Training youth healthcare: which interest is central?

Recently I had an exchange with a lactation consultant colleague about a training she will shortly follow. She reported to me that she had felt really awful about what she had been reading while preparing for that training. She had the feeling that the interest of the baby was fully inferior to the interest of the adults. This is in line with the Adult Supremacy concept we have written extensively about here before. I would like to give an impression of what we discussed.

C(ollegue): I just read the literature for a webinar I will follow and in which all sorts of things made me raise my eyebrows. It was about a particular problem in the breastfeeding relationship, and what I was very concerned about with most of the topics dealt with was: ‘Who has the problem and who has to adapt here: the adult/parents, or the child? How do we view this in our culture? Who is able and responsible to approach a problem with empathy – the newborn or young child, or the adult?’ Another question that arose is: ‘Is it ethical to force children into something that is not developmentally included in their evolutionary nature, their biological blueprint, and which is mainly focused on serving the adult interest? Are you not sending the message to the baby that they are not good enough? In the preparatory literature it was mentioned that one third of all infants do not go to the breast just like that. How am I supposed to understand that…? Is the statement that about 30% of children naturally tend to starve themselves by not going to the breast…? In other words, is not breast feeding natural behaviour or is it the result of how we handle situations? To top it all off, it was suggested that a child should not be offered the breast for 24-48 hours if necessary in order to force a certain different behaviour. In my opinion, you are actually saying to the completely dependent baby: ‘If you don’t do what we want, we will punish you.’ I was so angry… I experience this as psychological torture of the child. Those are heavy words – I realise that, but with the knowledge I have, they feel appropriate.


M(arianne): Oh, that sounds very intense…

C: Yes, it was… Sometimes I get so tired of these kinds of views, which I still see far too often… How come society changes so slowly and leaves children so unbelievably in the lurch?

M: Yes, that is a huge problem indeed… Do you do something with this feeling? Do you express it in a professional, constructive way? Do you write about it?

C: I find that difficult. I also see that it actually concerns two disciplines, namely anatomy and physiology and their impact on the breastfeeding relationship on the one hand, and the psychology of (parenting) views and their impact on the child on the other hand. That is the tricky part about it.

M: Hmmm… well… but if you look at it holistically, then there are no different disciplines around the child. Then we are only talking about this new little person who has needs in all kinds of ways, which ideally are well met by the parents/caregivers/society. Unfortunately, that is often not the case. It seems to me that unity of these fields should be at the heart of everything we do regarding the care of children.

C: Yes, I completely agree. I’m just afraid those who host the webinar do not look at it that way. And it is probably not even something conscious. That is why I have asked a number of questions about this, for the sake of raising awareness. This does bring up the question, however, of who we are there for as lactation consultants: for the needs of the parents (with the result that an attempt is often made to ‘fix’ the child) or to support the parents, but with the perspective and the needs of the child as a basic starting point?

M: Opinions probably differ on that one, too… 😉 Personally, I never think it is okay to put the child’s perspective aside, in any role! And of course this primarily concerns the relationship between the child and the primary caregivers, usually the parents. I just think that in many settings the attitude of being child-oriented is not yet as powerful as it should be.

C: No, I think so, too, so the question is how to get a good picture of both needs and how to satisfy them. Because it is so important that certain needs are fulfilled in childhood, I think that the best interests of the child deserves to be leading. At the same time, society asks so much from people that personal wishes and choices are often at odds with societal ‘demands’. As a result, daily practice is often at odds with the needs of children. That is a serious statement, but a true one nevertheless.

M: Absolutely, totally agree! How we organise society has such a big influence on parenting! Have you read ‘The myth of normal’ by Gabor Maté yet…? There does not necessarily have to be a conflict between the well-being of the parents and that of the child. If the parents could first (learn to) look with compassion at what they themselves missed and where they suffered pain… that would already be so helpful!

C: Oh yes, and that is exactly the hardest part. I really tried to raise my kids with child-oriented approaches, but I made a lot of mistakes in that too. That is an observation; I do not feel guilty about it, but it does make me sad. The result is partly that one of my children struggles with major psychological problems. You never know how things would have turned out differently, but it keeps me wondering. Fortunately, the other children are doing well.

M: Yes, I recognise what you mention. At the same time, it is also important not to view and approach our children as ‘the result of our own mistakes’. No one likes to be seen like that. Most parents do the best they can for their children. What we can see is that many parents lack assets and there are many reasons for this, including a lack of knowledge about the influence of early experiences on later life. It is therefore important to ensure that that parental competence can develop as well as possible, so that parents have a good understanding of how they can lovingly guide their child into adulthood. When parents dare and are able to explore what they missed in their own childhood (with some therapeutic support if necessary), it usually helps enormously to understand why some things in life are so difficult. If they do that before the birth of the first child, that is of course beautiful, but it is never too late to increase your insight. Understanding the difference between reacting impulsively from a trigger on the one hand and responding intuitively from awareness on the other hand is the essence. For that you have to dare to look at those own triggers, as well as at the explosive charge underneath. That is a big, but crucial task for adults.

We talked a bit further about the details of what she had been reading. I know this colleague as a very involved lactation consultant. I was pleased to hear that she felt so much resistance to the child-unfriendly suggestions and that she felt the question about the power relationship bubbling up. What I regretted was that in 2023 lactation consultants (and also other healthcare providers, for that matter) are still being given this kind of advice. From neurophysiology and interpersonal biology, we now know an incredible amount about the impact of disconnection from the child on brain development. Ignoring, threatening, neglecting, punishing, intimidating… they leave deep traces in the stress landscape of the body. They are not trauma sensitive at all and do not do justice to the child’s complete dependence and need for authenticity. Given the state of present day science, such practices do not (or no longer) belong in youth health care advice.
I hope that the colleague receives satisfactory answers to the questions she has asked and that she nevertheless keeps having the courage to put a child-orientated approach at the heart of her own work. Knowing her, I have every confidence in that!

Professionals and ACE-awareness, Episode 8 – This week: Kerstin Uvnäs Moberg

A little less than two weeks ago, we had a wonderful lactation consultant training day in Utrecht with a world-famous speaker on the topic of oxytocin, namely the Swedish professor Kerstin Uvnäs Moberg. Straight after her lecture, I had the privilege of sitting down with Kerstin for an interview for the ACE Aware NL-podcast, ‘Raising Resilience’. What an honour!
The editing is done, so the podcast is online for everyone to hear Kerstin speak. In this blog, I would like to share a few of the themes discussed.

Oxytocin is an amazing hormone and Kerstin has spent a lifetime studying it, writing about it, and most of all doing research on it. When she started examining its effects, she was intrigued and felt that there was more to it than just its well-known role in the field of birth and breastfeeding. She started talking about the hormone’s characteristics as an aside at first, when she gave lectures on other topics, but slowly but surely general interest increased and she was drawn to the subject, also by curious students who wanted to become knowledgeable on the subject. Sensing there was much more to oxytocin than met the eye and by truly dedicating herself to this totally new field, she evolved into a global expert.

Until those early days of oxytocin research, there had been an lot of attention on the stress hormones cortisol and adrenaline, dominant in the active or sympathetic part of the stress regulation system, the more ‘male’ side, one might say. When Kerstin started focusing on the relaxation half of the stress system, the parasympathetic or the more ‘female’ side, this was a whole new development. Beautiful mechanisms showed up: calm and connect, rest and digest, tend and befriend – all functions that historically are seen more as dominant in female realms of life, as they are very important in birth, breastfeeding, caretaking, and wound and trauma healing.

It took a while before oxytocin was seen as a serious topic to study. The newness of it caused some raised eyebrows here and there: ‘Is this serious? Is this real? Can we measure it? What is the added value of knowing more about this?’ Kerstin persisted and proved its huge relevance. She feels that although it is good that new topics in science are rigorously studied before claims are made, ideally the academic mind is open to innovations and willing to contemplate new ideas, guided by real curiosity. These days, oxytocin is a well-known substance, to the point even where its meaning is sometimes a bit superficially reduced to ‘the cuddle hormone’. Thus, the much more profound and diffuse effects on well-being, healing, and anxiety reduction and all the consequences those effects have on society are forgotten.

It was amazing to listen to Kerstin and notice how she aptly referred to aspects of oxytocin (which is not only a hormone but also a neurotransmitter) that might have revolutionary effects if taken much more seriously. For example, she mentioned the importance of being aware of certain healthcare routines that are done on a daily basis and are considered so normal and obvious that they are sometimes not even studied for their long-term effects, even though a deeper insight might make us all more conscious of their impact. After all, small effects in large numbers and high frequency do add up to making a huge clinical difference! There are many social factors that can play a role in this dearth of research: how much status do certain topics and thus studies have, how long does the follow-up need to be to say something meaningful about the intervention, what financial investment and professional prestige is connected to the decision to either setting up or pushing aside this kind of research?

Kerstin also considers it desirable that young students gain access to old scientific material in order to create an integrative view on the topics they study. Specialties in healthcare can be wonderful, but they may have the risk of fragmenting the human body into a collection of organs instead of seeing the body as a coherent whole that mirrors the result of a delicate (im)balance between complicated systems working together, from gut to brain and vice versa, with subtle rhythms and patterns deserving a sophisticated, respectful approach when studied.

It was music to my ears to hear such an eminent lady, who has dedicated a lifetime to this one topic, speak in such a holistic way about a hormone that is so old, so ‘well-preserved and archaic’, as she called it herself. Nevertheless, it was not always easy for Kerstin to bring that holistic effect of oxytocin to the forefront, because most journals that publish scientific articles want them to be specific and detailed, not broad and general, which is regularly considered superficial.
I was also deeply touched by Kerstin’s remark that the attunement of the mother to the baby’s needs, once she is flooded by oxytocin, may be the first time in her life where she feels that giving priority to that little human instead of herself is a logical thing to do, purely because of the baby’s total dependence on the mother for satisfying the hunger and the need for contact. This also implies that those around the birth mother need to be aware of the mother’s vulnerability and of the impact of saying, advising, or even demanding things that overrule the mother’s evolutionary intuition, stimulated by her high oxytocin levels.

All in all, it was a joy to listen to Kerstin and speak with her and a delight to hear, in reply to my questions about what she looks forward to, that she wants to write more and keep doing more research, as there is still so much about oxytocin that is worthy of a yet more thorough understanding. May oxytocin be a large part of what keeps Kerstin healthy, so that for years to come, we can all benefit from her bright mind and warm heart!

Book review ‘From madness to Wisdom’ by Iris van Zomeren

Through her beautiful email to ACE Aware NL I came into contact with the author of the book ‘From madness to Wisdom – The autobiographical life story of Iris van Zomeren’. We agreed that I would review it for the website. Iris sent it to me and as soon as I started reading it I was fascinated. (See also our book page; titles in alphabetical order of authors’ last names.)

The book begins with a foreword by psychotherapist Rachporn Sangkasaad Taal. She tells how she met Iris, who had already gone through all kinds of therapy. She writes that she is impressed by the post-traumatic growth (PTG) that Iris has achieved. With her introduction she makes it clear that the book is about a very tumultuous life, but to really understand how much lack of safety there was for Iris, reading cover-to-cover is the best thing you can do.

The book is written narratively, with lots of personal dialogues and exchanges between Iris and other main characters. That means that you as a reader are sucked into the poignant events. In addition, so much is explained in the field of psychological and emotional trauma healing processes that probably almost everyone can derive valuable insights from it. Iris takes the reader along on the journey she has made and we see her slowly but surely ‘breaking open’, blossoming, giving light and air to what she has endured. The intergenerationality is also evident: her parents were both damaged in their own childhood and the healing work that Iris is now doing has a positive effect not only for herself, but also for others in her family line. As a reader, you witness her deep self-examination and her harrowing recovery process; with how she writes, Iris invites you to “hold space” for that.

Iris starts with a sketch of her family situation, with parents with a background of domestic violence and sexual abuse, among other things. There is a lot that gets handed down to Iris and the other kids through intergenerational transmission. That is so intense that Iris can only survive by freezing and suppressing emotions and memories. With more trauma sensitivity, several adults could probably have picked up on signals, but Iris, like many children, is alone with her pain and despair.

In 38 often concise chapters she guides us through her experiences and in many chapters explanations are included in clear boxes about certain terms that are discussed in the text. This makes it easy for the reader who is new to the topic to follow unfamiliar concepts. Where relevant, Iris has included passages from letters, correspondence and diaries; these can be recognised by being written in italics.

Around the age of twelve, Iris starts to rebel more and more against the home situation, which leads to complex coping strategies. She finds no understanding at home; her parents lack the ability to acknowledge and address their own role in the problems. As a result, Iris loses the connection with her authentic self and an existential gloom arises.
Around the age of twenty, some of her painful experiences begin to emerge, but the time is not yet ripe and the sense of security is not yet sufficient to face everything. That sense of security does arise when she is in her early thirties and meets Erik, the love of her life. With him beside her, more and more of the trauma hidden in her emerges. It is a tough road and more and more she experiences a huge rage; this also puts pressure on her relationship with Erik. However, she notices that the anger also has a very good side and that it helps her to regain her self-esteem, her dignity, to undo the “in-dignation”.* As a result, she gradually and increasingly comes into contact with the underlying injuries. The realisation grows that anger does not have to be an obstacle, but can be a gateway to get in touch with yourself. Iris describes it beautifully: “You tend to see the anger as disorienting when in essence it is reorienting” (p. 62).

The desire for contact with her family of origin remains, but it also turns out to be very complicated again and again. This is mainly because the other family members continue to completely deny the events of the past. This is a phenomenon experienced by many people who want to address abuse and neglect within the family. There is often a great taboo on the subject, which makes restoring family relationships difficult and often temporarily or permanently impossible.

After two bizarre and very intense experiences, she comes closer to the origin of her trauma. Through a clearly described, very intensive therapy process, she becomes aware of how different sub-personalities have carried the trauma for her.

As many discover during their healing journey, a long-lasting need remains to seek the love you should have received as a child in places and with people where it cannot be found. The acceptance that that lack of the past can never again be compensated for, is often intense. It deserves mourning and processing time, time in which you learn to refocus, to see that what was not possible before, is possible now: choosing a social environment that can be with your pain and that sees your courage and your potential at the same time. Within a setting that is safe, nurturing, supportive and stimulating, the ‘detoxification process’ (p. 161) can still take place, a process necessary to return to your healthy core and from there to see and experience life in a new light.

With all the post-traumatic growth she is going through, Iris is increasingly successful in tracing the origins of the events of the past. Feeling through, seeing through and living through the old pain creates more and more compassion, not only towards other victims, but also towards the perpetrators of the past. Compassion is also in the foreground when she meets people from her childhood, with whom she enters into a conversation about what was going on for her at the time. This helps her experience the reality of her past more powerfully. She also increasingly experiences that the body, with all apparently ‘dysfunctional’ reactions, provides wise solutions to survive in circumstances that far exceed the comprehension, pain threshold and capacity a child has. The pain is stored in the most basic parts of the brain and in the cell memory of the body. The pain can therefore not be healed through cognitive insight alone. The body is allowed to speak, is allowed to tell the life story, supported by forms of therapy that are helpful.

Iris ends her book with the following observation: “Of course it is not the case that old things no longer arise, but there is less and less resistance in me and much more patience. And this patience is not a method, but the result of my intense healing process” (p. 303).

I see in that conclusion a beautiful link with the recently discussed book by Viktor Frankl. In his vision, happiness is not a goal, but the result of experiencing meaning in life. Iris says her patience was not a goal, but the result of her healing process. It is remarkable that life values such as patience and happiness seem to require profound processes in order to develop. They seem like a goal, but they turn out to be the result of something else, namely a deeply lived experience of recognition, acceptance and meaningful connection with the Self and the Other.

It seems that the great mandate and moral appeal which powerfully emerge from this book, are aimed at adults: the more courage they muster to face their own demons, the more likely they are to not pass on the evil spirits to the next generation. Working on your own trauma recovery is therefore an immense gift for your children and grandchildren. The cover-up culture with regard to family secrets, which Iris talks about in her book, can then undergo a fundamental change. This requires sincere compassion, so that judgment and shame do not have such a dominant place as is often still the case today. With her book, Iris has made an important contribution to that much-needed openness about the lifelong impact of domestic violence and abuse on the young child. Anyone who is (or has been) involved in this will be able to find, in addition to valuable insights, a lot of recognition, acknowledgment and also comfort and hope in this book. With more social awareness about this, we can ensure that our children do not have to go through madness to come to wisdom. They may then keep their childlike, often oh so wise giftedness and let it develop further.
This book, in which Iris has captured her life story in a poignant way, can be very helpful for those who are looking for knowledge about and possibilities for healing trauma.

*In this blog with Jet Markink we spoke about ‘de-guiltify’; both words, to ‘de-guiltify’ and to undo the ‘in-dignation’, are important aspects of the trauma healing process.

‘Raising Resilience’ – the ACE Aware NL podcast

Today is International Women’s Day! This year’s international theme is ‘Embrace Equity‘ and the Dutch theme is ‘Unlimited livability‘ – a call to work together to ensure that as much as possible, we can move through our living world, our life world, without social, cultural, financial and emotional limitations. For this, resilience is important. Resilience is sometimes described as the ability to deal flexibly with life’s challenges, among other things by truly really welcoming all your emotions. To achieve that and raise resilience, it is helpful if feminine energy has the upper hand, in both women and men.

The first 1000 days of a human life have a major impact on the rest of one’s existence. No longer is there any doubt about that now; this has been demonstrated in all kinds of ways and has been substantiated both empirically and scientifically. So the first 1000 days, from conception to about the second birthday, are essential. What happens during pregnancy and around birth really matters. In that phase the foundation is laid for the life that follows. When there is a lot of stress in those early years, it usually becomes more difficult for a child to handle things smoothly and to stay healthy on all fronts. Even when social and health problems do not appear until later in life, upon careful examination they often turn out to have their roots in childhood. With that knowledge in our pocket, the conclusion is obvious that we would all do well to cherish that period, so that life after birth can be lived in an unlimitedly livable way and can continue to be. And then it gets exciting… do we accept that challenge? How can we embrace equity in a practical sense? I do have some ideas. Let’s raise resilience! Let us take good care of our pregnant women, see the interests of children as equal to those of adults, and let us give vulnerability a more prominent place in our society.

In the context of vulnerability, this morning I thought of an amazing woman who has said beautiful things about it, namely Brené Brown. One of her most famous quotes is: “Vulnerability is not winning or losing; it’s having the courage to show up and be seen when we have no control over the outcome. Vulnerability is not weakness; it’s our greatest measure of courage.”
Vulnerability as courage – choosing not to be armed to the teeth, but to allow yourself to be wounded and to be open to your own feelings and those of others, even if it hurts. That can feel very scary. In a society where individualism is almost an ideology, co-reliance is a difficult concept. Do we simply dare to acknowledge that we need each other, that it is difficult not to feel connected to loved ones? That is quite normal, namely, because people are ‘wired for connection’: their entire neurophysiological system is set up for meaningful connection with others. When that connection is missing, sometimes already very early in life, it produces feelings of deep pain and loneliness. This can lead to the belief that you are ‘not good enough’, that you are not worthy of being loved, that you don’t belong and that you have to survive on your own. And then… what if that threatens to overwhelm you…?

A few years ago I saw the movie ‘The House I Live In’, in which addiction expert Gabor Maté says: “When people are in pain, they want to soothe that pain. So the question is not ‘why the addiction?’, but ‘why the pain?’ ” I was perplexed. That illness is usually an expression of a (especially emotionally) disturbed balance – that was a conviction I had already lived with for a quarter of a century. The layer that Gabor Maté added with this statement, however, felt like an inevitable paradigm shift. I felt like I had been given some kind of key that unlocked everything. To me, this seemed to be the essence, a vision that urgently deserves to be followed everywhere in society.

That is the idea from which ACE Aware NL was born: creating awareness about ACEs, adverse childhood experiences, and recognising that many behaviours and habits that are labelled as ‘difficult’ or ‘unhealthy’ are in fact survival strategies and self-medication for the pain of loneliness and exclusion. That is why I started ACE Aware NL, together with Victor Bodiut. And speaking of courage and vulnerability: without him I would not have dared to. Together we have laid a wonderful foundation, on which we now continue to build. The so-called ‘feminine’ energy has a prominent place in this: soft receptivity, intuition, room for ‘being’ instead of ‘doing’, attention to the emotional life, from the inside out, as inspiration for the more masculine energy.

Everywhere in nature, growth always takes place from the soft spots. This is very clear in babies and young children. For healthy growth, it is therefore important to ensure that this softness is protected and that no (physical and emotional) hardening occurs. Love, closeness, compassionate attention… those are the things the young child thrives on and with that you can raise the child’s resilience. How can you shape that? And what are the consequences of the lack of such care?

In order to discuss this extensively with experience experts and professionals, ACE Aware NL now also has a podcast entitled ‘Raising Resilience!’, together with Petra Bouma, who has been making the beautiful visuals for the blogs for some time now and who also put together artwork for the podcast, I have now set up the infrastructure for it and the first four episodes are online! You can listen to Nikk Conneman, Eefke Postma, Marie-liz de Jongh and Hilde Bolt. In the near future a lot of interviews will take place again and we will meet many more beautiful people. They will talk about their work, but also about their own experiences, which often contain a lot of touching wisdom as a result of grief.

Unfortunately, there is still a lot of shame and judgment around the subject of ‘trauma’. Those are not helpful, because they cause many people to experience a barrier to telling their story. People keep suppressing everything, eventually often resulting in illness. Opening up about the pain and grief of your life history… that takes a lot of courage. There is often so much wisdom in what people have to say about what was difficult for them and how they overcame those difficulties. I really have deep respect for that, because I also know how complicated it can be not to let the loneliness of the past fully influence your life in the present.

The tune of the podcast is entitled ‘Here Forever’. While preparing the launch, this fragment seemed to present itself to me. Here forever – forever here. To know that there are people you can always count on and perhaps to be such a person yourself for others… that is what creates a deep sense of security, the feeling that you are welcome with everything that belongs to you, just like you are. For many people, that appears to raise hope and confidence and resilience. The Raising Resilience podcast is therefore also a powerful plea to be alert together to what the youngest in our society need to grow up joyful and happy, on the way to an unlimitedly liveable future. We hope that you will enjoy the specia stories and insights with us and who knows, we may welcome you as a guest in due course!

Book review ‘Man’s Search For Meaning’ by Viktor E. Frankl, Part 2 (final)

Last week, we made a start with a review of Viktor Frankl’s ‘Man’s Search For Meaning’ and discussed what was dealt with in Part 1 of the book. Different aspects of finding meaning are the topic of Part 2 of the book, where logotherapy is discussed in a nutshell.

Logotherapy is sometimes called the Third Viennese School of Psychotherapy. Where Sigmund Freud focused on ‘the will to pleasure’ (psychoanalysis) and Alfred Adler on ‘the will to power’ (individual psychology), Viktor Frankl focused on ‘the will to  meaning’ (logotherapy), as meaning in life turns out to be the primary motivational force for most people. This is also what the increasingly mainstream concept of Positive Health notices. Of its six dimensions (Bodily Functions, Mental Functions & Perceptions, Spiritual Dimension, Quality of life, Social & Societal Participation, and Daily Functioning) the spiritual aspects turn out to be most often mentioned as what really matters. People can have chronic health issues, but as long as those are fairly well dealt with and they have meaning and purpose in life, they generally consider themselves healthy. If physical health is overall good, but meaning is missing, people give much more despondent descriptions of how they are. The more meaning people can discern in their lives, the bigger the chances that health and happiness flow from that. Those are then not goals in themselves, but the consequence of having found meaning and purpose in life and of being able to contribute to something bigger than one’s own life. In Nietzsche’s words, quoted by Frankl: ‘He who has a why to live for, can bear almost any how’ (p.109, author’s italics).

Without such a sense of meaning, Frankl writes, people can experience ‘existential frustration’. Not feeling challenged, but bored and useless, is understandably hard, he maintains, and deserves attention, instead of medication:

Existential frustration is in itself neither pathological nor pathogenic. A man’s concern, even his despair, over the worthwhileness of life is an existential distress but by no means a mental disease. It may well be that interpreting the first in terms of the latter motivates a doctor to bury his patient’s existential despair under a heap of tranquilizing drugs (p.108, author’s italics).

In other words: healthcare providers should take the worries of their patients seriously when it comes to them not seeing enough or even any meaning in life anymore. Frankl sees three different layers of meaning in life: ‘1) by creating a work or doing a deed (work); 2) by experiencing something or encountering someone (love); and 3) by the attitude we take toward unavoidable suffering (mental strength)’ (p.115). The sense of meaninglessness, ‘resulting from a frustration of our existential needs which (…) has become a universal phenomenon in our industrial societies’ (p.141) can create an ‘existential vacuum’, often more widespread in places where spiritual, ceremonial, professional and familial traditions have gone lost. This can lead people ‘to do what other people do (conformism) or (…) what other people wish [them] to do (totalitarianism)’ (p.111).
Logotherapy’s aim is ‘neither teaching nor preaching’ (p.114), but to help people broaden their views and find their own meaning in life and thus the logotherapist ‘will never permit the patient to pass to the doctor the responsibility of judging’. A beautiful explanation is this one: ‘A painter tries to convey to us a picture of the world as he sees it; an ophthalmologist tries to enable us to see the world as it really is’ (p.114,115). Logotherapy encourages clients to find the potential meaning of their life and Frankl terms this ‘the self-transcendence of human existence’. Only when we can truly feel and see this, we will be able to reach self-actualisation, ‘as a side-effect of self-transcendence’ (p. 115). This especially applies to difficult circumstances, when things look hopeless.

For what then [when fate cannot be changed] matters is to bear witness to the uniquely human potential at its best, which is to transform a personal tragedy into a triumph, to turn one’s predicament into a human achievement. When we are no longer able to change a situation (…) we are challenged to change ourselves (p.116).

We are called upon, however, to relieve suffering if possible, because to ‘suffer unnecessarily is masochistic rather than heroic’ (p. 117). What is needed for this is to find the ‘super-meaning’, not ‘to endure the meaninglessness of life, but rather to bear [the] incapacity to grasp its unconditional meaningfulness in rational terms. Logos is deeper than logic’ (p.122, author’s italics).
We can never be fully free from difficult conditions, so true freedom, in Frankl’s view, is the ‘freedom to take a stand toward the conditions’ (p.132), a route towards self-determination. This is typically human, because: ‘Man is capable of changing the world for the better if possible, and of changing himself for the better if necessary’ (p.133). If meaninglessness drives us crazy, it merely proves our humanness, Frankl says. This ties in with a quote from Krishnamurti’s work: ‘It is no sign of health to be well-adjusted to a profoundly sick society.’  That is not to say it is always easy. We can, for many different reasons, fall prey to ‘give-up-itis’ (p.141), losing all hope because we no longer focus on the remaining meaningfulness of life. Thus, we may lose all ability to deal with the suffering.
There is, however, a ‘difference between being valuable in the sense of dignity and being valuable in the sense of usefulness’ (p.152). Bearing whatever fate with dignity means rising above and growing beyond ourselves and thus increasing peace and wellbeing in the world.

That is hopeful, indeed. Compassionately exploring with people who grieve and suffer, the things that still make their life worthwhile may support them in finding the way back to their purpose and happiness. Seeing all this so impressively well laid-out by someone with a history like Frankl’s, is a humbling read.