THE FUNCTIONAL DIMENSION

In The Will to Meaning, Frankl (1985) describes only one among the four wills that motivate humans to act according to some of the greatest psychologists. For the Russian psychologist Pavlov (1881–1939), the most important was the will to survive. Pavlov developed the concept of conditioned reflex in his famous experiments with dogs. Sigmund Freud (1856–1939) considered the will to pleasure as the most important. Alfred Adler (1870–1937) regarded the will to power and superiority as the guiding wills in human existence. These three wills show what is common to human beings and to animals, namely that these center on the biological and the psychological dimensions.

Viktor Frankl (1905–97) maintained that the will to meaning is unique to human beings, because it expresses the dimension of the human spirit. This dimension is not a means for gaining something, nor is it a by-product of the

gain, such as gaining power for the sake of superiority, but it is the central aim in life.

Hiroshi Takashima, a Japanese physician, has presented a fourth dimension:

the functional dimension. Takashima has successfully incorporated and employed Frankl’s theory and method of logotherapy in his medical treatment and has shown the benefits accrued to medicine and to the individuals concerned from this approach. According to Takashima, in diagnosis and treatment, we have to consider all four dimensions.

In Humanistic Psychosomatic Medicine (1984), he wrote that sickness can begin in one of the four dimensions and influence the others. For example, an ulcer can be an organic illness and cause disturbance in the functional dimension. A correct diagnosis of the dimension in which the illness originates is necessary, along with an assessment of how the rest of the dimensions are affected. Thus there is a need to combine psychotherapy, medications, and logotherapy (meaning-oriented psychotherapy) to modify a client’s attitude toward his or her illness.

Takashima used the metaphor of an orchestra to illustrate his approach to medicine and to the four human dimensions: he compared the instruments of the orchestra to the somatic dimension and the technical skill of the musicians to the functional dimension. The musicians’ minds were analogous to the psychological dimension, and the conductor symbolized the spiritual dimension, because the conductor translates the spirit of the composer to the orchestra (Takashima, p. 24).

Takashima included in his book many cases to illustrate the working of the functional dimension. I have selected one that is characteristic of his attitude, as a physician, toward people in his care. In this case, he tells about a manager of a supermarket and coffeehouse who turned to him for help, complaining that he limped on his left leg. This limping had started three months ago, yet it was confined only to his workplace. Outside the office, he could walk without limping, climb steps, and take part in various sport activities. Only in his work during the day did he limp.

This patient was seen and tested by many doctors, including psychiatrists and neurologists, and no evidence was found of physical or neurological factors or causes for the limping. Takashima asked the patient when the limping had started.

He answered that it was when his boss has reprimanded him because of a mistake he made. When he returned to his office after that, he bumped his left leg against a chair and fell; all of the treatments that he received were of no avail.

Takashima asked the patient to walk for a while in his presence, and the patient indeed limped with his left leg. “Then I said to him,” Takashima tells, “try to limp on both legs.” “No jokes,” said the patient, and he did not try to limp.

Instead, he walked well—without limping on either leg. This patient saw that, when he tried to limp on purpose on his right leg, he could not limp on his left leg. Then he tried harder to limp on his left leg, but he couldn’t. Takashima asked this patient to return to the office and try to limp on his left leg on Mondays, Wednesdays, and Fridays and on his right leg on Tuesdays and Thursdays. The

patient laughed. Several days later he phoned Takashima and told him that he was sorry that he could not fulfill the doctor’s order, because he had forgotten how to limp (pp. 91–92).

This was a case of functional disease with an unknown cause, yet it was treated successfully with Frankl’s paradoxical intention, a method of treatment that Frankl described and presented in detail in a chapter of his first book, The Doctor and the Soul (1986, pp. 221–252).

In our times many people in their second half of life live only for the hour:

they tend to see the concept of here and now literally, as a call to grab as much from the pleasures of life as possible. These people live a life of care for their wealth but forget to care for their time. Their money cannot help them when the time comes to depart from this world, and their days are not returning as they wish. But those who make the necessary effort and find meaningful tasks for themselves, those who occupy themselves in activities that bring joy to others, see a blessing in their work and gain satisfaction and happiness in their lives.