MEANINGFUL RENUNCIATION (eBook)

Part II: Case Studies from Logotherapeutic Practice

(Heidi Schönfeld)

You Should Worry About Me!

Preamble

There is a psychological condition that was once grouped under the name "hysteria." Today, it goes by various terms such as dissociative identity disorder, histrionic personality disorder, and somatoform personality disorder, among others. In this condition, individuals simulate various physical or psychological ailments in order to garner attention and care from those around them. They can become so entrenched in their fabricated ailments that these complaints increasingly take on a real nature. Sometimes, the afflicted can no longer extricate themselves from the symptoms they have created, even if they wish to. Tragically, the people around them often grow weary of the constant demands for expressions of care, ultimately leading the sufferers into a state of miserable isolation.

Regarding the genesis of this condition, particularly within the psychoanalytic community, much speculation has been made about early childhood abuse experiences that might lead to a form of selfhatred. As a result, it is believed that patients may be inclined towards self-harm on the one hand and an excessive craving for attention and affection from others on the other. However, empirical research has not confirmed these speculations. Nevertheless, similar pathological patterns have been observed across generations, which could indicate genetic or role model factors at play.

Experience shows that the problem would not be resolved by intentionally giving people with hysterical tendencies more attention and expressions of love, based on the assumption that they are deficient in these areas and need to catch up. Such an approach only reinforces the idea that their manipulative tactics are effective and entrenches them further. The only sustainable way to help such patients is to motivate them to voluntarily give up their "hysterical behavior." Especially when they are still young, they can learn to engage passionately and energetically in personal interests without expecting positive feedback. This significantly increases their chances of naturally receiving the attention and recognition they so desperately seek.

Case Study

The First Session

Petra's family lives in Erlangen, where her father works for a large corporation. Previously, the family had lived in Berlin for 14 months due to his job, but they have now been back in their hometown in Franconia for a year. The twins were born in Berlin.

Petra’s mother struggled to find a babysitter for the little ones, but it had to be done so she could bring her 13-year-old daughter to my practice in Bamberg. It was too important for her to miss, despite all the chaos. Things had reached a critical point—the parents no longer knew what to do. According to her mother, Petra has been suffering from a therapy-resistant anxiety disorder, and logotherapy seemed like the family’s last hope.

Petra has been in behavioral therapy for two years. She first saw a colleague in Berlin, then seamlessly continued with a behavioral therapist in Erlangen after the family moved. But nothing helped. One doctor had also prescribed Ritalin for her, though her mother didn’t know why.

In my practice, I began the conversation with Petra by asking about school, her favorite subjects, and her friends. It didn’t take long before Petra began to warm up, and a sense of initial trust started to develop between us. At that point, we sent her mother off for a coffee, as we no longer needed her as comfort or support in the session.

To approach the topic of her fear and to avoid giving the fear any sense of power from the outset, I asked Petra whether she had brought her fear with her. "What does your fear look like? Is it sitting on the sofa or hiding underneath it?"

"I don’t know," Petra replied.

I tried to uncover what the girl was actually afraid of by asking various questions, but nothing seemed to work. Petra’s responses repeatedly circled back to the same refrain: "I don’t know. I have panic attacks. At school. At night. Often." But I couldn’t discover what she was actually afraid of; the core of the fear remained invisible.

"Because of my panic attacks, we even had to move from Berlin back to Erlangen, but they haven’t gone away here either," Petra explained, almost proudly. That sounded serious.

I took a piece of paper and drew a funny figure, which I called "The Blackmailer." We talked about how blackmail only works if you pay the blackmailer. If you pay nothing, the threat becomes meaningless. I compared excessive fear to a blackmailer, and for a brief moment, Petra was intrigued. But soon enough, she veered off topic and began vehemently criticizing her behavioral therapist, explaining in great detail how incompetent and foolish she was.

This didn’t look good. Petra harshly criticized her therapist’s professional abilities. I tried to steer the conversation back to her fear, but Petra didn’t want to talk about her issues; she wanted to complain about her therapist, and she did so with an impressive amount of selfconfidence.

By this point, it became clear to me that I, too, was being tested and closely observed to see what I had to offer. I returned to my drawing of "The Blackmailer," added a sign in his hand, and asked, "What’s written on this sign? What is the fear trying to scare you with?"

"I don’t know," Petra replied.

I remained calm and continued searching for the content of her fear. Finally, Petra suggested, "Maybe it’s a fear of being alone? Or maybe that something bad will happen?" She tossed these ideas out half-heartedly, not really convinced by them herself.

I began to consider what the main issue for this girl could be. More severe illnesses could be ruled out—there were no signs of psychosis; schizophrenia or depression didn’t seem to be in play. Endogenous depression can sometimes be accompanied by vague feelings of fear without a clear cause, but Petra was far too lively for that. There were also no signs that she was an especially insecure person. In fact, Petra was neither anxious nor shy. If anything, she was more demanding, sassy, and even a bit arrogant.

I knew that the logotherapeutic technique of "paradoxical intention" can only be applied when you understand the crux of an irrational fear, the point you can parody—and I didn’t know that point. So what to do? I decided to take a detour and try to make the fear itself seem ridiculous, hoping that in the process, something would surface that revealed what was truly bothering the child.

So, I invent "Ms. Fear” and play out a scene for Petra where she bravely says to Ms. Fear: "No, you’re not allowed to come with me to school today!" Then I dramatically lean back and, in a childishly fearful voice, say the opposite: "Oh yes, dear Fear, you’re welcome to take control of me."

Petra immediately enjoys the game and laughs. Suddenly, she starts talking nonstop, acting out both Ms. Fear and herself, clearly having fun with the theatrics. However, the underlying content of her fear still doesn’t emerge.

I then ask Petra to demonstrate a big, fat panic attack. She hesitates and asks if I’m serious. "Yes, absolutely," I confirm. She looks at me, puzzled for a moment, and then asks why I would provoke such a thing.

I explain: certain states of mind, such as joy or fear, can’t be artificially created on demand. Therefore, she wouldn’t be able to summon a real panic attack intentionally.

She takes this in thoughtfully—but it doesn’t lead to any breakthrough.

So, I try once again to parody fear itself: "Dear Ms. Fear, I request a panic attack at exactly 9:15 a.m., not earlier and not later, but right in French class, because it would be so wonderfully shocking for the teacher!" And other similar jokes.

Petra’s reaction is to compare my approach with her previous therapies, remarking that mine is very different from what she’s used to. She seems intrigued by this. I explain to her that fear and humor are mutually exclusive, and that laughing at one's own exaggerated and unnecessary fear can help banish it. She plays along again for a while, but it’s clear that she’s far more interested in the game itself than in potentially overcoming her fear.

She keeps asking why I do certain things and how I can explain my methods, but fear remains a non-topic for her.

I ask her, "What’s your fear called? Give it a name!" In my experience, personifying fears helps patients distance themselves from them. Petra responds cleverly, "That has to be carefully considered, because the name is important." But no name is provided.

I then ask, "What does your fear look like? Give it a shape!" She invents a pink fantasy figure and names it "Epilette Dummelette." I sigh inwardly, as this name is difficult to remember and cumbersome to use in therapy conversations, but I accept it for now.

We continue playing with Petra’s ideas for a bit longer, but what emerges are more fantasy stories. There is no trace of fear, let alone an overwhelming one. Eventually, we bring her mother back into the session. We tell her about "Epilette Dummelette," and Petra laughs as we talk. I try to explain some of the basics of logotherapeutic anxiety therapy to the mother. She reacts with uncertainty but is cooperative and genuinely tries to follow my guidance. It’s clear that she is willing to do whatever it takes to help her daughter.

Since...