The Golden Rule of control theory is “the most flexible part of a system controls its behavior.” This explains why the human cortex has taken over the world.

The cortex operates on simple principles: figure out what events happen together and generate responses to turn them to our advantage. To ensure that we don’t get stuck in habits that no longer serve us, the cortex also relentlessly prunes underutilized circuits. The adage “use it or lose it” is a feature, not a defect.

The worst outcomes in control theory arise when systems are “open loop.” Ask a pyromaniac to tend the fire and you will have a house fire. To prevent these situations, the brain generates anxiety when we can’t find a response that turns events in our favor. A familiar example is the finger cut that throbs mercilessly until we put a band-aid on it. The relief is psychological. The finger still sends the pain signals to the brain, it is just that the subconscious prevents them from rising to our conscious awareness.

In “Existential Psychotherapy,” Irvin Yalom turns his attention to the malaise of the modern age: how do we cope when our experience is controlled by events that we cannot perceive? This spans everything from loneliness (How do we know what our social partners really think?) to death (How can I survive when my body stops working?).

Drawing upon empirical studies and professional experience, Yalom builds a strong case that these questions drive psychopathology (the tendency to persist in maladaptive behaviors). 60% of all schizophrenics, for example, suffered the loss of a parent in childhood. The mind, suddenly bereft of a critical ally, cannot adapt to the shock, and so begins to push reality away. Yalom’s case histories further demonstrate that breakthroughs occur upon a shift from what is done to focus on why alternatives are rejected.

A materialist, Yalom identifies four types of irreconcilable concerns that drive clients away from life-affirming possibilities:

• Death – we cannot guarantee a future.
• Freedom – when change is painful, we surrender power to others.
• Isolation – our perceptions are unique and so we cannot share anything with anyone.
• Meaninglessness – the world is harsh and uncaring and will annihilate our works.

Writing for psychotherapists, Yalom must explain why, given the significance of these concerns, psychotherapy has not organized an effort to establish protocols for their redress. Freud, a megalomaniacal atheist, had a great influence in focusing psychotherapy on the cause of maladaptive behaviors. That bias persisted in therapies that seek to disrupt established patterns (surgery and psychopharmacology, most obviously, but also catharsis).

Yalom’s retort is that behavioral change takes root only when it is validated in practice. Healing is not found in self-understanding, but in the conviction that we can create successful relationships. While a therapist can guide that learning, most training programs cultivate a remote therapeutic demeanor that frustrates authentic exchange. Furthermore, the therapeutic literature suppresses “spontaneous” – and irreproducible – acts inspired by a surrender of emotional barriers, though every working therapist know that these often catalyze progress.

For these reasons, Yalom touts group therapy, where the therapist merely facilitates gains between peers. (Yalom borrows liberally from his prior “The Theory and Practice of Group Psychotherapy.”)

In his survey of theoretical antecedents, Yalom widens his view to include philosophy and literature. Here we find another possible driver of the modern malaise: it was only in the 20^th century that the public was exposed to existential concerns. Late in the book, Yalom dates the rise of existential anxiety at the transition from agricultural to wage labor. Prior to that transition, behaviors were rewarded by stable natural processes; in its aftermath, the rules could change at the whim of the master. Our social context went “open-loop.”

Having established the foundations for his investigation, Yalom addresses each of the four concerns in paired chapters, the first elaborating the psychological experience of sufferers and the second offering therapeutic methods. Regarding the latter, they are often forms of mental jiujitsu that lead the client to the well, and when he will not drink, tender gentle encouragement to change.

Some may find Yalom’s prescriptions helpful. As a mystic, I instead found myself struggling with frustration. Yalom recognizes that all the concerns are intertwined, and I can organize my response to his neurotic materialism in the response I offer to clients struggling with meaninglessness. The central question is not “What is the meaning of life?” but “Do I have meaning?” The only meaningful response comes from a valued partner who avers “Yes!”

This thread runs throughout Yalom’s writing. In every therapeutic observation, he extols authenticity – for the therapist to be present with the client. Breakthrough in group therapy often comes when the client reveals their vulnerability to witness from a peer, “Thank you for sharing. Now I can stop protecting myself and try to be your friend.” Among his sources, Yalom also expresses clear sympathy for those that humble themselves in service to healing (although he cannot fully accept the exemplar Buber, who was a man of faith). A detailed exploration of the attitudes of non-contingent love will help therapists check their intentions. And in his sections on loneliness and meaninglessness, Yalom cites studies showing that gratitude (saying “yes” to supporters) and service (saying “yes” to those in need) are the foundations of contentment.

This unique human capacity – to love – normalizes the modern malaise. After 10 billion years (give or take a few billion), humanity has this little window of some tens of thousands of years to exercise the capacity to give and receive love. To do so liberates us from the inevitable consequence of self-seeking: the resistance of the intimates whose choices we suborn. Moreover, in surrendering self-concern, we open the door to an eternity of opportunities known to every mystic, but that the atheist chooses not to recognize.

In summary, Yalom’s “Existential Psychotherapy” argues convincingly that psychotherapy should shift its focus from causes in the past to affirmation of opportunities in the future. He carefully constructs a framework for analyzing a client’s resistance to that affirmation, with strategies for overcoming reluctance. An authentic therapeutic presence is essential. Yalom’s humanity and integrity will inspire everyone reading this book. Ultimately, however, I believe that he suffers from a dour fatalism that is best relieved through spiritual sensitivities that his materialist orientation has closed to him.