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Dr.med. Dr.phil. Paul H. Bresser, Professor emeritus für Forensische Psychiatrie an der Universität Köln, Mitbegründer und langjähriger 2. Vorsitzender der Deutschen Gesellschaft für Logotherapie und Existenzanalyse.
(Inmitten der redaktionellen Arbeit an diesem Artikel erreichte uns die Nachricht, daß Prof. DDr. Paul Bresser am 2. Oktober 1993 plötzlich verstorben ist. Dieser Aufsatz ist somit zum Denkmal für einen Mann geworden, dessen noble und aufrechte Wesensart jeden beeindrucken mußte, der ihm begegnete.)

The Unconscious in Religiosity, Spirituality and Morality
Aureliano Pacciolla

Abstract:


The author explores that part of the unconscious which lies beyond the territory of subconscious drives and instincts. In particular, the regions of deeply rooted reliogisity and morality are charted. The concepts used in this context must not be misunderstood to imply the existence of a religious or moral "impulse" prompting us to a certain behaviour. Rather, they constitute the essence of a person's ethical or religious attitude, more aptly comparable to a compass than to some driving force.

Zusammenfassung:


Der Autor untersucht jene Region des Unbewußten, die jenseits des Bereichs der unterbewußten Triebe und Instinkte liegt. Im besonderen werden die Gebiete beschrieben, in denen der Ursprung einer tief verwurzelten Religiosität und Moralität liegt. Die Begriffe, die dabei verwendet werden, dürfen nicht im Sinne einer moralischen oder religiösen "Triebkraft" mißverstanden werden, die uns zu einem bestimmten Verhalten drängt. Sie bedeuten vielmehr die Quintessenz der religiösen oder moralischen Haltung eines Menschen, eher vergleichbar mit einem Kompaß als mit einer Antriebskraft.
Taking religiosity to mean a dimension so wide as to include also what is commonly intended by spirituality, and morality, it can be said that research on the unconscious spirituality can only start from three essential presuppositions: a peculiar anthropological view, a wide definition of religiosity, and a more complete view of the subconscious.
a) The first of these three presuppositions is an ontological anthropology which considers man in all his totality, that is, also his noetic dimension, different from the organic dimension and the psychic one, because it transcends both but together with them makes an individual a unique, indivisible and irrepeatable unity.
b) The second presupposition is a religiosity intended as an answer to the existential 'Wovor': as held by A. Einstein, man is religious since he asks himself the 'why' and the meaning of his own existence; and, as Frankl says, religiosity is the answer to the existential question of 'before what or before whom I want to be responsible for my life?' (1)
In this sense life is lived from the point of view of transcendence, that is, as a gift which transcends man's nature in itself, and religiosity is akin to something very activating because it makes conscious that by any decision, battle or destiny which is decided here in this life by and in the single individual we are associated with the divine battle on this earth. (2)
This general concept of religiosity sees a religious person as one who has a balanced sense of fragmentation related to an absolute because God is always transcendent, but also always an object of intention.
c) A third presupposition for the unconscious religiosity is a more complete view of the subconscious. The subconscious, more than a mere deposit only of instincts, from a prospective view point, is also a seat and a source of man's creative strengths; of the instinctive impulsive strengths as well as of the spiritual religious ones.
Even though the spirit and the impulse are two incommensurable phenomena, nevertheless both can be either conscious or unconscious, and for both there is no clear cut distiction between their conscious and unconscious levels. (3)

Exploring the Noetic Unconscious Level


From these three presuppositions Logotherapy begins research on unconscious spirituality which is found to be much richer and determinant that one would think because in the unconscious, besides the ethical unconscious and the moral conscience, there is also a sort of esthetic unconscious: the artistic conscience. In fact even the artist's inspiration has its roots in unconscious spirituality. (4)
Thus, from the viewpoint of Logotherapy, man can be specifically himself also in the area of his unconsciousness. On the other hand man is himself only when he is not prompted by his impulses but responsible for his values. (5)
The true, deep, spiritual existential personality is always unconscious in its depths. This is not facultatively but necessarily so, since the actualization of spiritual acts is a 'reality of realization'. The human person, actually, in its true being, is not susceptible to reflection, but only to realization. Existence, as well as conscience, properly speaking, does not undergo an analysis or reflection or reduction, since being an original phenomenon it is also in this sense unconscious: "The human person in its very depth is essentially unconscious. In its origin, the human spirit is unconscious spirit". (6; see also 7)
Actually our important existential and authentic decisions are taken in the depths of that unconscious spirituality with an absolute personal characteristic. Conscience, as 'being who decides for himself' belongs to the human being who is rooted in an unconscious foundation in the sense that conscience to begin with dips into the subconscious. Nevertheless the spirit is not unconscious only in its origin or beginning, but it is unconscious also 'in its final appeal'. It is in this sense that the important decisions are taken unreflectively and unconsciously. From this it can be said that besides a conscience of responsibility and of a conscious responsibility "there must also be unconscious responsibleness. (8)
Frankl explains all this by an analogy: it is as something that stays awake in a man even when he sleeps. That wakefulness in sleep is able to wake up the sleeping mother as soon as the soft breathing of her baby becomes restless, while she is indifferent to all the deafening noises from the street. Such a wakefulness in sleep does not fail even under hypnosis. The authority which decides whether something has to become conscious or has to stay unconscious, works unconsciously; but in order to decide it must be able to make a certain distinction - and only a spiritual essence can distinguish and decide. (9)
Therefore, spirit is unconscious also in that superior appeal that must decide on consciousness or unconsciousness, and spirituality not only can be unconscious but from its beginning to its end must be unconscious as well.
In the context of an unconscious spirituality, there is a religiosity that is unconscious.
This unconscious religiousness, revealed by our phenomenological analysis, is to be understood as a latent relation to transcendence inherent in man. If one prefers, he might conceive of this relation in terms of a relationship between the immanent self   I   and a transcendent Thou. However one wishes to formulate it,we are confronted with what I should like to term 'the transcendent unconscious'   as part and parcel of the spiritual unconscious. This concept means no more nor less than man has always stood in an intentional relation to transcendence, even if only on an unconscious level. If one calls the intentional referent of such an unconscious relation 'God', it is apt to speak of an 'unconscious God'. (10)
The relationship between man and the transcendent unconscious or the unconscious God, does not mean per se that God himself resides in the unconscious; it means that sometimes God is unconscious to us, and so hidden to ourselves. So, when in the Psalms we read of a hidden God (Deus absconditus), as we saw, it is a question of a hidden God in the sense of a hidden relationship between God and man, hidden on his part.
Authentic religiosity is characterized by an absolute lack of institutionalization and by an absolute personalization either in its conscious or unconscious dimension, as well as by intimacy: The quality of intimacy so characteristic of love is no less characteristic of religion. It is intimate in two senses: it is INTIMUM in the sense of innermost, and second, it is, like love, protected by shame. Genuine religiousness, for the sake of its own genuineness, hides from the public. (11)
This is why many can easily talk about their sexuality, even in its very details and of their perversions, while they seem inhibited in speaking of their religiosity, almost as if they should be ashamed of it. The problem is that many, consciously or not, inhibit their spirituality which spontaneously tries to emerge up to conscious levels. And when spirituality does not find an appropriate expression it is prompted into the subconscious; it has been driven back but never definitively suppressed. This is the reason why, in a certain way and at a certain level, spirituality remains always in man, even when it is repressed by the individual or by a particular society structured in a particular way.
The purpose of Logotherapy and Existential Analysis is that of re establishing the responsibility of man's trends and attitudes and therefore even of his unconscious spirituality. By doing so, Logotherapy avoids the psychoanalytic mistake of considering man as an object; Logotherapy personalizes man, so that he cannot be intellectualized and rationalized to be necessarily understood only by the reason, either pure or practical.
On unconscious spirituality there could be three misunderstandings against which we must be on our guard. The first one is pantheism: although the unconscious is characterized as 'even spiritual', never can it be circled with the aureole of divine. The unconscious relationship with God does not mean that God is within us and dwells unconsciously. This would be a thesis of an theological dilettantism. (12)
The second possible mistake that must be avoided is that of considering the unconscious as something divine. The unconscious is not divine and does not have even one divine, attribute, i.e. omniscience. This would be a mistake of careless metaphysics. A firm contact with experience should never be lost.
The third misunderstanding in considering the unconscious is that of viewing it as something impersonal and bound to the Es. This mistake had been already made by Jung because although he recognized in the unconscious even a religious aspect, nevertheless he made the mistake of locating the unconscious spirituality in the sphere of the Es. In such a way the Ego is not able to have a competence in the sphere of religiosity. For Jung, actually, unconscious religiosity is bound to religious archetypes and to elements of the archaic and collective subconscious. In Jung's thesis of unconscious religiosity there is no room or possibility for a personal decision of man; it seems that religiosity is essentially something impulsive, explained as something collective and archetypal.
According to Jung, something within me is religious, but it is not I who then is religious; something within me drives me to God, but it is not I who makes the choice and takes the responsibility. (13)
But it is not possible to talk of 'religious impulse' in the same way as of sexual impulse, and for this reason it is not possible to say that one is 'prompted to be religious'. Unconscious religiosity does not necessarily determine a conscious religiosity because it is always an open door of the free and responsible decision of man.
Another difference between Frankl and Jung is that for Frankl unconscious religiosity is not bound to the archetypes and so it is not innate nor therefore hereditary. Unconscious religiosity, actually, is not linked in any way to some biological element. Forestablished religious forms or originary religious forms are not archetypes dozing within us and transmitted via biology; rather they are patterns of our religious culture that come to us through traditions. Nevertheless we cannot exclude a priori any relationship between personal religiosity and experience of our childhood, especially when religiosity has been repressed.
Primary religiousness which has fallen prey to repression comes to the surface in the form of a naive or childlike faith. (14)
One purpose of Existential Analysis may be that of bringing up to a conscious level the unconscious religiosity. Often in a neurotic personality there can be noticed a disturbed relationship between its Ego and the transcendence in the sense of a repressed relationship. One of the consequences of the repression of unconscious religiosity is superstition. Either at an individual or social level, repressed faith perverts itself into superstition; and a repression of a religious feeling can be due even to a tyrannical intellect or to an exasperated technical wit. So, once again it must be stressed that the existentiality of religiousness has to be matched by its spontaneity. Genuine religiousness must unfold in its own time. (15)
As we have been talking of unconscious religiosity and unconscious spirituality, let us see now whether it is possible to talk of unconscious morality.
In analyzing dreams, which are an authentic production of our unconscious, and interpreting them by the patient's free association but within the context of Existential Analysis, it is possible to reach, besides the instinctual unconscious, even the spiritual unconscious which could be very useful to the very moral conscience: With regard to interpretation of dreams, it is still valid that moral conscience is the most useful pattern in order to show the efficacy of unconscious spirituality.
As a confirmation of this Frankl reports the analysis of some dreams: one of them is a warning that the conscience gives to the person; another dream shows unconscious spirituality in its function of self scolding. Dreams spouting from the moral conscience which show in a certain way the unconscious spitituality are not rare. All these dynamisms of unconscious spirituality, unconscious religiosity and of unconscious morality are characterized by an absolute lack of any institutionalization.
J. Fabry says that the logotherapist will help make patients conscious of their repressed spiritual conflicts, such as conflicts of conscience. Like repressed drives, the repressed voice of conscience will sometimes reveals itself in dreams. The psychoanalyst looks to dreams for manifestations of the instinctual unconscious; the logotherapist looks for telltale signs from the spiritual unconscious. (16)
In this sense it is possible to talk of 'unconscious morality' and, safeguarding first of all the decisional characteristic of a person, unconscious spirituality and unreligiosity are even moral instances. For this reason in dreams also are shown moral risks and spiritual situations that during a normal state of being awake we do not perceive, not at least with the same clearness in some details.
In other instances our moral conscience through dreams can bring us to a serious examination of a certain situation of ours with a more objective and a more serious self criticism than we while we are awake, when rationalization of our mistakes is much easier. Thus, dreams can show us some moral problems or conflicts not accepted at a conscious level; in this sense a real unconscious morality has all the right to be taken into account.
Again, in talking of unconscious morality there is a risk of making some mistakes. As unconscious religiosity must not be confused with a sort of religious instinct that prompts me to be religious, in the same way unconscious morality must not be confounded with a pseudo moral instinct which prompts me to have a certain morality. The human person is not prompted by the conscience: what actually happens is that a person is attracted by values and in the face his conscience has always to make his own decisions. If conscience really were a strength that prompts me in a certain direction, then we could talk of Super Ego. But in this case, the human person would behave morally only in order to free himself from the load of his Super Ego that otherwise would provoke remorse of conscience; this actually would not be at all really moral. The human person should not behave well for the purpose of freeing himself from a bad conscience which would oppress him. We do not have to behave well in order to have a good conscience; this would be simply pharisaical. The human person should be good for a purpose, for love of a person, for the sake of God.
This deep trend of the soul could be compared to the 'habitus' of scholastic philosophy that precedes the 'actus'. It is within the conscience where the synthesis is formed. This means that conscience cannot be reduced to a mere decision. Conscience is man's totality that gives off light, synthesis, coherence and will. It does not let itself be subordinate to decisions.
As a moral decision can be even unconscious, by the same token an unconscious decision can be moral in the sense that an unconscious moral decision is just the last ring in a long chain of decisions whose first one has been conscious and only subsequently has become a 'habitus'. For this reason man is not religious only in his external manifestations, i.e. complying with a religious institution. Man is much more religious, more spiritual, more moral than he can appear not only to others' eyes but even to his own eyes, because he also has within his own innermost self an unconscious spirituality, an unconscious religiosity and an unconscious morality that continuously must be heard and be brought to his own consciousness. For this reason a Logotherapist has a more complete and a more optimistic, as well as a more realistic anthropology than a Freudian psychoanalyst.
A psychotherapist's concept of man, and therefore of his patient, is extremely important. The effect achieved by a psychotherapist who believes that his patient is more immoral than he himself thinks is quite different from that of a psychotherapist who believes that his patient is more moral than he himself thinks. This has been shown in an experiment (17) in which 20% of the students in each classroom where indicated to the teachers as very promising students because their very high I.Q. had previously been observed in the tests. After eight months of the course all the students were exmined and the result was that those 20% had learned much more than the rest of the students. In reality, the 20% indicated to the teachers as promising did not have a higher I.Q. than the others; their better lerning was due to their teachers' attidude.
In this sense, the commitment, the realization and the meaning of man's life depend even on his Weltanschauung and on the choice or decision he makes at his conscious level to which he comes in the explication of his unconscious dynamisms. Only at this point is it possible to talk of a man's moral decision in its totality and therefore of the realization of man's wholeness.
For this reason Existential Alalysis is a scientific means that gives a worthwhile contribution to the genuinity of the human being and of religion.
This reciprocal interaction among science, religion and human nature is expressed by Frankl with the words of A. Einstein "Science without religion is paralyzed, and religion without science is blind...the problem is not the atomic bomb, the problem is the heart of man".
References:
( 1) Frankl V.E., Der Mensch auf der Suche nach Sinn, Herder, Freiburg 1972, p. 115
( 2) Frankl V.E., The Doctor and the Soul, Vintage Books, New York 1986, pp. 58 59
( 3) Frankl V.E., The Unconscious God, Hodder and Stoughton, London 1977, pp. 25 27
( 4) Frankl V.E., Theorie und Therapie der Neurosen, Reinhardt, Munchen 1975, p. 182
( 5) Frankl V.E., The Unconscious God, p. 25
( 6) Frankl V.E., ibidem, p. 30
( 7) Frankl V.E., Homo Patiens, Ed. OARI, Varese 1972, pp. 160-161
( 8) Frankl V.E., The Unconscious God, p. 60
( 9) Frankl V.E., ibidem, p. 30
(10) Frankl V.E., ibidem, p. 60
(11) Frankl V.E., ibidem, p. 46
(12) Frankl V.E., ibidem, p. 61
(13) Frankl V.E., ibidem, pp. 62 63
(14) Frankl V.E., ibidem, p. 65
(15) Frankl V.E., ibidem, p. 71
(16) Fabry J., The Pursuit of Meaning, Institute of Logotherapy Press, Berkeley 1987, pp. 73 74
(17) Hall J.A. et alii, "Human nature", Harvard May 1978

Prof. Dr. Aureliano Pacciolla is professor of Moral Theology in Rome, lecturing at the theological faculties of the Marianum, the Augustineum, and Regina Mundi. He is a Carmelite padre and is practicing in psychotherapy.

Address: Via Sforza Pallavicini 10, I-00193 Roma, Italia.



Zwiespalt und Widerspruch überbrücken - Paradoxe Intention
Franz Grundtner

"Prüfstein einer überragenden Intelligenz ist die Fähigkeit, gleichzeitig gegensätzliche Gedanken zu verfolgen und doch funktionsfähig zu bleiben" (F.S. Fitzgerald)


Zusammenfassung


Die Logotherapie bzw. Existenzanalyse nach V.E. Frankl versucht eine Aufhellung des Grenzgebietes zwischen Psychotherapie und Philosophie, unter besonderer Berücksichtigung der Sinn- und Wertproblematik der Psychotherapie.
Ein besonders effektives Verfahren im Methodenarsenal der Logotherapie ist die Paradoxe Intention. Ihre Anwendung ist vor allem bei angst- und zwangsneurotischen Erkrankungen geboten. Um sich von der Angst zu distanzieren, wird Humor mobilisiert: "Seiner Angst ins Gesicht lachen." Durch Selbstironie wird die Neigung zum Angsterleben gelöscht. Bei häufiger Anwendung dieser Methode wird dem Menschen zunehmend eine Wahlfreiheit ermöglicht; er kann zu humoriger Gelassenheit finden.
Paradoxe Intention ist ein Kernpunkt des psychotherapeutischen Dialogs; sie verhilft zu Entlastung und Ruhe, zu Gelassenheit und Mut, zu neuen Aktivitäten. Es ist eine Methode, die eine konsequente therapeutische Ausgestaltung der beiden anthropologischen Grundgegebenheiten menschlicher Existenz ermöglicht: der Fähigkeit zu Selbstdistanzierung und zu Selbsttranszendenz.
Es wäre aber verfehlt, wollte man die Paradoxe Intention auf eine bloße Technik reduzieren. Ganz wesentlich erscheint auch die philosophische Ebene: Der Mensch wird befähigt zu sinnerfülltem Verhalten, zu neuerlichem Werterleben, oder er ist zumindest imstande, sich wieder auf die Suche nach Sinn zu begeben. Paradoxe Intention regt an zu philosophisch inspirierter Lebensführung - zu "tragischem Optimismus" (V. Frankl).

Abstract
Logotherapy and Existential Analysis according to V.E. Frankl provides an elucidation of the border area between psychotherapy and philosophy, with the psychotherapeutic problems inherent in meaning and value being taken into account.


One very effective method within this psychotherapeutic approach ist Paradoxical Intention, which is recommended in cases of anxiety and obsessive-compulsive neuroses. The patient learns to confront his anxiety, to come to grips with it, to experience it as a subjective reality and to perceive it in an ironical manner, in the light of a greater reality. By mobilizing humour, he is enabled to put some distance between himself and anxiety: "Laughing into the face of one's anxiety". The experience of anxiety is counteracted by self-irony. Frequent application of this method helps to give the patient increasing freedom of choice and aids him in developing an attitude of humorous serenity.
Paradoxical Intention is a salient point in the psychotherapeutic dialogue, helping to provide relief, peace of mind, composure and courage to take up new activities. It is a method providing for consistent therapeutic application of those two fundamental, specifically human qualities: the "capacity for self-detachment and for self-transcendence" (Frankl).
But it would be wrong to reduce Paradoxical Intention to the status of a mere technique. There is certainly a technical aspect to it, in that it helps the patient to break out of anxiogenic behaviour patterns or to modify depressogenic thought patterns. What seems of crucial importance to me, however, is the philosophical level: the patient attains a capacity for meaningful behaviour, for renewed experience of values, or is at least capable of setting out again in search of meaning. Paradoxical Intention then provides the initiative for a philosophically inspired lifestyle, for "tragic optimism" (V. Frankl).

1. Einleitung


Tagtäglich nehmen Menschen psychiatrische Hilfe in Anspruch. Der Psychotherapeut ist konfrontiert mit Fragen dieser Menschen über Glück und Leid, Liebe und Erlösung, Angst und Schmerz.
Logotherapie und Existenzanalyse ermöglichen eine phänomenologische Betrachtensweise. Es geht hiebei nicht in erster Linie um Etikettierung von Symptomen, sie ermöglichen vielmehr eine "Entmythologisierung und Rehumanisierung der Psychotherapie" (V. Frankl).
Frankl hatte erkannt, daß die verbale Deutungskunst der Psychoanalyse den Weg in ein selbstverantwortetes Leben hemmen, möglicherweise sogar zur Abwehr notwendiger praktischer Lebensschritte führen kann. Ein zentrales Anliegen ist es für ihn, dem Patienten Anregung zu geben, einen Sinn im Leben zu finden.
Zu dieser Sinnfindung ist aber eine Art von innerem Wachstum notwendig. Sie erst ermöglicht es, daß der Mensch in der Entwicklung durch die Therapie sich selbst immer besser versteht. Viele Schwierigkeiten des Lebens haben ihre Ursache in der menschlichen Natur, in der Neigung der Menschen zu Zorn, zu Angst und in ihrer Unfähigkeit, Emotionen zu bewältigen.
In Logotherapie und Existenzanalyse wird das "Geistige" im Menschen betont, seine Fähigkeit zu "Selbstdistanzierung" und "Selbsttranszendenz". Es wird betont, daß der Mensch mehr ist als seine Stimmungen, seine Triebe, seine Charakteranlagen. Andererseits hilft ihm die Sinnfindung dabei, die Grenzen egozentrischer Existenz zu überschreiten, sich mit der Welt auseinanderzusetzen, sich zu entfalten, über sich selbst hinauszuwachsen. Erst auf diesem Wege kann er das lebendige Gefühl erfahren "ich selbst zu sein".
Ein Schlüssel zu Existenz, zu "ich selbst sein" ist der Umgang mit Angst. Gerade im Angstproblem liegt ein Knotenpunkt verschiedener Fragen des Mensch-Werdens und Mensch-Seins. Wo Angst nicht bewältigt wird, ist Auseinandersetzung mit der Welt nicht möglich, ist der Mensch in sich selbst gefangen. "Phobische Fehlhaltung ist unfreiwillig gelebter Nihilismus" formuliert Viktor von Weizsäcker.
In "Theorie und Therapie der Neurosen" hält Frankl fest: "Ein Wesen, das zu Freisein und Verantwortlichsein begnadigt ist, ist zum Ängstlichwerden und Schuldigwerden verurteilt".
Aus der Ausweglosigkeit von Angst entsteht "Angst vor der Angst", ein Teufelskreis, der den Angstkranken in sich selbst gefangen hält. Angst, die krank macht, ist demnach mißlungene Auseinandersetzung mit der Angst. Die Folge ist oft ein tiefer innerer Zwiespalt, eine starke Hemmung, sich mit der Welt, mit der Wirklichkeit auseinanderzusetzen.
Speziell hier gibt Logotherapie und Existenzanalyse in vielen Fällen die Möglichkeit, neue Brücken zu bauen, eine neue Form der Auseinandersetzung zwischen der Person und der Situation zu schaffen. Einen Weg aus dem Circulus viciosus weist Frankl in der "Paradoxen Intention": Der Patient lernt, auf die Angst zuzugehen, sich mit ihr auseinanderzusetzen, sie als bloß subjektive Realität zu erleben und angesichts einer größeren Realität zu ironisieren.
Laut Frankl wird der Patient im Rahmen der paradoxen Intention dazu angewiesen, "sich genau das, wovor er sich bis dahin gefürchtet hatte, von nun an - sich geradezu herbeizuwünschen (bei Angstneurosen) bzw. sich vorzunehmen (bei Zwangsneurosen); mit anderen Worten, sozusagen seinen Befürchtungen "den Wind aus den Segeln zu nehmen".
Nachfolgend einige Beispiele, die zeigen, wie mit Paradoxer Intention ein kreativer therapeutischer Prozeß, ein Ausweg angeregt wurde.

2. Ausgewählte Fälle


Schnüffeltic:
Ein 60-jähriger Patient entwickelt nach seiner Pensionierung einen "Schnüffeltic": dauerndes Aufschnupfen, das zuletzt derartig massiv wird, daß das Aufsuchen öffentlicher Orte kaum mehr möglich ist; Besuch von Veranstaltungen, Kirchgang, zunehmend sogar das Einkaufen wird vermieden.
In der Therapiestunde wird ihm vorgeschlagen, Schnupftabak zu kaufen und regelmäßig zu schnupfen. - Das sinnlose Schnüffeln sollte Sinn erhalten.
Tatsächlich führt dies zu einer wesentlichen Symptomreduktion. Allerdings entsteht in den folgenden Jahren wiederholt eine endomorph depressive Symptomatik, die entsprechend psychotherapeutisch und psychopharmakologisch behandelt wird.

Hustentic:


Eine 62-jährige Patientin erkrankt nach dem Tod ihres Gatten an einem Infekt der oberen Luftwege. In der Folge entwickelt sich ein ständiges Husten und Räuspern, das sich in Gegenwart anderer Menschen oft noch steigert, insbesondere dort, wo ein ruhiges und unauffälliges Verhalten erwartet wird (bei Vorträgen, in Warteräumen).
Die Konsultation vieler Ärzte bleibt fruchtlos, bis sie auf einen HNO-Arzt stößt, der ihr den merkwürdigen Rat gibt: "Begrüßen sie morgens ihren Husten". Zum freudigen Erstaunen der Patientin wird sie innerhalb kurzer Zeit nahezu beschwerdefrei.

Essentieller Tremor:


Eine 45-jährige qualifizierte Büroangestellte litt seit Jahren an essentiellem Tremor, den sie gut akzeptieren konnte. Eines Tages erhielt sie jedoch einen neuen Chef, der weit jünger war als sie. Wenige Minuten nach der ersten Begegnung fragte er taktlos: "Warum reißt es sie so? Haben sie etwas mit den Nerven?" Im Bemühen, sich vor diesem Chef zu beherrschen, wurde ihr "Reißen" noch stärker.
In mehreren Therapiegesprächen entdeckte sie jedoch ihre eigene jahrelange Tüchtigkeit, ihre gesicherte Position im Firmenbereich, und beschloß für sich: "Ich bin eine tüchtige Bürokraft. Ich darf Zittern, soviel ich will, und wenn der Chef kommt, dann zittere ich ihm was vor." - Prompt hatte sie damit Erfolg; das Zittern reduzierte sich zu einer - wenn auch lästigen - Nebensache.

Erwartungsangst:


Ein 24-jähriger Handelsreisender unternahm eine Bergwanderung mit seinem Schwager. Dabei wollte der bergerfahrene Schwager den Flachländer beeindrucken und erklärte ihm während einer Rast, weiter oben komme eine Stelle, die schwierig zu begehen sei. Sogar Geübte würden dort von Angst überfallen. Oft gebe es dort prekäre Situationen.
Bei diesen Ausführungen verging dem jungen Bergwanderer die Freude am Bergerlebnis. Er verkrampfte sich innerlich, begann zu schwitzen, und in Gedanken fürchtete er bereits, an dieser berüchtigten Stelle ebenfalls "hängenzubleiben". In dieser Notlage fiel ihm die oben angeführte Chefsekretärin ein, die er während eines Seminars kennengelernt hatte. Er beschloß, ihrem Beispiel zu folgen. In Gedanken sagte er sich, "wenn die Stelle tatsächlich zu schwierig ist, dann zittere ich meinem Schwager etwas vor. Nachdem er mich hierhergeführt hat, muß er auch zusehen, wie er mich wieder hinunterbringt".
Erleichtert stellte er fest, daß danach das würgende Angstgefühl nachließ. Als sie schließlich an die bewußte Stelle kamen, erwies sie sich bei weitem nicht so gefährlich wie befürchtet, und er konnte die Tour wieder genießen. Insgesamt aber wurde dieser Tag wahrlich zu einem "denkwürdigen Erlebnis".

3. Diskussion


Kreativität und Humor bilden - neben jenen Faktoren, die auch bei anderen Methoden der Psychotherapie eine Rolle spielen - die wesentlichen Elemente bei der Anwendung der paradoxen Intention.

Kreativität:


Paradoxe Intention fördert Intuition und Kreativität. Frankl hat darauf hingewiesen, daß Psychotherapie eine "Gleichung mit zwei Unbekannten ist, mit der Einmaligkeit und Einzigartigkeit des Patienten und Einmaligkeit und Einzigartigkeit des Arztes". Bisweilen fließen auch Elemente der Suggestion ein. Im richtigen Moment angewandt, übt der Psychotherapeut "Hebammenkunst": Was im Patienten drinnen ist, wird auf die Welt gebracht.

Humor:
Zum Gelingen ist auch ein Zugang zum Humor des Patienten wichtig. Frankl betont den großen Spielraum und den damit verbundenen höheren Freiheitsgrad. Oft bringt das Lachen eine lustvolle affektive Entlastung, eine wesentliche kathartische Reaktion.

Paradoxe Intention ist der Angelpunkt einer Therapie, an dem es gelingen kann, den Patienten neu zu orientieren. Er hat die Chance, sich selber zu finden, Entlastung, Ruhe, Gelassenheit und Mut zu neuen Aktivitäten zu finden.
Es wäre aber verfehlt, wollte man die Paradoxe Intention auf eine bloße Technik reduzieren. Gewiß gibt es hier eine technische Ebene, auf der dem Patienten dazu verholfen wird, daß er aus angsterzeugenden Verhaltensmustern ausbrechen oder depressogene Denkmuster modifizieren kann. Sie ermöglicht es ihm, in einem konstruktiven "inneren Dialog" mit sich selbst zu kommen.
Ganz wesentlich erscheint mir jedoch die philosophische Ebene: Der Mensch wird befähigt zu sinnerfülltem Verhalten, zu neuerlichem Werterleben, oder er ist zumindest imstande, sich wieder auf die Suche nach Sinn zu begeben durch Überwindung von eigenem Zwiespalt, eigenem Widerspruch. Im Annehmen seines eigenen Menschseins wird er authentisch, wächst er zum eigenen Sein heran.
Paradoxe Intention regt an zu philosophisch inspirierter Lebensführung - zu "tragischem Optimismus": "Die Welt ist nicht heil, aber sie ist heilbar" (V. Frankl).
Paradoxe Intention ist Brücke, nicht Selbstzweck, und dient einem höheren Ganzen.

Literatur



V. E. Frankl, Ärztliche Seelsorge
V. E. Frankl, Der Wille zum Sinn
V. E. Frankl, Die Psychotherapie in der Praxis
V. E. Frankl, Theorie und Therapie der Neurosen
E. Franzke, Der Mensch und sein Gestaltungserleben
R. Guardini, Vom Sinn der Schwermut
W. Pöldinger, Diagnose und Therapie der Depression
A. Beck, Kognitive Therapie der Depression

Dr. med. Franz Grundtner ist Facharzt für Neurologie in Neunkirchen, Niederösterreich. (Schöllerstraße 12, A-2620 Neunkirchen).




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