Jukka Packalen is a logotherapist graduated from Viktor Frankl Institute Australia / Life Change Therapies, a Certified Trauma Support Specialist (Trauma Institute International) and a trauma survivor
Psychological trauma and logotherapy have an innate connection. For what is Man’s Search For Meaning, if not a study in extremely traumatic circumstances and resilience? Currently, there is a paradigm shift occurring in trauma research and treatment that sheds new light on this connection, and logotherapy and trauma treatment can be seen as aligning in a whole new way.
The first wave of systematic trauma studies came in the 1980’s with the recognition of PTSD in DSM-III. According to Forward-Facing Trauma Therapy author Dr J. Eric Gentry, the dominant treatment modality was ”Implosion Therapy,” which drew heavily on the concepts of flooding of traumatic memories and catharsis. The therapy process of actively reliving trauma was extremely stressful and dropout rates in therapy were huge, even though the therapy was effective for those who could tolerate it. Soon new knowledge started to accumulate since the treatment of Iraq war veterans in the 90’s and a better understanding of how brain structures and dynamics are affected by trauma, marked by Joseph LeDoux’s study The Emotional Brain. As a result, treatments have become more compassionate and better tolerated by patients. The focus in trauma therapy has, however, still been in dealing with big traumatising life events in the past and in the psychological symptoms of trauma.
New Approach to Understanding Trauma
Viktor Frankl was not concerned only with symptomatics of mental disorders. He was equally, if not even more interested in the aetiology of disorders, as presented in his highly original work, On The Theory And Treatment of Mental Disorders. I’d like to think that Dr Frankl would be pleased to see the most recent paradigm shift in trauma treatment. The focus is now mostly on what it is that keeps trauma survivors from living a life aligned with their values. The approach is salutogenic and holistic, as opposed to the old pathogenic approach. This resonates well with logotherapists focusing on that which is healthy, the noös, and not that which is broken.
It is now understood that trauma is not necessarily brought on by a big life-altering event, such as an accident, rape or war. Trauma can also accumulate with time, when living under constant stress. The landmark studies of Adverse Childhood Effects (ACE) have revealed that childhood adversities affect the health decades later. We trauma survivors who come from poor and unstable families are more vulnerable to stress in later life and can develop even more debilitating symptoms than those with PTSD. These symptoms are now recognised by the advent of Complex Posttraumatic Stress Disorder in ICD-11. The diagnosis is already recognized by Healthdirect Australia (HDA), the United States Department of Veterans Affairs (VA), and the National Health Service (NHS).
The psychology of complex traumatisation is bewildering, and the hallmark symptoms of dissociation, emotional dysregulation, somatisation and relationship problems make complex trauma a condition difficult to recognise and treat. However, current research on the aetiology of the symptoms sheds some much needed light on understanding what is going on in these extreme states of trauma-related altered states of consciousness. Perhaps the most important recent work in understanding trauma has been conducted by Dr Stephen Porges, a pioneer in the new field of psychobiology. His work on the autonomic nervous system (ANS), the polyvagal theory, is groundbreaking and trauma is now best understood as something that occurs in the ANS as a response to real or perceived threat.
The Polyvagal Theory — A Breakthrough Study in Biopsychology
Before polyvagal theory, our nervous system was pictured as a two-part antagonistic system, with more activation signaling less calming and more calming signaling less activation. The polyvagal theory identifies a third type of nervous system response, the social engagement system which helps us build relationships and enables us to self-transcend. These three modes of the nervous system are triggered by the unconscious process of neuroception; the body’s threat and safety detection system. The first, and evolutionally most recently developed response to perceived threat is to search for safety in other people. If we see a friendly and relaxed face, our ventral vagal nervous complex activates and we calm down. If we fail to find safety, our nervous system attunes for the fight or flight response in the sympathetic nervous system, and we are physiologically prepared for direct action of fleeing or fighting. In this mode, executive functions in the central nervous system are to a high degree disabled and we act instinctively, not rationally. Logotherapist Elisabeth Lukas, with a clinical expertise spanning decades, attests to this when describing one form of severe stress, panic attacks. In Meaning-Centered Psychotherapy she writes that people fleeing from a burning movie theatre are not psychopaths; their bodies simply assume command and do what is needed for the survival of the organism.
If the danger perceived is so severe that no fighting or fleeing is seen as possible, the nervous system activated is the dorsal vagal complex and the resulting behavior is shutting down, feigning death. It is this state that explains the hallmark symptom of trauma, dissociation. Dissociation is a state of disembodiment, of non-existing, of losing contact to oneself and the surroundings. Of course, these responses to perceived danger appear on a continuum: a fight reaction does not always, luckily, entail physical violence. In everyday life it is probably mostly manifested as excessive sarcasm and selfishness. Also, dissociation is not always total. With time it may, however, become a mode of one’s being-in-the-world, a down-tuned, hypoaroused state of lifeless expression and depressive demeanour.
These ANS states are our normal and predictable behaviours under severe stress and the more we are subject to stress, the more readily the nervous system reacts to even normal, everyday stressors in life and the more they start to become modes of being-in-the-world. I know this from my own personal experience. Even when writing this article, I can feel my body going into a fight and flight response. I have to take breaks every few minutes to regulate the stress response. The process of becoming self-aware of these nervous system stress responses is called interoception and the process of engaging the calming ventral vagal nervous complex by relaxing exercises is called self-regulation. Drs Robert Rhoton, Thomas Aubrey and J. Eric Gentry of Arizona Trauma Institute recommend in Transformative Care: A Trauma-Focused Approach To Caregiving that trauma survivors scan their body for stress responses up to 200 times a day and activate a relaxation response when needed. I subscribe to this advice. It is something that I have to do constantly because my body is so attuned to trauma because of a life-long history with severe stress.
A New Understanding of Trauma and Logotherapy
I’d like to think that Viktor Frankl, a neurologist, would be positively excited by these developments in trauma research. They show that trauma is a somatogenic response to prolonged or overwhelming stress that has complex pheno-psychological manifestations. Viktor Frankl was well aware of how the ANS interacts with psychological “neurotic patterns”. Several of these are described in his book on mental disorders. He also suggests that if a condition is somatogenic and pheno-psychological, a two-pronged approach for treatment is needed: the somatogenic issue needs to be dealt with and the person behind the symptoms, the noetic in man, needs to be nourished.
This aligns precisely with how Dr Gentry presents his forward-facing trauma treatment approach, and it comes as no surprise that he refers to Viktor Frankl several times in his approach. He uses the metaphor that the space of free will between a stimulus and response collapses when the body goes in survival mode. To expand the space of free will, we need to become self-aware of stress responses and self-regulate. Forward-Facing Trauma Treatment focuses on freeing us up to live a life aligned with our values. Dr Gentry calls this intentional living. We logotherapists would call it noödynamics, living in the healthy tension between what is and what ought to be. My logotherapy teacher, Dr Paul McQuillan of Viktor Frankl Institute Australia, seems to confirm this: he says in an interview I recently conducted with him, that even people with most severe mental disorders can benefit from logotherapy, as long as they are stable. Being stable means in polyvagal terms being in the ventral vagal response state.
I would go as far as suggesting that stress can be altogether — whether toxic, traumatic or just temporarily overwhelming and hijacking the body — something that creates barriers for logotherapeutic encounters. Since everyone of us, stressed or not, has a will to meaning, an innate need to self-transcend, the question becomes how to remove this barrier from working with the noetic in a client. Or indeed when working with ourselves. The paradox is that to access the noetic tension, the body needs to be in a regulated state, a homeostasis.
The first step in helping others regulate, is to be regulated oneself. As social animals, we neurocept signs of dysregulation in others and match the dysregulated state. Hence, if we want to promote self-regulation, we need to be regulated ourselves. Learning interoception and self-regulation is a deeply personal journey, where ancient wisdom of the body, bodyfulness if you will, gives us guideposts to how to do it. The practices of mindfulness, meditation, yoga and qigong are wonderful ways to practise self-awareness and self-regulation. However, they all rely on patient and deliberate practice and are therefore not necessarily something that can be done throughout a busy stressful day. Luckily, there are also ways to trigger an acute relaxation response in the body with 1-2 minute exercises. These are also highly individual and what works for me, may not work for you. The basic exercise is to experiment with different ways of breathing. Diaphragmatic breathing, slowing down the breath and prolonging the outbreath are techniques that work for most, but there is also much more that one can do. Using myself as an example, simple stimulating of the nerve endings on the sides of my fingers brings a remarkable relaxation response that helps me cope with unconscious stress activations. Search for “Arizona Trauma Institute” in YouTube and you find 21 wonderful somatic exercises by Dr. Camea Peca that get you started in practicing these essential skills.
A 4S Model for Transcending Despite Trauma
So, to draw it all together: trauma is now understood as a phenomenon happening on the stress continuum and originated in the regulation patterns of the ANS. Prolonged or overwhelming stress can lead to a lowered threshold for stress reactions to be triggered. The body may start to act as if it has perceived threat, even when none is in fact present. The first stress response is to seek for security in others. This is evolutionally most recent and the most advanced of the responses, and typical for primates. The second trauma response is fight or flight. The most archaic stress response is the freeze response, feigning death, typical for lizards. Fight, flight and freeze all deny access to the noetic dimension in man. Logotherapy is therefore not as efficient as it can be, unless the nervous system is in the calm ventral vagal state. It is true, that one can with sheer defiant power of the spirit work with the noös, even when extremely agitated. But this is enormously taxing to the body and a much more gentle and advisable way is therefore inducing a relaxation response, before working with existential questions. It is not an accident that many logotherapeutic interventions include autogenic relaxation exercises.
We are holistic beings, and all dimensions work seamlessly together for our well-being. As Dr Frankl himself notes:
[…] there are no pure somatogenic, psychogenic or neurogenic neuroses, but rather only mixed cases—cases in which a somatogenic, psychogenic, or noogenic aspect pushes into the foreground of the theoretical or therapeutic field of vision.
The man is an indivisible holistic whole, and needs to be recognised and helped as one.
Working in a stress and trauma informed way in logotherapy, regardless of the setting where logotherapy is applied, would therefore be four S’s, that I would like to coin the 4S Model for Transcending Despite Trauma:
- Self-awareness or interoception; becoming conscious of stress reactions in the body,
- Self-regulation; inducing a relaxation response,
- Self-distancing; the noetic act of objectifying one’s circumstances and
- Self-transcendence; the noetic act of being intentionally directed to a valuable, meaningful task or to lovingly encountering another person.
Frankl, Viktor (2004) Man’s Search For Meaning. Penguin.
Frankl, Viktor (2004) On The Theory and Therapy of Mental Disorders. Routledge.
Gentry, J. Eric (2019) Forward-Facing Trauma Therapy. Compassion Unlimited.
LeDoux, Joseph (1998) The Emotional Brain: The Mysterious Underpinnings of Emotional Life. Simon & Schuster.
Lukas, Elisabeth & Schönfeld, Heidi (2019) Meaning-Centred Psychotherapy: Viktor Frankl’s Logotherapy in Theory and Practice. Elisabeth-Lukas-Archiv.
Porges, Stephen (2017) The Pocket Guide to the Polyvagal Theory. The Transformative Power of Feeling Safe. Norton.
Rhoton, Robert. & Aubrey, Thomas. & Gentry, J. Eric (2018) Transformative care: A trauma-focused approach to caregiving. Arizona Trauma Institute.