Frankl struggled with such fundamental issues as not knowing how long he would be imprisoned in the concentration camp, the ever-present reality of death all around him, and the despair that overwhelmed many inmates. He had to struggle to maintain any sense of hope that he would survive when the odds seemed so overwhelmingly against him.

One stroke of luck Frankl mentions is being rewarded with "premium coupons." He was given these for digging a tunnel. They were very important because they could be redeemed for twelve cigarettes. He could trade each cigarette for a bowl of soup. These bowls of soup were important in keeping him from starving.

Frankl was willing to use his psychotherapeutic training in listening and being supportive to make himself useful. For example, one capo valued him because Frankl would listen carefully as he poured his heart out to him. This helped Frankl obtain some of the seemingly minor privileges on which his survival depended.

When Frankl said the best men didn't make it out alive, he means that it took a ruthlessness and callousness to survive. The best men would sacrifice themselves to save others or would keep act so as to keep their principles intact. Survival, however, came from putting oneself first and from being willing to compromise one's principles to stay alive. As Frankl states:

On the average, only those prisoners could keep alive who, after years of trekking from camp to camp, had lost all scruples in their fight for existence; they were prepared to use every means, honest and otherwise, even brutal force, theft, and betrayal of their friends, in order to save themselves. We who have come back, by the aid of many lucky chances or miracles—whatever one may choose to call them—we know: the best of us did not return.