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Through a variety of circumstances, an economically brilliant marriage, an excellent and experienced partner, and his own circumspect intelligence, he built up a nationwide chain of stores, which he then sold for a dazzling sum to a large corporation. At 30, he had amassed a fortune of several million 1965.
At this point he might have let up for a brief while, relaxed, perhaps even thought deeply about what next, wither or what for. Instead, he plunged immediately into another business enterprise. Soon, he was working over 70 hours a week and was so consumed with business concerns that his marriage was in peril.
When he came for therapy, he had plans for a third empire since he wanted to see if he could start a business from scratch with little capital, no business partners, and no outside council, the business equivalent of wilderness survival. Harvey became aware of certain troublesome incongruities. The economical practices of his family of origin stayed with him, and despite the fact that his income from interest alone was enormous, he searched the newspaper for sales when he shopped and was perfectly willing to drive several miles to save a few dollars on a television set.
But it was the airline ticket caper that spurred him into taking a serious look at his goals in life. He, his wife, and another couple were planning a vacation to the Orient. The difference between first class and coach for the 12-hour flight was several hundred a ticket. Harvey's wife, his friend, who incidentally worked for Harvey, and the friend's wife, all wished to fly first class. Harvey refused to spend the extra money for a wider seat and free champagne, as he put it, and he booked a coach ticket, while the other three, including his wife, traveled first class.
Harvey had a good sense of humor and recognized the comedy of the situation. Still, he was deeply troubled by the situation and developed anxiety, insomnia, and some hypochondrial complaints. At this juncture, he sought psychotherapy.
In therapy, the airline ticket episode became the fulcrum for a far-ranging discussion of values. If money was to be spent lavishly for trivial comforts, why was Harvey killing himself to make more money? Why devote his entire life to money? He had already more than he could spend and had proved he could earn it. He began to question his basic lifelong meaning system.
One of the first insights Harvey acquired in therapy was that he had falsely centered his life, since material good constituted at best a fragile sense of life meaning, one that would not withstand examination. The event that propelled Harvey into a crisis of meaning was that he had successfully and precociously achieved his life goal, always a danger in a non-transcendent life-meaning schema. Other events that may precipitate such a crisis include a confrontation with death or some urgent boundary experience that confronts the individual with his or her existential situation and illuminates the insubstantial nature of many systems of meaning. Some major upheaval that suddenly uproots the ritual and tradition of the social order may also throw certain values, for example, the social customs of society into sharp relief. One not only stops being rewarded extrinsically for adherence to ritual, but even more important, one becomes aware of the absolute relativity of the values one once considered as absolutes.
Some patients undergo a crisis of meaning as a result of psychotherapy. As patients explore themselves deeply and open new vistas within, old compulsive patterns are undermined and eventually deconnected. Patients who for much of their life have lived narrowly within the confines of fixed repetitive patterns are faced with the freedom that their compulsivity has guarded them from. For example, the sexually compulsive patient Bruce, whom I described in chapter 5, had always filled free or reflective time with sexual fantasy or pursuit. When, in the course of successful therapy, Bruce's compulsivity weakened and then entirely loosened its hold on him, he passed through a crisis of meaning. It was not that he had a prior satisfying sense of meaning, but his compulsive activity had always provided a potent antidote to meaninglessness, namely engagement. The problem was that the content of Bruce's compulsive engagement was so limited and restrictive that he failed to realize many of his deeply human potentials. Consequently, he had no conscious crisis of meaning in his life, but in its place, he experienced massive existential guilt. Guilt at not becoming what he had it in him to be. When Bruce first faced life, son's compulsive activity, life seemed to him flat, colorless, zestless, and above all, pointless. Much time in therapy was then devoted to an exploration of goals, to examining what Bruce's internal wisdom told him about what should be the basis for his life.
Clinical research, the purpose in life test. In 1964, James Crumb and Leonard Mahalik, two psychologists greatly influenced by the work of Victor Frankle, published a psychometric instrument designed to measure purpose in life. This questionnaire, the Purpose in Life Test (PIL), consists of 20 items to be rated on a seven-point scale. The instrument originally consisted of two additional sections, a 13-item completion part and an open-ended paragraph to be written on personal ambitions and goals. However, only the first section has been used in subsequent research. On each item, position four is designated as neutral, and different descriptive terms are given for positions 1 and 7. For example, the first item reads "I am usually," and position one is defined as "completely bored," while position 7 is "exuberant, enthusiastic." The other 19 items with their two defined anchor points are: "Life to me seems," 1 "completely routine," 7 "always exciting." "In life I have," 1 "no goals or aims at all," 7 "very clear goals and aims." "My personal existence is," 1 "utterly meaningless without purpose," 7 "very purposeful and meaningful." "Every day is," 1 "exactly the same," 7 "constantly new and different." "If I could choose, I would," 1 "prefer never to have been born," 7 "like to have nine more lives just like this one." "After retiring, I would," 1 "loaf completely the rest of my life," 7 "do some of the exciting things I've always wanted to." "In achieving life goals, I have," 1 "made no progress whatever," 7 "progressed to complete fulfillment." "My life is," 1 "empty filled only with despair," 7 "running over with exciting good things." "If I should die today I would feel that my life has been," 1 "completely worthless," 7 "very worthwhile." "In thinking of my life I," 1 "often wonder why I exist," 7 "always see a reason for my being here." "As I view the world in relation to my life, the world," 1 "completely confuses me," 7 "fits meaningfully with my life." "I am a," 1 "very irresponsible person," 7 "very responsible person." "Concerning man's freedom to make his own choices, I believe man is," 1 "completely bound by limitations of heredity and environment," 7 "absolutely free to make all life choices." "With regard to death, I am," 1 "unprepared and frightened," 7 "prepared and unafraid." "With regard to suicide, I have," 1 "thought of it seriously as a way out," 7 "never given it a second thought." "I regard my ability to find a meaning, a purpose or mission in life as," 1 "practically none," 7 "very great." "My life is," 1 "out of my hands and controlled by external factors," 7 "in my hands and I am in control of it." "Facing my daily tasks is," 1 "a painful and boring experience," 7 "a source of pleasure and satisfaction." "I have discovered," 1 "no mission or purpose in life," 7 "clear-cut goals and a satisfying life purpose."
The PIL test has enjoyed wide usage. Over 50 PhD dissertations on purpose in life have been written which employ it as a major measuring tool. But before discussing some of the results of this research, I shall closely examine the validity of the instrument. First, the face content of the items deals with several different concepts. Eight items deal explicitly with life meaning, purpose, mission. Six items deal with life satisfaction. Life is boring, routine, exciting or painful. Three items deal with freedom. One item with fear of death, one with contemplation of suicide, and one with worthwhileness of one's life. To my mind, this conceptual confusion raises serious questions about the validity of the instrument. Although, for example, life satisfaction or consideration of suicide may be related to meaning in life, they are even more obviously related to other psychological states, most notably depression. Little information has been provided by the test authors about methods of item selection or of individual item behavior. In the light of these methodological shortcomings, one reviewer suggested that a single item, "how meaningful is your life," might be as valid as the entire scale. Furthermore, the PIL is obviously loaded in social desirability. A correlation coefficient of .57 is reported with the Marlowe-Crowne Social Desirability Scale. The PIL, as critics have pointed out, reflects certain values. For example, it assumes that responsibility acceptance is equivalent to a positive sense of life meaning. Although this is an interesting hypothesis, it is not clear that responsibility and meaning are so related.
Charles Garfield administered the PIL to subjects from several subcultures: ghetto residents, engineers, graduate students in psychology and religious studies, commune inhabitants, and then interviewed subjects with high, low, and intermediate scores to determine what each item meant to them. Depending in part upon their culture, subjects interpreted the items in highly idiosyncratic ways. For example, on item nine, "My life is empty or running over with exciting good things," ghetto residents thought of empty stomachs. Commune residents viewed "empty" as associated with losing one's ego in meditation and bliss. Engineers equated "empty" with dullness, and psychology students viewed "exciting" as not a good thing but associated it with agitation or nervous activity. Similar divergent responses on other items underscored the facts that not only is the wording ambiguous, but also that the test is highly value-laden and based on assumptions inherent in a Protestant work ethic with emphasis on goal-directed behavior, future orientation, activity over passivity, and the positivity of high levels of stimulation. These criticisms are substantial, indeed devastating, and have never been satisfactorily answered by researchers using the PIL. They all make it difficult for one to have a high level of confidence in the instrument. Still, it is the only game in town, the only psychological instrument that has been used widely to study meaninglessness in a systematic manner.
Keeping these reservations in mind, let me consider some of the research findings. First, several validity studies have indicated that the test results correlate satisfactorily with therapists' ratings of life purpose in patients (correlation of .38) and with ministers' ratings of parishioners (.47). By and large, patient populations have a lower PIL than have non-patients, although some studies are equivocal. For example, one showed a surprisingly small difference in the scores of indigent psychiatric patients and undergraduate students (108 versus 106). Note that there are 20 items, each with a 7-point scale. The highest score is thus 140, the lowest 20. Furthermore, the PIL seems to measure an independent personality variable. It does not correlate highly with other scales. Aside from the MMPI depression scale, some moderate overlap with the SW anomie scale, and, as I have already noted, the social desirability scale.
The PIL has been employed in many clinical settings with diverse populations. Delinquent adolescents and high school students who abuse drugs have been shown to have low PIL scores. Patients hospitalized for chronic alcoholism and psychotic disorders have lower PIL scores than have neurotic outpatients. The mean of both hospitalized patients and outpatients is significantly lower than in a non-patient sample. Alcoholics have been reported as having particularly low PIL scores. Another study showed only low normal scores for hospitalized alcoholics, but did note that with a month-long treatment program, the PIL score rose significantly. A study of outpatients in a British clinic demonstrated that the more highly neurotic and socially introverted patients, as measured by the personality inventory, have lower PIL scores. Sexual adjustment was studied in a group of normal undergraduates, and it was found that the more sexually frustrated and maladjusted students have lower PIL scores.
One study compared PIL scores of physically ill patients and reported an interesting finding. Patients who were critically ill had higher PIL scores than had patients with a minor ailment or non-patients. The authors speculated that these results indicate the approach of death catalyzed the critically ill patients to come to terms with their lives, to work through their doubts, and to come to some inner peace. The relationship between social and religious attitudes and values (Rokeach Value Survey) has been much studied. A low PIL score has been shown to correlate with high valuing of hedonism, excitation, and comfort. A high PIL has been shown to correlate with strong religious beliefs that play a central role in the individual's life. However, another study fails to replicate this finding. Another study demonstrates a correlation between a high PIL and conservatism, anti-hedonism, religious puritanical values, and idealism. Successfully matriculating Dominican nuns have higher PIL scores than have their less successful cohorts. Two studies demonstrate that a high purpose in life is associated with low death anxiety. Earlier I discussed how involvement in a meaningful group or cause increases one's sense of meaning. Several studies have tested this concept and demonstrate that a high PIL score is correlated with involvement in organized groups (either religious, ethnic, political, or community service) and involvement in sports and hobbies. One study, however, reveals no correlation between social activism, civil rights demonstrations, and PIL. Could this be a result of the presence of some of "Maddiey's Crusaders"? An Australian study reports a correlation between high PIL and a positive world view, goal orientation, and self-transcendent goals, that is, interests that extend beyond the individual's material and mental well-being. Another study indicates that high PIL undergraduates are significantly more likely to have made vocational choices than are those with low PIL scores. However, a study of business executives and nurses indicates no relationship between PIL scores and work attitudes or work motivation. Finally, it has been shown that ghetto residents, blacks or Mexican-Americans, have lower PIL scores. There are contradictory findings on the general relationship between PIL and socioeconomic class and also between males and females, with males generally found to have higher PIL scores.
The Life Regard Index. Before considering the implications of these findings, let me briefly examine one other instrument designed to study life meaning. The Life Regard Index, John Batista and Richard Almond, is more conceptually sophisticated than the PIL but has unfortunately had no subsequent use. The instrument differentiates framework items such as "I have a clear idea of what I'd like to do with my life" from fulfillment items such as "I feel that I am living fully." The authors suggest that both a framework and a belief that one is fulfilling that framework is necessary to a sense of life meaning. The instrument was successfully validated via interviews of subjects, correlates highly with the PIL, and is probably free of the confounding effects of social desirability. The relation between self-esteem and a life regard meaning in life was explored. The authors concluded that a satisfactory level of self-esteem is necessary but not sufficient for a well-developed sense of meaning. That is, it is possible for an individual with high self-esteem to have low meaning in life, but not for one with low esteem to have high meaning. One must, as Erik Erikson suggested, solve the task of establishing self-worth and personal identity before being able to develop a satisfying sense of life meaning. The research suggests that positive life meaning is dependent upon some fit between one's goals and values and the roles and needs of the social structure in which one is ensconced. Finally, the authors demonstrated that one has a greater sense of meaning if one perceives oneself as approaching one's goals at a satisfactory rate.
Summary of research results. The empirical research on meaning in life corroborates the following:
1. A lack of sense of meaning in life is associated with psychopathology in a roughly linear sense. That is, the less the sense of meaning, the greater the severity of the psychopathology.
2. A positive sense of meaning in life is associated with deeply held religious beliefs.
3. A positive sense of life meaning is associated with self-transcendent values.
4. A positive sense of meaning in life is associated with membership in groups, dedication to some cause, and adoption of clear life goals.
5. Life meaning must be viewed in a developmental perspective. The types of life meaning change over an individual's life. Other developmental tasks must precede development of meaning.
A caveat. It is important to note the wording of these conclusions. The phrase "is associated with" recurs. For example, "a low sense of meaning in life is associated with psychopathology." That does not mean, however, that there is any evidence that the absence of meaning causes psychopathology. All the research studies are correlative. They merely demonstrate that diminished life meaning and pathology co-occur. One might equally well argue from this research that diminished life meaning is a function, that is, a symptom of pathology. Indeed, one study demonstrates that in depressed patients, the sense of life meaning is dramatically increased by electroshock therapy.
Chapter 11. Meaninglessness and Psychotherapy. In the previous chapter, I approached the question of life meaning as it is conventionally framed. Meaning in life is an important psychological construct which primapacia relates deeply to all of us. I accepted this construct at face value and accordingly discussed the array of meaning-offering life activities and described the pathological clinical manifestations of the phenomenological state of meaninglessness. Now I shall turn to the immediate everyday problem of therapists who are confronted with patients who state that they have no meaning in life. A therapist who accepts a patient's formulation of the problem is likely to share that patient's sense of entrapment. Such a therapist is reminded of his or her personal incomplete quest for meaning in life. "How is it possible?" the therapist wonders, "for one to solve something for someone else, one cannot solve for oneself." The therapist may well conclude that the problem is insoluble and find ways to circumvent it in therapy. To avoid this untherapeutic sequence of events, the therapist's first step must be not to accept at face value the patient's formulation of the problem. Instead, the therapist must rigorously examine the legitimacy of the complaint that life has no meaning. If one analyzes the ground on which the complaint rests, that is, the meaning of the question, "What meaning is there in life?" one learns that often, to a great extent, the question is primitive and contaminated. For one thing, the question as conventionally posed assumes that there is a meaning to life that a particular patient is unable to locate. The question is in conflict with the existential view of the human being as a meaning-giving subject. There is no pre-existing design, no purpose out there. How could there be one when each of us constitutes our own out there? Another major problem inherent in questions about life meaning is that they are so often confounded with a host of other issues. When these other concerns are dissected and discarded, the patient's primary meaning crisis is less lethal and far more manageable. I shall attempt to refine the clinical question of meaning in life by first considering why we need meaning and then examining the various concerns that often obscure the question.
Why do we need meaning? Decades of empirical research have established that our perceptual neuro-psychological organization is such that we instantaneously pattern incoming random stimuli. The Gestalt movement in psychology, founded by Wolfgang Kohler, Max Wertheimer, and Kurt Koffka, has spawned an enormous amount of research both in perception and in motivation which demonstrates that we organize molecular stimuli as well as molar behavioral and psychological data into Gestalten, into configurations or patterns. Thus, when presented with random dots on wallpaper, one organizes them into figure and ground. When confronted with a broken circle, one automatically perceives it as complete. When presented with diverse behavioral data, for example, a strange noise at night, an unusual facial expression, a senseless international incident, one makes sense out of it by fitting it into a familiar explanatory framework. When any of these stimuli or situations do not lend themselves to patterning, one feels tense, annoyed, and dissatisfied. This dysphoria persists until a more complete understanding permits one to fit the situation into some larger recognizable pattern. The implications of such meaning-attribution tendencies are obvious. In the same way we face and organize random stimuli and events in our daily world, so too we approach our existential situation. We experience dysphoria in the face of an indifferent, unpattered world and search for patterns, explanations, and the meaning of existence. When one is unable to find a coherent pattern, one feels not only annoyed and dissatisfied but also helpless. The belief that one has deciphered meaning always brings with it a sense of mastery. Even if the meaning schema that one has discovered involves the idea that one is puny, helpless, or dispensable, it is nonetheless more comforting than a state of ignorance. It is evident that we crave meaning and are uncomfortable in its absence. One finds a purpose and clings to it for dear life. Yet the purpose one creates does not relieve discomfort effectively if one continues to remember that one forged it. Frankl compares the belief in personally constructed or invented life meanings to climbing a faker's rope that one has oneself thrown into the air. It is far more comforting to believe that the meaning is out there and that one has discovered it. Victor Frankl insists that "meaning is what is meant by a situation which implies a question and calls for an answer. There is one solution only to each problem, the right one, and there is one meaning only to each solution, and that is its true meaning." He takes issue with Sartre's position that one of the burdens of being free is that one must invent meaning. Throughout his writing, Frankl asserts, "Meaning is something to be found rather than given. Man cannot invent it, but must discover it." Frankl's position is basically religious and rests on the assumption that there is a God who has ordained a meaning for each of us to discover and fulfill. Even though we cannot comprehend the meaning in its entirety, Frankl insists we must accept on faith that there is a coherent pattern to life and a purpose to man's suffering. Just as the experimental animal cannot comprehend the reason for its pain, so too is it with human beings who cannot discover their meaning because it lies in a dimension beyond their comprehension. Yet are the basic premises of this argument tenable? After all, if there were a God, why should it follow that he had a purpose for life and, above all, a purpose for each of us? Let us not forget that it is man, not God, who is obsessed with purpose.
Meaning in life and values. Thus, one meaning of meaning is that it is an anxiety-implicating. It comes into being to relieve the anxiety that comes from facing a life and a world without an ordained, comforting structure. There is yet another vital reason why we need meaning. Once a sense of meaning is developed, it gives birth to values which in turn act synergistically to augment one's sense of meaning. What are values and why do we need them? Tolstoy, in his crisis of meaning, not only asked "why" questions ("Why do I live?") but also "how" questions ("How shall I live? By what shall I live?"), all of which expressed a need for values, some set of guidelines or principles to tell him how to live. A standard anthropological definition of a value is "a conception, explicit or implicit, distinctive of an individual or characteristic of a group, of the desirable which influences the selection from available modes, means and ends of action." In other words, values constitute a code according to which a system of action may be formulated. Values allow us to place possible ways of behaving into some approval-disapproval hierarchy. For example, if one's meaning schema stresses service to others, then one is easily able to develop guidelines or values that permit one to say, "This behavior is right," or "This behavior is wrong." I have stressed in earlier chapters that one creates oneself by a series of ongoing decisions. But one cannot make each and every decision de novo throughout one's life. Certain superordinate decisions must be made that provide an organizing principle for subsequent decisions. If that were not the case, much of life would be consumed by the turmoil of decision-making. Values not only provide the individual with a blueprint for personal action, but also make it possible for individuals to exist in groups. Social life, Clyde Kluckholm tells us, would be impossible without them. Values add an element of predictability to social life. Those belonging to a particular culture have some shared conception about what is, and from this conception develop a shared belief system about what must be done. Social norms emanate from a meaning schema that has the consensus of the group and provide the predictability necessary for social trust and cohesion. A shared belief system not only tells individuals what they ought to do but what others probably will do as well.
Meaning of life and other ultimate concerns. Our human needs for overall perceptual frameworks and for a system of values on which to base our actions together constitute the pure reasons that we search for meaning in life. Generally, however, the question of meaning is contaminated. Issues other than meaning per se are attached to it and confound it. Returned for a moment to Tolstoy, who often asked, "Is there meaning in my life which will not be destroyed by the inevitable death awaiting me? All my acts, whatever I do, will sooner or later be forgotten, and I myself be nowhere. Why then busy oneself with anything?" These questions are not about meaning, but about meta-meaning concerns, and revolve about the issue of transience. Will we leave anything enduring behind us? Do we vanish without a trace? And if so, how can our life matter? Is everything pointless if, as Bertrand Russell lamented, "all the labors of the ages, all the devotion, all the inspiration, all the noonday brightness of human genius are destined to extinction in the vast death of the solar system. And the whole temple of man's achievement must inevitably be buried beneath the debris of a universe in ruins." Ernest Becker argues persuasively that our universal ambition is prosperity, that is, continued experience, and that death is the chief enemy with which we must contend. Human beings try to transcend death, not only in the many ways discussed in the first section of this book, but also through counting or mattering or leaving something of themselves behind. As Becker said, "Man transcends death not only by continuing to feed his appetites, that is, in simple-minded blissful visions of heaven, but especially by finding a meaning for his life, some kind of larger scheme into which he fits. It is an expression of the will to live, the burning desire of the creature to count, to make a difference on the planet because he has lived, has emerged on it, and has worked, suffered, and died." Thus, the wish to leave something behind of oneself, to matter, to make a difference, Becker would argue, is an expression of an effort to transcend death. Meaning used in the sense of one's life having made a difference, of one's having mattered, of one's having left part of oneself for posterity, seems derivative of the wish not to perish. When Tolstoy lamented that there was no meaning in his life that would not be destroyed by the inevitable death awaiting him, he was stating not that death destroyed meaning, but that he failed to find a meaning that would destroy death. We too easily assume that death and meaning are entirely interdependent. If all is to perish, then what meaning can life have? If our solar system is to be ultimately incinerated, why strive for anything? Yet, though death adds a dimension to meaning, meaning and death are not fused. If we were able to live forever, we would still be concerned about meaning. What if experiences do pass into memory and then ultimately fade? What relevance does that have for meaning? That happens to be the nature of experiences. How could it be otherwise? Experiences are temporal, and one cannot exist outside of time. When they're over, they're over, and nothing can be done about it. Does the past vanish? Is it true, as Schopenhauer said, that "what has been exists as little as what has never been"? Is memory not real? Frankl argues that the past is not only real but permanent. He is sorry for the pessimist who despairs when he watches his wall calendar grow thinner each day as a sheet is removed and admires the man who saves each successive leaf and reflects with joy on the richness experienced in the days represented by the leaves. Such a person will think instead of possibilities, "I have realities." We are dealing with value judgments, not with statements of fact. It is by no means an objective truth that nothing is important unless it goes on forever or eventually leads to something else that persists forever. Certainly, there are ends that are complete unto themselves without requiring an endless series of justifications outside ourselves. As David Hume said in the 18th century, "It is impossible that there can be a progress ad infinitum and that one thing can always be a reason why another is desired. Something must be desirable on its own account and because of its immediate accord or agreement with human sentiment or affection." If no ends were complete unto themselves, if everything had to be justified by something else outside of itself, which must in its turn also be justified, then there is infinite regress. The chain of justification can never end. Not only does death anxiety often masquerade as meaninglessness, but the anxiety stemming from awareness of freedom and isolation is also frequently confused with the anxiety of meaninglessness. Envisioning existence as part of some grand design that exists out there and in which one is assigned some role is a way of denying one's freedom and one's responsibility for the design and structure of one's own life and a way of avoiding the anxiety of groundlessness. Fear of absolute loneliness also propels one into a search for identification with something or someone. To be part of a larger group or to dedicate oneself to some movement or cause are effective ways of denying isolation.
Meaning of life a cultural artifact. The question of meaning in life is not only confounded by issues belonging to the ultimate concerns of death, freedom, and isolation, but it is also extraordinarily difficult to comprehend it free of the biases inherent in a particular culture. A cartoon I once saw illustrates the problem aptly. It depicts a bevy of eager American travelers listening to the words of a bearded Tibetan holy man on a precipitous mountain peak. The caption read, "The purpose of life, if I knew that, I'd be rich." The cultural bias illustrated by the cartoon influences the views of a prominent psychiatrist who, when writing on meaning in life, asserts with full conviction, "No human can always achieve, always create, no human being can be continuously successful in his endeavors. But to go in the right direction. Not to have achieved, but achieving. Not arriving at the inn, but walking toward the inn. Not resting on the laurels, but moving towards the laurels. Putting one's talents to the most constructive, productive, and creative use. This is perhaps the main sense of life and the only possible answer to the existential neurosis which cripples human efforts and maims human minds." With the same sense of conviction, Frankl describes achievement or accomplishment as an obvious and self-evident category of life meaning. But is it obvious? Is striving, creating, achieving, or progressing part of existence, part of the deepest layer of human motivation? The answer is most assuredly no. There were other eras in our own culture where goal-directed striving was by no means accepted as a commonly sanctioned mode of finding meaning in life. An inscription on a sundial of great antiquity states, "Horas non numero nisi serenas" (The hours don't count unless they're serene). From notes that man's burning ambition for fame and lasting achievement has been common from the Renaissance up until the present day, whereas it was little seen in medieval man. Furthermore, in northern European countries, it was not until the 16th century that man's obsessional craving to work first appeared. The belief in progress, that civilization was inexorably heading in a desirable direction, is similarly a notion of relatively recent origin which did not take recognizable shape until the end of the 17th century. Other contemporary cultures take issue not only with an achievement-oriented sense of life purpose but with the very concept of purpose in life. One of the most articulate spokesmen for an alternate view is D.T. Suzuki, the Zen master. In an extraordinarily luminous essay, Suzuki illustrates two opposing postures to life by comparing two poems. The first, a 17th-century haiku by Basho, reads: "When I look carefully, I see the auma blooming by the hedge." The second, a verse by Tennyson, reads: "Flower in the crannied wall, I pluck you out of the crannies. Hold you here, root and all, in my hand, little flower. But if I could understand what you are, root and all, and all in all, I should know what God and man is." In the haiku, Basho simply observes carefully an auma, an inconspicuous, unpretentious, almost negligible plant blooming by the hedge. The haiku conveys, though Suzuki tells us its subtlety is lost in translation, a tender, humble, close, and harmonious relationship to nature. Basho is quiet. He feels much but gently allows his last two syllables, called "aana" in Japanese and appropriately rendered in English by an exclamation point, to convey what he feels. Tennyson is eloquent and active. He plucks the flower. He tears it away from nature, root and all, which means that the plant must die, and inspects it closely as though to dissect it. Tennyson attempts to analyze and to understand the flower. He stands away from it in a scientifically objective fashion. He uses the flower to know something else. He transforms his meeting with the flower into knowledge and ultimately into power. Suzuki suggests that this contrast illustrates Western and Eastern attitudes toward nature and, by implication, toward life. The Westerner is analytical and objective and attempts to understand nature by dissecting and then subjugating and exploiting it. The Oriental is subjective, integrative, totalizing, and he attempts not to analyze and harness nature, but to experience and harmonize with it. The contrast then is between a searching-action mode and a harmonizing-union one, and is often phrased in terms of "doing" versus "being."
If we step outside of our contemporary skins and look backward, we readily see that our posture toward purpose has undergone a gradual evolution. The early Christians valued contemplation above all else. Recall Christ's words: "They sow not, neither do they reap nor gather in the fields, yet your heavenly Father feedeth them. Or consider the lilies of the field, how they grow. They toil not, neither do they spin." The early Christians viewed work and wealth not as goals to be pursued but as obstructions which clogged the mind with care and consumed the time that should be spent in the service of God. In the early monasteries, the lay brothers did the manual labor. Artistic expression, manuscript illustration, was more highly valued, whereas contemplation was considered the most holy endeavor. That hierarchy is apparent in the stone carvings on Romanesque cathedral facades. In the late Middle Ages, human beings began to yearn to know the laws of nature and to work toward active subjugation of the physical world. A central motif in 13th-century astrological tracts was "the wise man will dominate the stars." Renaissance man explicitly assumed an active stance toward the world. Men like Leonardo da Vinci, Cardano, Bruno, and Benvenuto Cellini believed the world existed to be transformed, and they rescued the concept of work and of craftsmanship from the neglect into which it had fallen. In the 16th century, John Calvin proposed a theological system that has ever since greatly influenced the West's attitudes toward life purpose. Calvin believed that humans were predestined by God's grace to be either elected or damned. The elected intuitively knew of their foreordained salvation and, by God's wish, were to participate actively in the affairs of the world. In fact, Calvin said that a sign that one was of the elect of God was one's worldly success. The damned, on the other hand, were the failures in worldly life. The Puritan tradition, influenced by Calvin and from which we are not yet entirely unshackled, valued sacrifice, hard work, ambition, and social position. Work was considered godly. "The devil finds work for idle hands." One's nation was viewed as a rowboat. Each person was part of the crew and had to pull his or her own oar. One could either row or be excess baggage, a parasite on the others. This ethic worked wonderfully well for the economic vitality of the young and developing United States. But for generations of individuals who, in one way or another, did not feel that they measured up, it set the stage for feelings of guilt and worthlessness. The Western world has thus insidiously adopted a worldview that there is a point, an outcome of all one's endeavors. One strives for a goal. One's efforts must have some end point, just as a sermon has a moral and a story, a satisfying conclusion. Everything is preparation for something else. William Butler Yeats complained, "When I think of all the books I have read, wise words heard, anxieties given to parents, of hopes I have had, all life weighed in the balance of my own life, seems to me a preparation for something that never happens." A useful language for discussing this Western worldview may be borrowed from aesthetics, where a distinction may be made in a musical composition between passages that have introduction or preparation quality and those that have exhibition or fulfillment quality. In the West, we view our life's activities in the same way. Past and present are preparation for what is to follow. But what is to follow? If we have no belief in an immortality system, then we come to feel that life is all preparation without exhibition quality. The sentiments "pointless" or "senseless" follow naturally from this belief. It must be remembered, however, that art is not life. The distinction of art is that it can provide a balance of preparation and exhibition in a way that life can't. The belief that life is incomplete without goal fulfillment is not so much a tragic existential fact of life as it is a Western myth, a cultural artifact. The Eastern world never assumes that there is a point to life or that it is a problem to be solved. Instead, life is a mystery to be lived. The Indian sage Bhagwan Shri Rajneesh says, "Existence has no goal. It is pure journey. The journey in life is so beautiful, who bothers for the destination. Life just happens to be, and we just happen to be thrown into it. Life requires no reason."
Psychotherapeutic strategies. I began this chapter by stating that an important first step for the therapist is to reformulate the patient's complaint of meaninglessness in order to discover the presence of contaminating issues. The experience of meaninglessness may be a stand-in for anxiety associated with death, groundlessness, and isolation. And the therapist is well advised to analyze and approach these concerns along the lines discussed in previous chapters of this book. Often, the therapist may be useful to the patient by maintaining a relatively culture-free perspective toward meaning and by helping the patient appreciate that meaning is highly relative. The formula that since life has no clear purpose, it follows that life is not worth living is based on culture-bound, arbitrary assumptions. What other technical options are available to the therapist? I shall review the literature dealing with clinical approaches to meaninglessness, but will first note that it is an impoverished literature. Aside from a few scattered clinical notes describing exhortative techniques and some superficial techniques offered by Frankl, the literature is mute. Why should this be so? Perhaps it's because meaninglessness is so frequently a compound or derivative rather than an elemental concern, and appropriate therapist techniques have been developed and described elsewhere in appropriate contexts. Perhaps meaninglessness is such an inherently baffling issue that it defies the development of successful technology. Accordingly, therapists may have learned to inattend selectively to the issue and to identify only those questions for which they have an answer. This is a discouraging state of affairs. But to those clinicians who are searching for a purpose in their clinical investigative careers, it could be a beckoning opportunity. This chapter gathers together a wide range of reflections on the problem of meaninglessness with the intention of providing a horizon against which therapists may fashion new and creative responses to an old problem.
The therapist's set. When the therapist approaches conflicts involving the ultimate concerns of death, freedom, and isolation, one of his or her first acts is mind-setting. The same act is required of the therapist dealing with meaninglessness. Therapists must increase their sensitivity to the issue. Listen differently, become aware of the importance of meaning in the lives of individuals. For many patients, the issue is not crucial. Their lives seem filled with meaning. But for others, the sense of meaninglessness is profound and pervasive. Therefore, therapists must be attuned to meaning. They must think about the overall focus and direction of the patient's life. Is the patient in any way reaching beyond himself or herself, beyond the humdrum daily routine of staying alive? I have treated many young adults who were immersed in a California singles lifestyle which is characterized to a large degree by sensuality, sexual clamor, and pursuit of prestige and materialistic goals. In my work, I have become aware that therapy is rarely successful unless I help the patient focus on something beyond these pursuits. But how, how does the therapist affect such a refocusing? If the therapist has a heightened sensitivity to the importance of meaning in life, then the patient will, through picking up subtle cues from the therapist, become similarly sensitive to the issue. The therapist will implicitly and explicitly wonder about the patient's belief systems, inquire deeply into the loving of another, ask about long-range hopes and goals, explore creative interests and pursuits. I have, for example, found it singularly rewarding to take an in-depth history of the patient's efforts to express himself or herself creatively. All of these activities are an integral part of the patient's life. If one is to know and to value oneself, one must learn to identify and to value these parts. The therapist, in order to care for the patient, must know the patient as deeply as possible. That includes knowing these meaning-seeking, meaning-providing activities. I remember one young engineer, an extraordinarily isolated individual who worked at a solitary job during the day and spent evenings and weekends tinkering with his private computer that occupied almost his entire living space. I found it difficult to relate to him. He seemed restricted, lifeless, inexorably dull, and I often visualized him as a little laboratory mouse sniffing at me in my office. My therapeutic fantasy consisted of blowing up that damned computer and bringing some people into his life. We seemed at an impasse. I could develop no sense of caring for him, and accordingly couldn't budge him from his isolated ways. Finally, I began to inquire what he did every evening with his computer. He was reluctant to answer because he felt much shame about his solitary, reclusive, endless tinkering, which for most of his life had constituted a symbol of his failure to relate to other people. Eventually, however, he opened up and spent two hours describing his tinkering in fascinating detail. Those sessions changed everything in therapy. He and I both finally understood that the senseless tinkering was in truth an important form of creative expression and not merely some sublimating or substitute activity. As a result of this sharing, our relationship became much closer, and he was willing to share other important secrets with me. I gradually helped him to bring other people into his life along with, rather than as a replacement for, his creative work and finally to share that work with others.
Dereflection. Earlier I described Frankl's dictum that "happiness cannot be pursued. It can only ensue. The more we deliberately search for self-satisfaction, the more it will elude us. The more we fulfill some self-transcendent meaning, the more happiness will ensue." For patients in therapy, it is necessary that therapists help them take their gaze off themselves. Frankl describes a specific technique, dereflection, which in principle involves diverting the patient's gaze away from themselves, from their dysphoria, from the source of their neurosis, and toward the intact parts of their personalities and the meanings that are available for them in the world. The technique of dereflection, as described by Frankl, is simplistic and consists of little more than telling the patient to stop focusing on himself or herself and search for meaning outside of self. This transcription of Frankl interviewing a 19-year-old schizophrenic girl is representative.
Frankl: "Now, you are in a state where reconstruction of your life is the task awaiting you. But one cannot reconstruct one's life without a life goal, without anything challenging him."
Patient: "I understand what you mean, Doctor, but what intrigues me is the question, what is going on within me?"
Frankl: "Don't brood over yourself. Don't inquire into the source of your trouble. Leave this to us doctors. We'll pilot you through the crisis. Well, isn't there a goal beckoning you? Say, an artistic accomplishment. Are there not many things fermenting in you? Unformed artistic works, undrawn drawings which wait for their creation, as it were, waiting to be produced by you? Think about these things."
Patient: "But this inner turmoil..."
Frankl: "Don't watch your inner turmoil, but turn your gaze to what is waiting for you. What counts is not what lurks in the depths, but what waits in the future. Waits to be actualized by you. I know there is some nervous crisis which troubles you, but let us pour oil on the troubled waters. That's our job as doctors. Leave the problem to the psychiatrists. Anyway, don't watch yourself. Don't ask what is going on within yourself, but rather ask what is waiting to be achieved by you."
Patient: "But what is the origin of my trouble?"
Frankl: "Don't focus on questions like this. Whatever the pathological process underlying your psychological affliction may be, we will cure you. Therefore, don't be concerned with the strange feelings haunting you. Ignore them until we make you get rid of them. Don't watch them. Don't fight them."
For any patient who is excessively self-absorbed, Frankl feels that a long search within for causes of the anxiety generally compounds the problem and is ultimately counterproductive by making the patient even more self-absorbed. For such a patient, he
recommends that a therapist take the position and convey this position to the patient that because of irreversible factors, the patient's family history, genetically transmitted anxiety, genetic imbalance of the autonomic system, and so forth, the patient is destined to experience a high baseline amount of anxiety for which there is relatively little one can do except take medication or engage in exercise or some similar palliative activity.
The therapist must then direct attention toward work on the patient's attitude toward his or her situation and toward the detection of meanings available for the patient. The specific technique depicted in the preceding vignette seems so authoritarian that it would be distasteful and most likely ineffective for many contemporary American therapists and patients. No doubt that is to some extent a cultural artifact. The average Viennese citizen is traditionally more likely to revere professional titles and knowledge, but it's problematic on another account. The appeal to authority, "We doctors will pilot you through the crisis," is ultimately undermining to personal growth since it blocks the path to one's awareness and assumption of responsibility.
Frankl's point stands nonetheless. It is often vitally important to shift the patient's gaze from himself or herself onto others. The therapist must find a way to help the patient develop curiosity and concern for others. The therapy group is especially well suited for this endeavor. Self-absorbed narcissistic proclivities are readily apparent and inevitably the pattern of taking without giving becomes a key issue in the group. Therapists may ask patients to reflect on how others feel at the moment. Therapists may, in a flowing, unstructured manner, provide training in empathy for others. In groups of acutely disturbed patients, I have often assigned morbidly self-absorbed patients the task of introducing new patients to the group and of helping these patients express their pain and their problems to the others.
Discernment of meaning. Frankl suggests that it is the therapist's task to comprehend some coherent pattern, some meaning gestalt. In what would appear to be the random and tragic events of life, often much ingenuity is required of the therapist, as one of Frankl's cases illustrates. He was consulted by an elderly, depressed general practitioner who could not overcome the loss of his wife two years previously.
"I quote Frankl. Now, how could I help him? What should I tell him? Well, I refrained from telling him anything, but instead confronted him with the question, 'What would have happened, doctor, if you had died first, and your wife would have had to survive you?' 'Oh,' he said, 'for her this would have been terrible, how she would have suffered.' Whereupon I replied, 'You see, doctor, such a suffering has been spared her, and it is you who have spared her this suffering, but now you have to pay for it by surviving and mourning her.' He said no word, but shook my hand and calmly left my office."
Frankl cites another example of how he has helped patients to detect their life meaning. The following transcript is from an interview with an 80-year-old woman near death from cancer who was deeply depressed and ridden by anxiety and the feeling that she was useless.
Frankl: "What do you think of when you look back on your life? Has life been worth living?"
Patient: "Well, doctor, I must say that I had a good life. Life was nice indeed, and I must thank the Lord for what it held to me. I went to theaters. I attended concerts and so forth."
Frankl: "You are speaking of some wonderful experiences. But all this will have to end now, won't it?"
Patient (thoughtfully): "In fact, now everything ends."
Frankl: "Well, do you think now that all of the wonderful things of your life might be annihilated and invalidated when your end approaches?"
Patient (knowing that it did): "..."
Frankl: "But tell me, do you think that anyone can make undone the happiness, for example, that you have experienced? Can anyone blot it out?"
Patient (now facing me): "You are right, doctor, nobody can blot it out."
Frankl: "Or can anyone blot out the goodness you have met in your life?"
Patient (becoming increasingly emotionally involved): "Nobody can blot it out."
Frankl: "What you have achieved and accomplished?"
Patient: "Nobody. Nobody can blot it out."
Frankl: "Or what you have bravely and honestly suffered, can anyone remove it from the past wherein you have stored it, as it were?"
Patient (now moved to tears): "No one can remove it. After a while, it is true. I had so much to suffer, but I also tried to be courageous and steadfast in taking life's blows. You see, doctor, I regarded my suffering as a punishment. I believe in God."
Frankl: "But cannot suffering sometimes also be a challenge? Is it not conceivable that God wanted to see how Anastasia would bear it? And perhaps he had to admit, 'Yes, yes, she did so very bravely.' And now tell me, can anyone remove such an achievement? An accomplishment from the world?"
Patient: "Certainly no one can do it."
Frankl: "What counts and matters in life is rather to achieve and accomplish something, and this is precisely what you have done. You have made the best of your suffering. You have become an example for our patients by the way and manner in which you take your suffering upon yourself. I congratulate you on behalf of this achievement and accomplishment. And I also congratulate your roommates who have the opportunity to watch and witness such an example."
Frankl reports that the interview enhanced the patient's sense of meaningfulness and that in her remaining week of life, the patient's depression lifted and she died filled with pride and faith.
Terry Zelki and John Watkins report a study in which they treated 12 dying patients with a similar clinical approach which heavily emphasized the development of meaning. The authors administered the Purpose in Life test (PIL) both before and after therapy and report a significant increase in purpose in life.
What type of meaning does the therapist help the patient find? Frankl stresses the uniqueness of each patient's meaning but does not, as we see from the clinical transcriptions, shrink from hinting broadly or providing some explicit, formed meaning to the patient. The meanings he provides consist of the triad of meaning categories I described earlier in this chapter: creative accomplishment, experience, and attitude toward suffering. When stressing either creative accomplishment or experience, Frankl emphasizes the permanence of the past. Accomplishments and experiences are stored away and endure forever. When all other meaning seems obscured by present tragedy and suffering, Frankl stresses that one may still find meaning in assuming a heroic stance toward one's fate. One's attitude may serve as an inspiring model for others—children, relatives, friends, students, or even other patients on the ward. One's acceptance of inevitable suffering may be seen as an embracement of God from whom the suffering emanated. Or finally, one's heroic attitude toward one's fate is meaningful in itself, in much the same way that Camus regarded prideful rebellion as the human being's final response to absurdity.
Frankl's therapeutic technique, as illustrated by these two case examples, which are highly representative of his technical approach, is problematic for the same reasons that his approach to de-reflection is problematic. In an authoritarian fashion, he offers the patient a meaning. But in so doing, does he not move the patient even farther from the assumption of full personal autonomy?
The same issue emerges when we examine other therapists who focus on meaning. Young, for example, reports a case in which he also explicitly suggested a meaning schema to his patient. The patient was a young, analyzed, secularized, enlightened Jewish woman with a severe anxiety neurosis. Young inquired about her background and learned that her grandfather was a rabbi who had been widely regarded as a zaddik, a saint who possessed second sight. She and her father had always scoffed at this nonsense. Young felt that he had an insight into the neurosis and told her, "Now I am going to tell you something you may not be able to accept. Your grandfather was a Zaddik. Your father betrayed the secret and turned his back on God, and you have your neurosis because the fear of God has got into you." The interpretation, Young reports, struck her like a bolt of lightning.
That night, Young had this dream: "A reception was taking place in my house, and behold, this girl, the patient, was there. She came up to me and asked, 'Haven't you got an umbrella? It is raining so hard.' I found an umbrella and was on the verge of giving it to her. But what happened instead? I handed it to her on my knees, as if she were a goddess." Young's dream told him that the patient was not just a superficial little girl, but that she had the makings of a saint. However, her life was directed toward flirtation, sex, and materialism. She had no way to express the most essential feature of her nature, namely that in reality, she was a child of God whose destiny was to fulfill his secret will. Young told the patient his dream, as was his wont, and his interpretation of it. In a week, he reports, the neurosis had vanished. It is rare, incidentally, for Young to report a successful brief therapy case.
Peter Kenbomb provides another example of the therapist who explicitly directs the patient toward some purpose. The patient, a man in his early 30s, had a profound lack of self-worth and personal identity stemming in large part from parental neglect during his formative years. He had considerable amnesia for his life before age 8 and in therapy persistently bemoaned his lost childhood. The therapist felt that one important way the patient could recreate his lost childhood and redefine himself as a person with a childhood was to commit himself to a child. The patient and his wife had made a firm contract not to have children. Therefore, therapist and patient worked out a plan by which the latter would dedicate himself to working with a Big Brother organization. Kenbomb reports that this worked out splendidly. Contact with a child helped the patient view himself and his past differently. A year later, the patient and his wife decided to have a child, at which point therapy successfully concluded.
Programmed meaning. James Crumb reports on a systematic two-week crash course logotherapy program with alcoholics in which he attempted, in a less authoritarian way, to improve a patient's ability to seek and find meaning. Crumba makes the assumption that if one is to find some coherent pattern in complex life situations, one must be able to perceive details and events in a comprehensive manner and then to recombine this data into some new gestalt. Accordingly, the crash program attempts to expand perceptual awareness and stimulate creative imagination. The program for the expansion of perceptual awareness included exercises in recording visual stimuli. For example, a subject was exposed to Rorschach cards and to seaside scenes and assisted in the recall of details. The program for creative imagination consisted of such exercises as viewing a picture on a screen, projecting oneself into the picture, and relating the picture to some wish based on past experiences. The pre-post two weeks later PIL tests showed an increase in purpose in life scores. However, the follow-up time was inadequate and one has no way of ascertaining outcome specificity. That is, which features of the intensive course were responsible for what results. The inferential leap from visual perception and creative imagination to the perception of a life meaning schema is broad and strains credulity. But if positive outcome results are replicated, then a more detailed analysis of this procedure is warranted.
Engagement. The major therapeutic answer to meaninglessness. Let me return for a moment to the suicide note with which chapter 10 began. Little is known about the man who wrote this note, but this much stands out. He was not in life, but had removed himself from life. Removed himself so far that life and the activity and the experience of human beings seemed puny and absurd. Even within his brief fable, one character, one of the brick-carrying morons, distances himself still more by asking why he carries bricks, and from that moment he and the writer as well are lost.
There is something inherently noxious in the process of stepping back too far from life. When we take ourselves out of life and become distant spectators, things cease to matter. From this vantage point, which philosophers refer to as the galactic or the nebula's eye view or the cosmic or global perspective, we and our fellow creatures seem trivial and foolish. We become only one of countless life forms. Life's activities seem absurd. The richly experienced moments are lost in the great expanse of time. We sense that we are microscopic specks and that all of life consumes but a flick of cosmic time.
The galactic view presents a formidable problem for therapists. On the one hand, it seems unassailably logical. After all, the ability to be self-aware, to step outside of oneself, to view oneself from a distance is one of the human being's most valued attributes. It is what makes one human. In most situations, a broader, more comprehensive perspective generally provides the observer with more objectivity. Yet, this particular perspective drains the vitality from life. For one, to assume it for prolonged periods results in profound dispiritedness, and continual immersion in it may be lethal. The tradition of philosophical pessimism, to take one example, is a natural derivative of the nebula's eye view. And in the 19th century, its leading spokesman, Schopenhauer, viewed temporality from such a distance that he concluded that it makes no sense to struggle for some goal that from the galactic perspective vanishes in an instant. Thus, happiness and goals are unattainable because they are phantoms of the future or part of the vanished past. Predictably, he concluded, "Nothing is worth our striving, our efforts and struggles. All good things are vanity, the world in all its ends, bankrupt, and like a business which does not cover its expenses."
What can be done? What can the therapist offer to offset the noxious effects of the galactic view? First, there are logical inconsistencies in the argument that the nebula's eye view must lead to Schopenhauer's position that nothing matters. And since nothing matters, life is not worth living. For one thing, if nothing matters, it should not matter that nothing matters. In a penetrating essay on the absurd, Thomas Nagel suggests in supremely unruffled fashion that the absurdity that is made evident by the nebula's eye view is not a prima facie disaster and simply does not warrant that much distress. The ability to assume the nebula's eye view is, Nagel states, one of our most advanced, precious, and interesting traits and is not agonizing unless we make it so. To allow it to matter so heavily betrays a failure to appreciate the cosmic unimportance of the situation. Nagel suggests that a true appreciation of the nebula's eye view, coupled with the knowledge that it is our strength to be able to assume that view, should permit us to return to our absurd life laced with irony instead of with despair.
Another fact for therapists to note is that an actual mattering underlies the despair associated with the not-mattering of the galactic view. For example, though Schopenhauer concluded that nothing matters, nothing is worth our striving, many things mattered to him: it mattered to him to convince others that things did not matter, to continue writing actively until the end of his life, to philosophize rather than to commit suicide. Even to the man who wrote the suicide note about the brick-carrying morons, things mattered. It mattered that he tried to comprehend the human condition and to communicate his conclusions to others. If he had sought my help before his suicide, I should have tried to communicate to this mattering, living part of him.
Kent Bach suggests another antidote to counteract the toxicity of the galactic view. Keep in mind that though that view undermines meaningfulness, it does not do so in any absolute sense. Rather, it renders things meaningless only when one is in that cosmic perspective. Such times are part of one's life, but only part. Meaninglessness is an experiential state. And though it is so consuming that it appears to render meaningless everything in the past and the future as well as in the present, it can do that only when we view our lives from the galactic perspective. Meaning is what something needs to matter only when in that perspective. At other times, things matter because they matter. Things matter to us all the time. It matters to me that I communicate these ideas as clearly as possible. At other times, other things matter: relationships, tennis, reading, chess, talking. Must the fact that these activities don't matter from the nebula's eye view, that they don't hang together as some unified whole, take away their mattering? When things matter, they don't need meaning to matter.
This concept has immediate therapeutic implications. The therapist must help the patient to understand that current doubting or the adoption of a new meaning schema does not vitiate the reality of past mattering. Three patients come to mind. The first had been a nun for 25 years and then, after losing her faith, had left the order. Her current depression and sense of ennui was deepened by her belief that she had lived a lie for all of her adult life. Another patient had, at the age of 55, begun writing poetry and soon discovered that she had enormous talent. I treated her at the age of 60 when she was dying of cancer. She was deeply embittered at the fact that she had wasted most of her life as a farmer's wife, raising children, washing dishes, digging potatoes—activities that did not accord to her current meaning schema. Another patient, in the midst of an acrimonious divorce battle, had been deeply wounded by her husband of 20 years who attempted to strip meaning from her by exclaiming that he had never loved her.
All three patients were helped by the realization that a new meaning schema or a deep state of doubt that is current viewing of life from a galactic perspective does not vitiate the mattering that existed at other times. The former nun gradually understood that her current lack of faith did not erase the faith she had once had, nor did it erase the good she had done then as a teacher under the aegis of a different meaning system. The poet too learned in therapy that her earlier life had much meaning to her at the time. She had raised her children, grown food, mingled with the cycle of nature, and in the midst of all this, her poetry had been conceived and silently germinated. Her poetry today was a product of her entire life. Its particular character was shaped by her unique life experiences. Even the ancient scraping of dirt from potatoes found its place in the vital texture of her verse. The third patient learned too that past mattering was not only imperishable but very precious. She grew bold in her defense of it and was able to say to her husband, "If you lived with me for 20 years without loving me, that's your tragedy. As for me, though I don't love you now, I once loved you very much and spent many of the best years of my life with you."
Engagement in life. Though some of these philosophic rebuttals to the state of meaninglessness have some interesting implications for psychotherapy, they lack potency and remain, for the most part, psychotherapeutic curiosities. Reason, in this instance, as in all other matters of therapeutic change, is not in itself sufficient. The therapist requires a more potent approach.
David Hume, in a famous passage in the Treatise, points the way. As a result of musing while in the galactic perspective, he was beset by clouds of doubt, philosophical melancholy. As he wrote, "Most fortunately, it happens that since reason is incapable of dispelling these clouds, nature herself suffices to that purpose, and cures me of this philosophical melancholy by some avocation and lively impression of my senses, which obliterate all these chimeras. I dine. I play a game of backgammon. I converse and am merry with my friends. And when after three or four hours' amusement I would return to these speculations, they appear so cold and strained and ridiculous that I cannot find in my heart to enter into them any further."
Hume's antidote to the meaninglessness inherent in the cosmic perspective is engagement. And engagement is Sartre's and Camus' solution as well—a leap into commitment and action. Tolstoy chose that solution too when he said, "It is possible to live only as long as life intoxicates us." But alas, the tug of the galactic perspective was too great for him. And he concluded the sentence, "As soon as we are sober again, we see that it is all a delusion and a stupid delusion."
And engagement is the therapist's most effective approach to meaninglessness. Earlier I discussed the hedonistic paradox: the more we explicitly search for pleasure, the more it eludes us. Frankl argues that pleasure is a byproduct of meaning and that one's search should be directed toward the discovery of meaning. I believe that the search for meaning is similarly paradoxical. The more we rationally seek it, the less we find it. The questions that one can pose about meaning will always outlast the answers. Meaning, like pleasure, must be pursued obliquely. A sense of meaningfulness is a byproduct of engagement.
Engagement does not logically refute the lethal questions raised by the galactic perspective, but it causes these questions not to matter. That is the meaning of Wittgenstein's dictum: "The solution to the problem of life is seen in the vanishing of the problem." Engagement is the therapeutic answer to meaninglessness, regardless of the latter's source. Wholehearted engagement in any of the infinite array of life's activities not only disarms the galactic view but enhances the possibility of one's completing the patterning of the events of one's life in some coherent fashion—to find a home, to care about other individuals, about ideas or projects, to search, to create, to build. These and all other forms of engagement are twice rewarding. They are intrinsically enriching, and they alleviate the dysphoria that stems from being bombarded with the unassembled brute data of existence.
The therapist's goal, then, is engagement. The task is not to create engagement nor to inspirit the patient with engagement. These the therapist cannot do, but it is not necessary. The desire to engage life is always there within the patient, and the therapist's clinical activities should be directed toward removal of obstacles in the patient's way. What, for example, prevents the patient from loving another individual? Why is there so little satisfaction from relationships with others? What are the parataxic distortions that systematically poison his or her relationships? Why is there so little work satisfaction? What blocks the patient from finding work that is commensurate with his or her talents or finding pleasurable aspects of current work? Why has the patient neglected his or her creative or religious or self-transcendent strivings?
The therapist's most important tool in this context is his or her own person through which the therapist engages with the patient. In the ways I have discussed earlier, the therapist guides the patient toward engagement with others by first personally relating deeply and authentically to the patient. Therapists also, as models of personal commitment to engagement, may offer themselves as objects with whom patients may identify. Therapists care about their professional mission. The growth of other human beings matters to them. They help others, often in creative ways, to search for meaning.
In summary, the therapist's first step in dealing with the question of meaninglessness is to analyze and refine the question. Much that is subsumed under the aegis of meaninglessness belongs elsewhere, either as a cultural artifact or as part of other ultimate concerns—death, freedom, and isolation—and must be treated accordingly. Pure meaninglessness, especially when it emanates from assuming a detached galactic perspective, is best approached obliquely through engagement, which vitiates the galactic perspective. This therapeutic approach differs greatly from the therapeutic strategies I have described for dealing with other ultimate concerns. Death, freedom, and isolation must be grappled with directly. Yet, when it comes to meaninglessness, the effective therapist must help patients to look away from the question to embrace the solution of engagement rather than to plunge in and through the problem of meaninglessness. The question of meaning in life is, as the Buddha taught, not edifying. One must immerse oneself in the river of life and let the question drift away.
Epilogue. The discussion of meaninglessness brings me back full circle to the definition with which I began. Existential therapy is a dynamic approach that focuses on concerns rooted in human existence. Each of us craves endurance, groundedness, community, and pattern. And yet, we must all face inevitable death, groundlessness, isolation, and meaninglessness. Existential therapy is based on a model of psychopathology, which posits that anxiety and its maladaptive consequences are responses to these four ultimate concerns. Though it was necessary to discuss each of the ultimate concerns separately, in vivo they are intricately interwoven and constitute the subtext of therapy. In the dialogue between patient and therapist, they provide both content and process. The patient's confrontation with death, freedom, isolation, and meaninglessness offers the therapist explicit interpretive content. Even when these themes do not overtly arise in therapy, they still provide a modus operandi. Such psychic phenomena as willing, assuming responsibility, relating to the therapist, and engaging in life are the key processes of therapeutic change. It is precisely these crucial activities that are all too often considered unimportant throw-ins in many therapeutic systems.
Existential therapy compels attention in that it is firmly planted in ontological bedrock, the deepest structures of human existence. It is compelling, too, because it is humanistically based and alone among therapeutic paradigms is entirely concordant with the intensely personal nature of the therapeutic enterprise. Moreover, the existential paradigm has a broad sweep. It gathers and harvests the insights of many philosophers, artists, and therapists about the painful and redemptive consequences of confrontation with ultimate concerns. Yet, it is a paradigm, a psychological construct that can be justified only by its clinical usefulness. As is the case with all constructs, it will eventually be followed by another construct with greater explanatory power. Every clinical paradigm that has not been prematurely engraved in stone by some official institute is organic or, by offering a novel perspective, it permits previously obscure data to emerge. These new data modify, in turn, the parent paradigm. I regard this existential paradigm as an early formulation based on clinical observations that are necessarily limited in source, scope, and number. It is my hope that this paradigm will be organic—that it not only will prove useful to clinicians in its present form but will stimulate the discourse necessary to modify and enrich it.
The end. This concludes Existential Psychotherapy written by Irvin D. Yalom, narrated by Douglas James. Copyright 1980 by Irvin D. Yalom. This edition is published by arrangement with Basic Books, an imprint of Perseus Books LLC, a subsidiary of Hachette Book Group, Inc., New York, New York, USA. All rights reserved. Produced in the year 2024 by Echo Point Books and Media LLC, which holds the copyright there, too.