The International Journal



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Dr. Ignazio Punzi is psychologist at the "Casa Famiglia Padre Monti", a home for AIDS patients. Also, he is doing practice as a psychotherapist in Rome. Formerly he has worked with CARITAS for a number of years, caring for homeless people.


Finding Meaning in Unavoidable Suffering
Robert C. Barnes, Ph.D.

Abstract:


Although the search for meaning, being a highly personal enterprise, does not lend itself easily to categorization, we may, according to Frankl, discern three main kinds of existential values - creative, experiential and attitudinal values. It is the latter category of values which is explored here in depth.
By responding, each in his or her individual manner, to the tragic triad of human existence - pain, death, and guilt -, we bear witness to the human capacity to turn a personal tragedy into a triumph. The logotherapeutic counselor tries to relate the experience of suffering to a meaning the counselee can accept.

Zusammenfassung:


Obgleich sich die Suche nach Sinn, als ein höchst persönliches Unterfangen, kaum in Kategorien zwängen läßt, können wir doch mit Frankl drei Arten von existentiellen Werten unterscheiden, nämlich schöpferische Werte, Erlebniswerte und Einstellungswerte. Die vorliegende Arbeit behandelt die dritte dieser Wertkategorien.
Indem wir uns, jeder in seiner ganz individuellen Art und Weise, mit der tragischen Trias der menschlichen Existenz - mit Leid, Schuld und Tod - auseinandersetzen, legen wir Zeugnis ab von der menschlichen Fähigkeit, eine persönliche Tragödie in einen Triumph umzugestalten. Der Logotherapeut versucht, das Erlebnis persönlichen Leides mit einem Sinn in Verbindung zu bringen, den der Ratsuchende akzeptieren kann.
In Viktor E. Frankl's concept of the tragic triad of human existence, he refers to pain, death, and guilt (4:125). Suffering itself is a facet of Frankl's tragic triad in how we respond to each of the three.
Suffering gives individuals one of the highest forms of bearing witness to the human capacity to turn a personal tragedy into a triumph (4:126). We may not be able to change our fate, but by the defiant power of the human spirit, we can change our attitude. Frankl speaks of mobilizing the defiant power of the human spirit - which, more than physical or psychological strength alone, can overcome obstacles and conquer difficulties (3:27). Through logotherapy, we can find a meaning in life even when confronted with a helpless situation. No matter how life calls upon us to suffer, that suffering can have meaning if it changes us for the better. Changing ourself often means rising above ourself, truly using self transcendence, learning to mold even our suffering into human achievement. By self transcending, we exercise the most creative of all human potentials.
When we see meaning in life, we are able to endure any suffering. The logotherapeutic counselor tries to relate the experience of suffering to a meaning the counselee can accept.
One of my clients, whom I shall call Douglas, was a 34 year old petroleum engineer who loved his wife and his two children. He worked hard, provided well for his family, was devoted to religious concepts, and reared his children according to the principles of his faith. Unbeknownst to him, Douglas' wife had an affair with a close friend of the family. She was not interested in counseling to reconcile her marriage. Her mind was made up. There was nothing Douglas could do to dissuade her. Frankl defines fate as that which lies beyond human freedom - beyond our power to control. Douglas' fate was decided by his wife. She said to me, "My lover will also be getting a divorce, and I intend to take my children and establish a new family with the person who will become my second husband." Douglas dealt with his grief and was able to cope with his feelings of rejection by considering the greater tragedy that his six year old son and eight year old daughter were experiencing. Through a self transcending change in attitudes, he was able to transmute his unavoidable suffering into a victorious achievement. His faith gave him strength to face his fate instead of being destroyed by it. Through self transcendence, he reached beyond himself to those he loved and to values in which he believed. He fought for custody of his children. After two weeks of a bitter trial byjury, Douglas won their custody. As a man in his mid thirties, he was a father with a broken heart but a triumphant spirit.
Two years later the children's mother took Douglas back to court for a second emotionally draining custody battle. She had convinced the children they would be coming to her and had promised them everything from trips to Disneyland (a major amusement park in the USA) to maid service in her home. (What a basis for building an existential vacuum in the lives of her children!) After a week in court, when the judge read the jury's verdict that the children would remain in Douglas' custody, he collapsed in exhaustion. He said to me, "I've got to go home and tell the children. Their mother has already instructed them by long distance telephone to have their bags packed. I don't know how much longer I can handle this." I looked at him reassuringly and said, "You have a task that awaits you. You believe in this task with every fiber of your being. You are determined that your children will be brought up in a loving home, where they are taught values that are eternal. Knowing that your children need you, you will never have to wonder if you will have the strength to fulfill your task" (1:82 83).
Logotherapy teaches us that in the dimension of the human spirit, we can become the master of our fate, not the victim, even in the face of any limitation. However, logotherapy emphasizes the potential meaning of unavoidable suffering. Frankl points out that accepting unnecessary suffering is masochism (4:126). What he directs our attention to is a fate that cannot be changed. Suffering, Frankl reminds us, would not have a meaning unless it is absolutely necessary.
In Frankl's book The Doctor and the Soul, he wrote, "Whenever one is confronted with an inescapable, unavoidable situation, whenever one has to face a fate that cannot be changed, e.g., an incurable disease, just then is one given a last chance to actualize the highest value, to fulfill the deepest meaning, the true meaning of suffering" (2:178). In Frankl's words, "What matters most of all is the attitude we take toward suffering, the attitude in which we take our suffering upon ourselves (...) Suffering ceases to be suffering in some way at the moment it finds meaning" (3:178, 179).
Several years ago, my wife Dorothy was diagnosed as having cancer. It broke my heart to realize her pain. Someone said to her, "Why you, Dorothy, with all the good you have done and can do with your life?" Her response was, "Why me? Why not me?" She was aware that appropriate handling of suffering is a dimension of serving. Both of us believe that God enables us to use our own pain, not only to enrich ourselves, but also to strengthen others. When cancer appeared again this past October, my Dorothy called upon the same faith to help her find purpose and meaning in what she had to endure. Her response reminded me of the words of Nietzche who said, "That which does not kill me makes me stronger."
In Elisabeth Lukas' book, Meaning in Suffering, she gives two eloquent personal examples of such self transcendence. She tells of her mother's tragic bout with cancer and the triumphant spirit with which she faced it. "She acted with courage, not to overcome her own suffering, but to alleviate ours" (6:138).

Dr. Lukas also tells of her own interaction with Frankl when he suffered a heart attack in 1979 during a visit in Munich. She reached him by telephone in the intensive care unit of the hospital. In her own words, "I wanted to say so much to help, comfort and thank him, but I couldn't find the words. Here, like Mother at her sick bed, was a person who had more strength than the people around him, and he set an example. He spoke calmly. To die held no terrors for him. He accepted any decision of fate because it was beyond his responsibility . . . Thus, he tried to comfort me who myself could not find words. He wanted to tell me, 'Remain calm, too, when you'll face death some day ...' This was his legacy, a lesson from the hospital bed. He did not think of heart failure - he thought of me" (6:139)!


Paul Tournier wrote, "There is no life exempt from suffering. There is no life which, from birth, does not already have to carry the weight of hereditary weaknesses, no life which does not suffer emotional shocks in childhood, which does not suffer daily injustices, hindrances, injuries, and disappointments. To all this pain must be added sickness, material difficulties, bereavement, old age, worry about loved ones, and accidents. In the lives of even the most privileged there is something that is hard to accept" (7:143).
Four years ago, we lost a good friend, a prominent physician. Open heart surgery was performed on him. This operation has worked for many, but not for him. In the months of his decline, he knew with a physician's insight what was happening. Conscious to the very end, he thought deeply about the preparation for his own death. He recalled the meanings he had actualized during his lifetime   accomplishments death could not void. He brought eight thousand babies into this world during his career. For years, people drove many miles to see him, bypassing other medical centers. He was known for being genuinely interested in the whole person. He listened with an educated ear and a caring heart. When patients couldn't pay for their medical care, they received the same high quality treatments as those who paid.
A related example of what Frankl calls "tragic optimism" is seen in the courageous attitude of our deceased friend's widow. Someone said to her, "We had hoped you could have many more beautiful years together. It almost seems you were cheated." She responded, "Cheated? Oh my, no! Many women live a lifetime and never know the love of such a man. What we shared far surpasses what other couples know whose marriage lasted many more years. Cheated?" she asked once again. "No, I was significantly blessed."
I have long believed in the concept of the wounded healer: those who show an undefeated spirit in desperate circumstances can do something for us which others cannot do.
Several years ago I heard Rollo May who was 76 years old at that time. During the question period following Dr. May's speech, a woman asked, "Dr. May, you have talked about the wounded healer, but have you known any suffering in your own life? You're an internationally famous psychologist, a widely recognized author. Did you experience any suffering that helped you become the sensitive therapist you are known to be? How might the concept of the wounded healer apply to you?"
May responded, "I am the second child born to a schizophrenic mother. My older sister is schizophrenic and has been confined for years in a mental hospital.
As soon as I could walk, I learned to get out of the house. I became a loner and was very sensitive. My father abandoned us when I was a pre schooler. I have had heart problems ever since I was four. I fought malaria and was hardly ever without fever from the time I was 20 until I was nearly 30. I also suffered from tuberculosis. From my academic training I gained knowledge to help others, but from my experiences I gained the desire and ability to help them."
In my own life, my mother died when I was three weeks old. Her younger sister came to take care of my four year old brother and me. Later she married my father. When I was five, my new mother gave birth to my brother Richard. While she loved all of us, Richard was very special to her. At 18, a drunk driver killed him on his first trip home from college. The week after his funeral, Mother redecorated the nurseries in our church and volunteered as a "nursery home visitor." She took religious teachings about spiritual aspects of parenthood to expectant mothers in the church. She visited their homes, not to tell about her sorrow, but to help them more meaningfully anticipate their joy.
In my own home, my wife and I anticipated for years the challenge of being parents. By reasonable standards, we have much with which we could nurture a child. We know the importance of love in a child's life. We could teach our child about our faith. We both have doctoral level psychological training which gives us insights in child rearing, and the means to provide whatever level of education our child may have wished to pursue.
The child who came to be ours by adoption was nearly 16 years old, from a background of severe child abuse. Handsome and intelligent, he had remarkable potential for growth and many capacities to help others. For a while his spirit flourished, he was active in his church youth group and outstanding in school and community dramas. But then came heavy drinking, substance abuse, promiscuity, thefts, school failures, lies, and the loss of more than twenty jobs after finishing high school. Only now and then would his beautiful spirit shine through the maze of negative choices. We loved him, and he loved us in return - at least the best he knew how. After wasted years, the pattern was obvious that he chose to stagnate instead of grow. He was fixated on the concept that the world owed everything to him because he had a difficult childhood. The lining of his existential vacuum is made from his consistent lifestyle of using people.
We have never given up hope that his spirit would work its way through his twisted thoughts. Tragic optimism helps us hold onto that hope. Selftranscendence helps us value what we have learned from these experiences with our son, and use this insight to help other parents in many ways we would otherwise not have been able to do.
I myself live within a body that has major limitations because I had polio when I was thirteen, two years before the polio vaccine was available. My body is crippled, but I as a person am not. Logotherapy teaches us that we are three dimensional beings. My soma (my body) became sick. My psyche (my emotions and intellect) experienced a healing through the acceptance that my body had limitations, but my life does not need to be shaped by those limitations. Our noetic dimension (our spirit) can never become sick. Somehow in my noetic dimension, even as a teenager, there was an awareness that I am a whole person, that the Creator has purpose for my life, and that no disease took away anything I needed to fulfill the tasks that await me. As a spiritual being, I am not even slightly diminished by having a lame leg. In fact, I can truly say that, because of the opportunities I have had to serve and help others, my life is extraordinarily rich in meaning.
Several months ago, a mother made an appointment for me to see her daughter who is a victim of progeria, a disease that causes a child to age 7 to 10 years for every year he or she survives. So rare is the disease that there are only nine progeric patients known to be alive in the world at the present time. A 10 year old child could easily look like a 100 year old person with wrinkled and withered skin, and with eyes bugging out of their bald heads. All body tissues and organs age at the same rate, and they truly become very old while yet very young. The mother who called for the appointment told me her daughter, whom I shall call Mary, was 15 years old. This is older than most progeric patients live to be. Mary's mother said to me, "I understand that you deal with such issues as finding meaning in life. Mary knows she does not have a lot longer to live, and she is struggling with many questions about meaning in her own life. Before the hour came for Mary to arrive at my office, I reminded myself that I would need to see beyond Mary's progeric soma, and focus on what could be truly beautiful: her spirit. Mary's mother alerted me that Mary was blind in one eye, and that the other eye was already covered by a cataract. She mentioned too that Mary was the size of a delicate seven year old child, and that she would look older than anyone I would ever have seen. She even described that Mary's four front teeth had grown together as one tooth. I was thankful for ways that life had prepared me. Surely I, who have lived in a body that is different  though not that different, should be able to accept a child whose body was different. I was confident that my spirit and her spirit could touch, and that we would communicate effectively.
When Mary entered my office, I experienced one of the biggest surprises I have ever had, not at all because of the grotesque physical appearance, but because Mary walked in with the grace of a ballerina and the charm of a princess. For a moment, I was stunned - and all for the right reasons. Mary was living proof that the spirit within us can never be sick. The instruments of the spirit may become dulled or diminished, but the spirit itself can never be sick! Mary's dulled eyes focused on me with a phenomenal intensity. Her smile was so spontaneous that I forgot to look for the unusual teeth. The thoughts of this 15 year old were so candid that I felt comfortable and natural as her counselor from the moment we were together. I said to her, "Mary, you have much more personal charm and poise than most people of any age. How have you developed that?" She answered, "From the start, my mother prepared me for the world that would have to look at me, but she loved me as if I were the same as everyone else. From as early as I can remember," Mary said, "I believed something inside me was like something inside everyone else, and so I learned to interact with others on that basis."
Mary told the story of when she was a little girl she had a little neighborhood playmate whose name was Tommy. They played together and loved each other as dearly as children can. One day Tommy's mother thought it was time to talk to him about Mary's extraordinary physical condition. She said, "Tommy, do you know what the word different means?" "Oh yes, Mama, I know what different means," Tommy answered. Then his mother asked, "Do you know how Mary is different from other girls and boys?" "Oh," Tommy said, "Mary is different because she has two pairs of roller skates and the rest of us only have one."
Together Mary and I faced some important questions. We don't know how much longer she has yet to live. She no longer has the stamina to stay in school all day every day, and so she has a teacher who comes to her home. Yet she has some energy, and she wants to do something meaningful with her life. She believed me that if she does something solely for herself, she will not find meaning in it. She accepted my suggestion of beginning with a project that would involve helping someone else. I went back to her story about Tommy and the roller skates, and I asked how old Tommy was when he said that. He was four years old. We mutually agreed that children that age and younger have a special gift for accepting others who are different, and for responding to love in a natural way. Mary mentioned her love for children, and that she realized she would more than likely not live to marry and have children of her own. We came up with the idea of her volunteering in a childcare center for little preschool children. The last time Mary and I were together, she happily described her schedule of working two hours per day, three days per week, with two and three year old children in a private nursery. She said to me, "I'm happiest on those days. I think of the children as my children. I give them the gift of my love."
The last case history to be included may already be familiar to some of you because Dr. Elisabeth Lukas very generously wrote about my work with this family in an article that appeared in the current "International Forum of Logotherapy" (5:51 54). In February, 1992, a family came to my office whose little girl had been killed one day before her fourth birthday. I knew the circumstances they were coming to talk to me about, and I thanked God for the experiences in my life that prepared me to help this family. The grief stricken mother, father, and 13 year old brother told me about that tragic day. A neighbor lady had stopped by on her way to the grocery store to see if Mrs. Smith needed anything, "Let me go with you," Mrs. Smith said. "Sally's fourth birthday is tomorrow, and I need to get some things so I can bake a birthday cake for her." While Mrs. Smith was getting her purse, Sally ran outdoors so she could go too. Unfortunately, the neighbor lady had left the engine of her car running. In a flash, little Sally had jumped into the car, pulled the gear shift into reverse, and was thrown out of the open door as the car began to back up. Almost hysterically Mrs. Smith told the story. "When I came out of the house, the car was backing round and round over my precious little girl's body. I screamed and ran to her," Sally's mother said. "I scooped her up in my arms. Blood was coming out of everywhere - her ears, her nose, her mouth. She couldn't talk, but she was still breathing. Her eyes were looking right into mine." Sobbing in my office, little Sally's mother said, "I can't get that sight out of my mind, Dr. Barnes. I can't even go to sleep at night. I just keep seeing all that blood, and I see her eyes looking into mine. Then she died. Why did I have to be the one, why did I have to see my child bleeding and dying and not able to speak? Why me?"
I took Mrs. Smith's hands into mine and I said, "I am so sorry for your pain. Truly I am. I'm so sorry for the loss of your precious child. I am so sorry it was you who had to see that blood and live with that memory. And yet, I am so thankful it was you who held Sally in the last moments of her life. She had come through you, and before she returned to her heavenly father, she knew she was in her mother's arms. She could no longer speak, but she could see. I'm so glad it wasn't a stranger who held her as she drew her last breaths. I'm so glad she knew she was in the arms of her mother."
"Oh, Dr. Barnes," Sally's mother said. "I hadn't thought of it that way. I'm glad it wasn't a stranger who found her and held her as she died. I'm thankful I could be the one. Seeing it this way, I can live with my memory now."
Is there meaning in suffering? Let me leave you with this thought: Those who have gone down into the depths of life are most certain of its heights. The veterans of life with the most scars have found the greatest dimensions of meaning, and believe the struggle most worthwhile!

REFERENCES


1. Barnes, Robert C., "Finding Meaning in Suffering." The International Forum for Logotherapy. Vol. 12: No. 2, Fall, 1989.
2. Frankl, Viktor E., The Doctor and the Soul. New York: Vintage Books, 1973.
3. Frankl, Viktor E., Man's Search for Meaning. New York: Washington Square Press, 1965.
4. Frankl, Viktor E., The Unconscious God. New York: Simon and Schuster, 1975.
6. Lukas, Elisabeth, "Logotherapeutic Crisis Intervention: A Case History." The International Forum for Logotherapy. Vol. 16, No. 1, Spring, 1993.
6. Lukas, Elisabeth, Meaning in Suffering. Berkeley, CA: Institute of Logotherapy Press, 1986.
7. Tournier, Paul, The Healing of Persons. New York: Harper and Row, 1965.
_____________________________________________________________
Robert C. Barnes, Ph.D., is professor and chairman of the Department of Counseling and Human Development at Hardin-Simmons University, Abilene, Texas 79698, USA. A Diplomate of Logotherapy, Prof. Barnes is president of the Board of Directors of the Viktor Frankl Institute of Logotherapy in the USA.

Beispiel einer logotherapeutischen Krisenintervention [*]
Elisabeth Lukas

Die folgende Geschichte einer logotherapeutischen Krisenintervention wurde mir von Herrn Prof.Dr. Robert C. Barnes berichtet. Robert C. Barnes ist Leiter des "Department of Counseling and Human Development" der Hardin-Simmons University in Texas und einer der bedeutendsten Logotherapeuten der USA.


In der Nähe des Wohnortes von Robert C. Barnes hatte sich ein furchtbarer Unfall zugetragen.
Zwei Familien wohnten in Nachbarhäusern nebeneinander; die beiden Mütter waren miteinander befreundet. Eines Morgens fuhr eine der beiden Mütter mit ihrem Auto vor der Haustüre der anderen vor, ließ den Motor laufen, sprang aus dem Wagen, ließ sogar die Wagentüre offen, weil sie sofort zu einem entfernt gelegenen Supermarkt weiterzufahren gedachte, und lief zum Hause. Dabei rief sie ihrer Freundin fragend zu, ob sie ihr etwas mitbesorgen sollte. Die andere Mutter erwiderte erfreut, daß sie dieses angebot gerne annehme, weil ihr Töchterchen am nächsten Tag seinen 4. Geburtstag feiern werde, und mehrere Kinder zur Party geladen seien. Da benötige sie noch allerlei Zutaten für das Fest. Plaudernd zog die Frau ihre Freundin mit sich in die Küche, um ihr einen entsprechenden Einkaufszettel anzufertigen.
Mittlerweile hatte das kleine Mädchen, das am nächsten Tag seinen 4. Geburtstag feiern sollte, das Auto der Nachbarin vor dem Hause bemerkt. Weil es schon öfters darin mitgefahren war und solche Ausflüge als sehr vergnüglich empfunden hatte, schlüpfte es, nichts Böses ahnend, in den Wagen. Was dann geschah, kann nur vermutet werden. Wahrscheinlich spielte das Kind an der Handbremse herum und löste sie, woraufhin das Auto vorwärtsruckte. Vielleicht fiel die Kleine dabei heraus, vielleicht sprang sie auch erschrocken heraus. Jedenfalls setzte sich das Auto aufgrund eines Einschlags der Räder genau auf das Kind zu in Bewegung, erfaßte es und überrollte es.
Fast im selben Moment, als die Räder das Mädchen wieder freigaben, traten die beiden Frauen aus dem Haus. Entsetzt stürzte die Mutter auf ihr Kind zu, das sterbend am Boden lag, und riß es in ihre Arme hoch. Das Kind, noch wenige Sekunden bei Bewußtsein, schaute ihr direkt in die Augen, während ihm das Blut aus Nase, Mund und Ohren quoll. Dann verschied es.
Verständlicherweise erlitt die Mutter einen schweren Schock, und auch die Zeit, die danach verging, brachte keine Linderung. Nacht für Nacht wachte die Frau schweißgebadet auf, von Traumbildern gequält, in denen sie immer wieder das blutverschmierte kleine Gesicht ihrer Tochter vor sich sah, die brechenden Augen auf sich gerichtet. Schließlich konsultierte sie einen Psychologen. Doch dieser fand das tröstende Wort nicht, im Gegenteil, seine bohrenden Fragen nach der Vorgeschichte, etwa, ob das Kind überhaupt erwünscht gewesen wäre, und dergleichen mehr, regten die Frau derart auf, daß sie in seiner Praxis in einen hysterischen Weinkrampf verfiel. Indigniert schob sie der Psychologe zur Hintertüre hinaus, weil er nicht wollte, daß seine im Wartezimmer sitzenden Patienten dieses "Theater" mitbekämen. Zum Schluß drückte er der Frau wohlmeinend, aber nicht gerade sehr taktvoll, die Adresse einer Selbstmordverhütungsstelle in die Hand und zog sich eilig in seine Praxis zurück.
Nach diesem enttäuschenden Versuch, Hilfe zu finden, vergingen weitere Wochen, und die Mutter kam nicht zur Ruhe. Tagsüber passiv und wie gelähmt, fürchtete sie nach wie vor die von Alpträumen geprägten Nächte, in denen sich alles an ihr, Leib und Psyche, in Pein aufbäumte und verkrampfte. Da hatte ihre Schwester anläßlich eines Besuches eine Idee: sie riet ihr, Robert Barnes aufzusuchen. "Er ist ebenfalls Psychologe und Psychotherapeut", sagte sie zu ihr, "aber er arbeitet nach einer anderen Methode. Vielleicht weiß er Rat." So gelangte die Frau in die Praxis eines Logotherapeuten, und ich rekonstruiere nun möglichst wortgetreu, was mir Robert C. Barnes erzählt hat:
"Die Patientin wirkte wie auf den Kopf geschlagen, und doch krümmte sie sich unter einer inneren Hochspannung. Was war es, das zwischen ihr und der Leidbewältigung stand? Sie verriet es mir in einem Satz, den sie ständg wiederholte: 'Warum mußte ich meinem kleinen Mädchen beim Sterben zuschauen, warum mußte ausgerechnet ich diesen schrecklichen Anblick, der mich nie mehr losläßt, erdulden?' Hier tat sich das Zentrum der Tragödie auf, weshalb ich darauf einging. 'Liebe Frau', antwortete ich, 'Sie haben Erschütterndes mitgemacht. Aber ich bin so froh, daß Sie Ihr Mädchen in jenem entscheidenden Augenblick in den Arm genommen haben. Ich bin aufrichtig froh, daß Sie nicht, vor Entsetzen starr, auf halbem Wege stehen geblieben sind und etwa die Hände vors Gesicht geschlagen haben. Dadurch haben Sie Ihrem Kind einen wirklich guten Abschied ermöglicht. Hätten Sie nämlich gezögert oder sich abgewandt, wäre das Letzte, was Ihr Kind von dieser Welt wahrgenommen hätte, der staubige Autoreifen gewesen, der über es hinweggerollt ist - oder bestenfalls ein fremdes Gesicht. So aber durfte es zuletzt in die Augen seiner Mutter eintauchen und darin die Liebe ablesen, die es ein Leben lang begleitet hat. Wir können sicher sein, daß die Kleine zu diesem Zeitpunkt keinerlei Schmerz gespürt hat, denn eine derart schwere Verletzung betäubt alle nervlichen Empfindungen. Nein, sie war schmerzfrei und geborgen. Geborgen, denn es gibt keine größere irdische Geborgenheit - schon gar nicht für ein Kind - als in den Armen der Mutter... Ihr Mädchen durfte somit im Bewußtsein seines Geliebtseins aus der höchstmöglichen Geborgenheit in eine ganz andere Geborgenheit hinübergleiten... was für ein guter Abschied! Allerdings um den Preis, daß Sie eben jenen schrecklichen Anblick auf sich nehmen mußten und jetzt in Ihrer Erinnerung zu tragen haben.'
Während ich sprach, war die Patientin aufmerksamer und zugleich innerlich ruhiger geworden. 'Sie meinen, es war gut, was ich gemacht habe, gut für das Kind?' fragte sie zurück. - 'Es war das Beste, das Sie in Ihrer Situation tun konnten', bestätigte ich ihr. 'Schmerzfrei und geborgen...' murmelte die Patientin vor sich hin, dann straffte sie sich. 'Wenn das so ist, dann kann ich mit dem blutigen Gesichtchen meiner Tochter vor Augen leben.' - 'Sollte sie wieder in Ihren Träumen erscheinen, nehmen Sie sie einfach nochmals in den Arm und wiegen Sie sie...'. Die Patientin verließ mich gefaßt. Ein späteres Kontrollgespräch ergab, daß sie von Stund an ungestört zu schlafen vermochte."

Diskussion der Fallgeschichte


Bis heute kennen wir kaum schlüssige Antworten auf die Frage, welche Faktoren in der Psychotherapie ausschlaggebend sind. Da es sich beim vorliegenden Bericht um einen wenig komplexen und kurzfristig "gelösten" Fall handelt, können wir leichter versuchen, den dabei wirksam gewordenen Faktoren auf die Spur zu kommen. Deshalb will ich meinen Bericht mit ein paar Gedanken dazu ausklingen lassen.

a) Diagnose


Vor aller Therapie steht nun einmal die Diagnose - und die Gefahr einer Fehldiagnose. Eine solche entsteht, wenn eine Sachlage beim Patienten über- oder unterbewertet wird, wodurch sich das Gesamtbild verfälscht.
Bei der geschilderten Problematik hätte es schnell zu einer Überbewertung des traumatischen Ereignisses kommen können, weil der Tod eines Kindes nahezu das Schlimmste ist, das einer Mutter widerfahren kann. Allein, dieser Tod, für sich genommen, hat die Pathogenese der seelischen Störung bei der Mutter gar nicht hervorgerufen, wie sich im Verlauf der Intervention gezeigt hat. Auf der anderen Seite hat der zuerst konsultierte Psychologe das traumatische Ereignis zweifellos unterbewertet, indem er in der Vorgeschichte nach pathogenen Elementen gesucht hat. Damit entfernte er sich zu weit von der eigentlichen Last, unter der die Frau zusammengebrochen war.
Robert Barnes beging keinen der beiden Fehler. Mit der Überlegung: "Was steht zwischen ihr und der Leidbewältigung?" bewies er seine richtige Einschätzung der Sachlage: er schätzte das Leid (den Tod des Kindes) als prinzipiell bewältigbar ein, und gleichzeitig als an der Pathogenese beteiligt, weil noch unbewältigt.
Bei richtiger Einschätzung der Sachlage überhört man auch nicht die wesentlichen Sätze des Patienten. Die psychotherapeutische Erfahrung lehrt uns nämlich, daß die meisten Patienten über ein erstaunliches "Vorwissen" verfügen, was ihre Probleme angeht. Es ist ein weder rein rationales noch rein emotionales, sondern vielmehr intuitives Erfassen dessen, was "unerledigt" (Kübler-Ross), "unausgewogen", im weitesten Sinne "unwert" und "unwürdig" der eigenen Person ist. Nur können die Patienten dieses Vorwissen in kein Fachwissen einordnen, während die Psychotherapeuten mit ihrem Fachwissen darauf angewiesen sind, es mit dem Vorwissen ihrer Patienten in Verbindung zu bringen.
Robert C. Barnes hat also bei richtiger Einschätzung der Sachlage seine "Sensoren" auf das "Vorwissen" seiner Patientin gerichtet, und siehe da, sie lieferte es ihm: "Warum mußte ausgerechnet ich diesen schrecklichen Augenblick erdulden?" Das ist eine pathogene - genauer: neurotische - Reaktion, auf die das Franklwort paßt: "In der neurotischen Existenz rächt sich an ihr selber die Defizienz ihrer Transzendenz".[1] Hier, an dieser Stelle, trauert nicht eine Mutter um ihr Kind, sondern hadert ein Mensch mit seinem Los. Und genau hier, an dieser Stelle, heilt die Wunde nicht.

b) Therapie


Wenn ein Mensch sein Los beklagt, gibt es aufs Neue zwei potentielle Fehleinschätzungen des therapeutischen Umgangs damit.
Eine davon ist gegenwärtig sehr verbreitet. Sie geht von der These aus, daß es absolut notwendig und die Seele reinigend sei, daß sich der Betreffende intensiv ausklage. Die Folge ist leider oft, daß der Patient in einem schädlichen Selbstmitleid gefördert und bestärkt wird. Die andere erkennt zwar die dämonische Spirale, in die sich ein Patient solcherart immer tiefer hineindreht, sieht aber die Alternative lediglich in einer Abstoppung seines Haderns ohne existentielle Auseinandersetzung mit dem Gegenstand der Klage.
Robert Barnes war von seinem logotherapeutischen Hintergrund her gegen beide Varianten gefeit. Mit der konfrontativen Feststellung: "Ich bin so froh, daß Sie Ihr Mädchen...in den Arm genommen haben" beendete er die Spirale des Selbstmitleides bei seiner Patientin abrupt, um ihr den Sinn dessen, was sie da beklagt, transparent zu machen: "Sie haben Ihrem Kind einen wirklich guten Abschied ermöglicht". In der nachfolgenden Begründung wird das Erschütternde des Beklagnisses in keiner Weise weggedrückt. Es darf leidvoll bleiben, denn das Leid gerinnt zum Opfer, zum nachträglich bejahten Opfer: "Wenn das so ist, kann ich...damit leben". Die Transzendenz des Leidvollzugs ist wieder hergestellt, die neurotische Störung weicht.
Die Trauer wird nicht weichen und soll es auch nicht, denn "die Trauer um einen Menschen, den wir geliebt und verloren haben, läßt ihn irgendwie weiterleben..." [2]. Aber der ohne Hader Trauernde regeneriert sich im Schlaf, in dem die Grenze zwischen dieser und jener Welt fließend wird, und die Lebenden und die Toten einander besuchen dürfen.

[*] Anmerkung des Herausgebers: Der hier geschilderte Fall wird auch in dem Artikel von Robert C. Barnes, der in diesem Heft abgedruckt ist, erwähnt.


Literatur
1) Viktor E. Frankl, "Der unbewußte Gott", Verlag Kösel, München, 7.Auflage 1988, Seite 64
2) Viktor E. Frankl, "Ärztliche Seelsorge", Fischer Taschenbuch Verlag, Frankfurt/M., 4.Aufl. 1991, Seite 148


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