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Milan Košuta: Everyday Pursuit of Something Good

How to find meaning in everyday life? What can existentialism offer to us? Leading Croatian psychiatrist and existential therapist Milan Košuta answers these questions.

How did you decide to become a psychotherapist and why?
During my medical studies, I recognized two things that are important in the healing process; superior technology and the ability of a sufferer to recognize their authentic needs and thus facilitate their healing process or, ideally, heal themselves. As I found the engineering approach to a man repulsive, there was nothing left for me but to do psychotherapy, which at its core has the ideal of helping a person to recognize his or her authentic needs. Of all approaches, the existentialist-phenomenological approach seemed to me to be the “most open”, to have the least ideology. All this happened in the eighties of the last century, during the period of communist ideology in Yugoslavia, and my generation developed special sensitivity towards totalitarianism in everything, including psychotherapy, and we were fleeing from every ounce of ideologization. At that time, Victor Frankl appealed to me more than both Freud and Jung and other great psychotherapists, so I went to Vienna to learn from people in his circle.

Can you point to a moment in your education that you felt was crucial to your formation as a therapist?
There are three key points. Encounters with the great Vlado Jerotić, who truly believed in the importance of a spiritual human being. The request from the Head of the Department of Psychiatry to leave the Clinic for Psychological Medicine at the Rebro because I prefer Frankl over Freud. An open letter sent by Frankl accusing the Society for Logotherapy and Existential Analysis of not teaching psychotherapists in accordance with his teaching. From all of this, I have concluded that it is necessary to concentrate on the meeting of two people, on the search for the authentic needs, and, if one believes in God, it should be made easier for the relationship with God to be stronger and more immediate.

What do you think existentialism can offer a person, in opposition to other types of therapy? What would you name as a special “gift” of existential psychotherapy?
Existentialist therapy, it seems to me, is more focused on the possibilities of a man here and now than other types, and does not deal with either the past or the future. There is no ideology and that is why psychotherapists fear this approach. Everyone would be some kind of “tool” and the tool is something different in every person.

Existentialist psychotherapy often deals with issues that we don’t like to deal with on a daily basis – questions of death, illness, finding meaning in difficult situations? What would you recommend to our readers in this experience? Of course, the question is complex, but maybe some guidelines for getting started, some wisdom, some pearls of existentialist therapy that you saw through practice and your own work?
One can always complain when something difficult comes down. And it may, and that seems to me what life is about, use bad to discover ever newer and finer parts of oneself. Just look at the abyss in the eyes of a man who has never experienced anything wrong! It’s frightening!

Depression is one of the leading problems in the world today. According to the World Health Organization, more than 300 million people worldwide suffer from depression, and it is the first cause of disability. How does existential psychotherapy view depression?

Today, everything is called depression. The states of emptiness and boredom, the states of long meaningless living, fears of goodness, loneliness or aloneness, or the problem of not being able to be alone or finding value in being alone, long-term exposure to low doses of stress, to name only a few things. By stating all of these things, I also refer to the area that the existential-phenomenological approach in psychotherapy works with.  A particular area is the fear of death, that is, the “knowledge” of that that it is bad in the death. This is an extremely important area – “openness” to death. When the aforementioned conditions last long enough, and when the genetics is such that serotonin and similar systems are disturbed, then depression occurs, which is treated not only with psychotherapy but also with medication.

In your last book, The Love Life of Professor Balthazar Sertic, you dealt with the theme of trying to create a meaningful life. What do you find most important about this story?

The most important thing in life is to search for the good in this very day and to accept the fact that there are days where it is difficult to find it. And then to pursue it again the next day. I argue that it can also be found there in the late years, all the way to the end, and even in the intensive care unit while the man is hooked to different appliances and waits for “that hour.” Unless the day was marked by the pursuit of the good, it was more or less in vain.

20 years ago you wrote the book “Meeting as a cure”. For me personally, it is one of the most important books on psychotherapy in the Croatian-speaking area, and it marked one of the turning points for the way I perceive psychological challenges and mental health. I think this book is today likely important. But since it was written in the year 1999, is there anything you would like to add to it today?
I would just like to emphasize even more that there is far less useful than one thinks of analyzing the past or the future. Find, man, in this hour, someone good, and so on.

What do you think about the way psychological problems are viewed today? Do you think the direction in which psychiatry and psychotherapy are going is good? What would you recommend?
In Croatia, we are constantly whining. From the recounting of evil one only has it worse. The world suffers from the problems of pseudo communication, from the pathological attachment to the material, from the sick idea that someone will win something and that the last will be better; the spiritual being of man and his authentic needs have never been so neglected as they are today. It is paradoxical that more and more preconditions are created for a quality and long life, and there are fewer and fewer lives. Psychiatrists today have too little belief that psychotherapy can have beneficial effects. Psychiatrists are too concerned with genetics, biochemistry, pharmacology and the like.

And finally, what would you tell our readers? Some pearls of wisdom that flow through your years of practice and / or life experience?
There is no conclusion. Let us keep everything open.