer and fasting, not shaken by his wasting disease and concern from family members. Binx reassures the younger siblings that their brother would rise on the final day without any need for a wheelchair. Despair is defeated by Christian faith working in love. The deceased brother’s prayers for Binx’s conversion proved efficacious in the end. Several points merit further mention regarding faith for Walker Percy. First, Christian faith need not be anxious, unknowing, or absurd, as it tends to be for Kierkegaard (cf. Crowe 2015). Binx Bolling’s “Apollonian Catholic balance,” in contrast with “Protestant anguish,” stems from a Thomistic faith that is a form of knowledge (Dewey 1974, 291; Percy 1989, 100). It is both reasonable—though not rationalist—and bestows direct, spiritual knowledge of God, balancing Kierkegaard’s dialectic of doubt requiring a leap of faith into the unknown. Traditional faith may be above nature, but it is not against it. Second, Percy displays a rich sacramental vision. Confession and the eucharist make frequent appearances in his fiction, but, perhaps more profoundly, Percy assigns the physical world great importance. Binx’s marriage and many natural descriptive details—like the Korean dung beetle or chindolea bush—play key roles in his search. They are not simply to be aesthetically enjoyed or ethically committed to, rather they are pregnant with divine mystery, that is, the divine Logos. Searching for Meaning in the Clinic The paradigm of patients searching for meaning can positively inform the goals of care conversations. Beyond their biological or psychological functioning, 9 Schimmoeller and Rothhaar where do patients derive meaning in their lives? This, to be sure, Frankl would see always at play in the background of such discussions. His theory helps offer a framework for making the “noological” dimension more explicit, particularly in chronic disease or at the end of life, where suffering grows and hope can, at times, fade. Even if one cannot work to achieve any goal or has no one to love, suffering presents an opportunity for meaning, even if finite and impersonal. Man is always free, in the end, to transcend suffering and not be determined by it. Applying insights from logotherapy can thus help contextualize pain, symptom management, and daily functioning, clarifying human concerns, especially in the face of disability and death. Physicians can be gentle, compassionate guides in the search for meaning. Many patients, however, are not consciously aware of their own despair or the possibility of a search for something more. Indeed, many live in the aesthetic sphere like Binx Bolling, concerned more with pleasure, health, and security than higher values. At the very least, physicians should be conscious of the danger of perpetuating aesthetic pursuits, and the possibility that medicine may often reinforce them. Health is certainly a good thing, but it needs to be integrated within a hierarchy of values, not merely a vehicle for pleasure nor an end in itself in bodily perfection. There are obviously more important things in life and participating in concealing an aesthetic patient’s hidden despair does him no favors. However, it is inadequate to pose an ethical way of life as an alternative. Duty and commitment to a cause—including nominal adherence to the Ethical and Religious Directives for health care—is insufficient to supply meaning. Tragedies can become a great opportunity for patients to attend to their own search for meaning, perhaps for the first time. Although they are always painful, and this should not be overlooked, especially in unredeemed suffering outside of Christian faith and practice, disasters and crises, especially for Percy (1961), are the only ways to defeat despair, so long as one takes advantage of it (pp. 127, 106). They shake us up from our humdrum everydayness to reevaluate matters from a fresh perspective. They remind us of our finitude—we will not live forever, and little is guaranteed in this fallen world—allowing us to see from a more authentic, existential angle. For the aesthete, Binx Bolling, it was only when being shot in the shoulder that he first became aware of the possibility of a search for more in life. Patients similarly can become aware of a search for meaning thanks to tragedy and thus physicians have an important role to play when meeting them in the midst of suffering and trials. The latter can help direct patients through noological realms in the likeness of Victor Frankl or Walker Percy, knowing that, though only Christian faith (the religious sphere) will ultimately satisfy the search, we first of all need encouragement to take responsibility for seeking meaning. This has even been posed as a new model for the physician–patient relationship and opens up hope for those of us in medicine who are Christians (Nash 2013). Binx Bolling’s search for meaning included entering medical school to integrate the blessings of modern scientific knowledge with the value-laden narratives of illness brought by patients. Acknowledgment The authors thank Paul Day for offering comments on prior versions of the essay. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) received no financial support for the research, authorship, and/or publication of this article. ORCID iD Ethan M. Schimmoeller 0003-2380-8515 https://orcid.org/0000- Notes 1. Concerning the relationship of the camp experiences and his psychiatric theory, Frankl shares a riveting account of parting ways with his first manuscript containing logotherapy upon admission to Auschwitz: “At that moment I saw the plain truth and did what marked the culminating point of the first phase of my psychological reaction: I struck out my whole former life” (Frankl 2006, 14). Over twelve million copies of Man’s Search for Meaning were in print in 2006. 2. That said, it may be helpful to share a contemporary definition of nous along the lines of the Greek Church fathers. From the Philokalia: “the highest faculty in man, through which—provided it is purified—he knows God or the inner essences or principles of created things by means of direct apprehension or spiritual perception. Unlike the dianoia or reason, from which it must be carefully distinguished, the intellect does not function by formulating abstract concepts and then arguing on this basis to a conclusion reached through deductive reasoning, but it understands divine truth by means 10 3. 4. 5. 6. The Linacre Quarterly XX(X) immediate experience, intuition, or “simple cognition” (St. Isaac the Syrian). The intellect dwells in the “depths of the soul.” It constitutes the innermost aspect of the heart (St. Diadochos). The intellect is the organ of contemplation, “the eye of the heart” (Palmer, Sherrard, and Ware 1981, 384). There is question along post-Reformation lines as to the character of Christian faith and the incarnation, which Walker Percy picks up and will be mentioned later. See Fr. Alexis Trader (2012) for an analogous evaluation of cognitive therapy. Kierkegaard was a Pietist, a branch of reformed Lutheranism with a strict spirituality, often emphasizing Jesus’s Passion over His love of humanity. Kierkegaard was a devout Christian his entire life, arguing against what he saw as the unChristian lifestyles of many “Christians” in his native Denmark. His faith has a decided agony in it, but its sincerity and depth shine through, and so it is not unreasonable that one would convert to Catholicism upon reading him. Although not directly addressed here, Percy saw scientism—unbalanced faith in science to disclose the truth of reality, often motivating modern medicine—to blame for displacing traditional Christianity and committing “spiritual suicide” (Majeres 2002; Michel 2011). A materialistic worldview married to American moralism has made today an “age of suicide” (Percy 1983; Desmond 2005, 61). He refers to science as a detached mode of being where one “is no more aware of the mystery which surrounds him than a fish is aware of the water it swims in” (Percy 1961, 43). Only engaging particular times, places, and people can satisfy despair, as well as integrate scientific knowledge into a broader worldview. References Allsopp, Michael E. 1993. “Of Medicine & Metaphor: Significant Findings from Walker Percy.” The Linacre Quarterly 60, no. 1 (February): 48–56. Bishop, Jeffrey P. 2011. The Anticipatory Corpse: Medicine, Power, and the Care of the Dying. Notre Dame: Notre Dame Press. Bishop, Jeffrey P. 2013. “Of Idolatries and Ersatz Liturgies: The False Gods of Spiritual Assessment.” Christian Bioethics 19, no. 3: 332–47. Camus, Albert. 1955. The Myth of Sisyphus and Other Essays. Translated by Justin O’Brien. Originally written 1940. New York: Vintage. 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He also reflects on human dignity and poverty, and enjoys artistic pursuits when not practicing his golf swing.