It has become customary in the world of mental health services provision to call “mental disorders” biopsychosocial things. This way of characterizing made-up disorders has arisen for a number of reasons, the primary one of which is that biopsychosocial sounds like it is saying a lot when of course it is saying nothing in particular. As weak as it is, however, it is made even weaker by its explicit exclusion of distress arising for existential reasons. You mean to say that meaning, value, and life purpose count for nothing?
Providers of mental health services tend not to take a client’s meaning needs, life purpose concerns, or conflicts of values into account. How often do you suppose a client is asked, “Tell me a little bit about your life purpose choices and decisions” or “Are you more a meaning-maker or more a meaning-seeker?” The answer is virtually never. These sorts of questions are not part of the everyday landscape that mental health service providers inhabit. There are a few exceptions to this rule, for instance among some existential psychotherapists, but as a rule the question “What really matters to you?” is rarely asked.
Most psychiatrists, psychologists, psychotherapists, and other mental health service providers don’t possess an interest in the meaning, purpose, and value of life. They don’t train in these three concepts or provide a coherent set of ideas or even a working vocabulary that would allow them to chat with clients about these matters. Indeed, they may never have thought about meaning, purpose, or value themselves. Does the average mental health service provider have a clear understanding about the requirements to make meaning: what it takes to influence, create, and provoke the psychological experience of meaning? Have they thought through how people can be helped to name and frame their life purposes? Most surely have not.
Can it really be the case that it doesn’t matter to a client whether or not he is living according to his values and principles or contrary to his values and principles? How mentally or emotionally healthy can a person be expected to feel if he is not making meaning and not manifesting his life purposes? If living bereft in those ways, don’t we expect a person to feel sad and anxious, don’t we suppose that he will be pulled in the direction of meaning substitutes and anxiety soothers? Why wouldn’t a person be expected to fill up on sex or shopping or cookies or Scotch in the absence of meaning?
Nor is such a conversation so difficult to have. It is really not so hard to paint a picture of what value-based meaning making might look like, what it would feel like to make daily meaning investments and seize daily meaning opportunities, what it would take to create your own personal menu and mix of meaning opportunities, and what the process looks like for naming and framing your life purposes. The main problem seems to be that these matters are not on the radar of mental health service providers. They are fixated on the current model of “diagnosing and treating mental disorders,” a discredited labeling model that ought to be jettisoned as quickly as possible.
To be sure, their training programs fail them—almost certainly they have never taken a single class in which meaning or life purpose was discussed. Their leaders are failing them too, as virtually all of them have ties to the pharmaceutical industry and our current pill-pushing mentality. Nor are clients themselves helping much, as they have gotten into the habit of presenting their difficulties in terms of sadness, anxiety, addictive behaviors, and so on rather than as existential difficulties having to do with meaning and life purpose. If a client does not bring it up and his therapist likewise does not bring it up, how will it ever get on the table?
If we want our mental health service providers to do a better job of realizing what actually matters to human beings, how life purpose and meaning issues are implicated in emotional distress, and what they as providers can do to help, there are a minimum of four steps to take in that direction:
1. Providers must come to their own personal understanding of the value of discussing meaning and life purpose with clients. Do they sincerely believe that issues of meaning and life purpose aren’t important? They must come around to valuing the importance of meaning and life purpose in human affairs and, having made that pivotal change in outlook, demand of themselves that they include life purpose, meaning, and value in their conversations with clients.
2. Providers must arrive at some concepts about meaning and life purpose that they themselves believe and understand. If you yourself have no idea where meaning resides, how a conflict in values can be resolved, what it takes to make a strong life purpose decision and then stand behind that life purpose decision, and so on, how helpful can you be in helping others make meaning and live their life purposes?
3. Providers must adopt or create language that allows them to talk intelligently with clients about life purpose, meaning, and value. This idiosyncratic language might sound like, “Let me tell you what I mean by a meaning investment and why that might be important for us to talk about” or “There’s a practice I’d like to tell you about called a morning meaning check-in that might help you orient your day around your meaning intentions.” Without such a vocabulary in place, conversations about meaning and life purpose are nearly impossible.
4. Providers must be willing to bring these matters up with clients if clients do not bring them up themselves. By bringing these matters up they will be better able to tackle what is causing their client’s distress, rather than circling around the “symptom picture” of what the distress looks like. The likelihood may be great that, for example, your client’s sadness is neither biological nor psychological in nature but existential instead. Wouldn’t that be important to get at?
All of this is surprisingly easy to accomplish if only mental health providers took an interest. Consider the following example. Here is the complete email exchange between a young man we’ll call Michael, who wrote me out of the blue, and me. Michael wrote:
Dear Dr. Maisel,
I have been going through a hard time for as long as I can remember and have pursued every option available to me without feeling like I’ve gotten ‘better.’ I am twenty-seven and male. I was hoping you could give me some advice about what course of action I might take next. I am going to try to make this email brief as I have a tendency to go on and on when talking about this subject.
My mental health history is long and complex so I’ll summarize by saying I was diagnosed with ADHD as a kid and took Ritalin until around the age of eleven. I was then diagnosed with depression and anxiety and placed on Paxil, which gave me the symptoms of bipolar disorder that I was subsequently diagnosed with and for which I was treated for years. All of these treatments made me increasingly sick and unmotivated.
I finally went off all medication before I started college (around age eighteen), and eventually ended up at a university where I studied and had a decent time other than a couple of serious life crises and occasional bouts of depression and anxiety. I graduated with highest honors and a very good GPA, but by the time I graduated I was beginning a depressed episode that would be nearly continuous from the age of twenty-two until the present. I started smoking marijuana to cope with severe anxiety and depression around that time and have done so on and off since then.
I worked two very different jobs in very different places, both provoking extreme anxiety, boredom, isolation, and frustration in me, although my coworkers and management all liked me and were upset when I decided to leave. Now, I am living with my father in a very rural community where I am more isolated than ever, more anxious and more depressed than ever. I spend most of my time reading about depression, exercising and meditating when I feel like I can, and reading a lot of fiction and philosophy in addition to psychology.
I have almost no contact with the outside world other than occasional shallow conversation with neighbors (which I dread) and seeing my therapist once a week, but she isn’t helpful and is mostly grounded in a form of Buddhist psychology I find very vacuous and unappealing. If I start talking about the meaning of life, she says things like ‘But don’t you want to be happy?’ as if I’m being a jerk by worrying about something as insubstantial as “meaning.”
Everything in life feels like a chore. There is nothing I can imagine doing for long enough to make money from it. Occasionally I will get extremely interested in a subject or project, which has always been the case throughout my life, but instead of lasting for months like these interests used to, I become disenchanted and bored within a day or at most a week. After that I can’t even force myself to engage with that topic anymore without feeling severely depressed. I’ve tried to get a job but anxiety, aversion, disinterest and a sense of pointlessness just hammer me to the ground every time something comes up.
On top of all of that, or maybe at the core of it, is the fact that I just hate myself. I feel like I’ve squandered my life away and like I don’t even deserve to feel better or have anything good from life because I have no talents, no skills, and nothing that makes me special other than this grinding depression. Most recently I travelled to a foreign country using some of the last of my savings, hoping for some kind of epiphany or change of heart. Instead I just felt incredibly alone and realized the emptiness even of beautiful beaches and the warm sun. It all just felt like it was being wasted on me, a piece of garbage with no hope for a decent life.
I’m contacting you because I’ve read parts of some of your books. I’ve tried to follow the programs in them but got stuck early on. I just kept getting overwhelmed by the pointlessness of it all and by my own lack of talent or anything particular to say. Rethinking Depression felt promising but I just haven’t been able to come up with any meaning that could possibly apply to my own life. I have nothing to offer and I don’t want anything particular from the world, so the obstacles I come up against immediately frustrate me to the point of complete apathy. I’m only writing this email because I’m desperate, but I have no idea what I’m desperate for. Maybe to feel like less of a loser and to think that maybe I’m worth something.
I don’t know how to make this more coherent or tighten it up so I’ll just leave it there. If you have any advice, thoughts, or can point me in some direction, I’d appreciate it. If you need more information please let me know as well. Thanks in advance.
Michael
To this I replied:
Hello, Michael:
Well, you are at a good age to make some new meaning investments 
. As you probably know but perhaps need to remind yourself, you will have no life purposes until you choose your life purposes and little sense of meaningfulness until you make decisions about what meaning investments you want to make and what meaning opportunities you want to seize.
You ought not to expect life to “feel” meaningful—you have to dig into your values and principles and decide what sort of life would make you proud—that is, you must manifest your values and principles and, if you are lucky, experience life as meaningful as a result of having made those efforts. That’s it in a tiny nutshell . Good luck to you!
Best,
Eric
To my reply Michael wrote:
Thank you for the fast response. I know that there is no meaning unless I create it. But no matter how much I think about that and try to execute it, any meaning I come up with feels as empty as anything else and doesn’t motivate me to do anything differently.
For example, I came up with a meaning statement that was something like “I want to live in a way that I can feel proud of” a la Sartre. But my mind is still incredibly scattered and the words end up meaning nothing after a few days, when I try to think up a new meaning statement. I did this for a few weeks before finding I could no longer continue this cycle because it felt so hollow. I’m not sure what to do now.
Michael
To this I replied:
It isn’t a life purpose statement that you need now—the one you articulated is just fine . It is that you have to muster the energy and the inner resources to TRY some prospective meaning opportunities to see if they in fact pan out. Meaning opportunities come with no guarantees. They are absurd, optimistic, hopeful guesses about what might existentially work.
Volunteer for something, write something, relate to someone, start juggling in public, do something completely different, try something—basing your guesses on the values and the principles you want to uphold. Make your life count by TRYING something—only then will you be able to see if that something ‘mattered enough.’ Yes, you have tried this before—and you must try it again. Create a new list of meaning opportunities—that’s step one. Then DO some of them—that’s step two.
Best, Eric
Michael ended our brief correspondence with the following reply:
Thank you. I will give this a try. It actually helps a little to realize that there is no other option.
Does this amount to a complete examination of Michael’s meaning needs and meaning realities? Of course it doesn’t. Will this little interchange turn Michael’s life around? Probably it won’t. But isn’t it interesting that Michael found even this minimal interaction helpful? What if a human experience specialist worked with Michael in the areas of value, life purpose and meaning? What if that—and not Michael’s putative “mental disorders”—were the focus of the work? Isn’t it just possible, bordering on quite likely, that such a focus would do more for Michael than more pills, new pills, or “therapeutic talk” about his upbringing?
The future of mental health requires that we add this focus and make it a priority. There is no reason why we can’t begin to take a sophisticated view of the relationship between life purpose, meaning, and value, on the one hand, and distress relief, mental wellness, and physical wellness, on the other. In this sophisticated view, it will become better understood that human beings might want to exhaust themselves in the service of some life purpose and by so doing create distress and physical problems; yet at the same time, even as they create that distress and difficulty, they may be providing themselves with exactly what they need and even be creating “genetic happiness,” that deep happiness that comes from living our life purposes, experiencing meaning, and expressing our values.
In this sophisticated view, it will be understood that both can be true, that living as a value-based meaning maker can hurt, but that it can also help. We will begin to accept—even honor—the distress that arises because we have decided to fight for some cause close to our heart, struggle with some mind-breaking scientific problem, or paint the ceiling of our Sistine Chapel. We will then work to reduce that distress, insofar as that is possible, without calling the cause of that distress, our meaning-making efforts, into question. We will never say, “Don’t make meaning—it is causing you too much distress.” Rather we will say, “What can we do to reduce your experience of distress even as you pursue your meaning-making efforts?”
We will also add, “And by the way, it may be that your genes love it that you are living your life purposes.” In a report on Mother Nature Network on the work of Steven Cole and his team at UCLA, Melissa Breyer explained, “The researchers assessed and took blood samples from eighty healthy adults who were classified as having either hedonic or eudaimonic wellbeing. Hedonic wellbeing is defined as happiness gained from seeking pleasure; eudaimonic wellbeing is that gained by having a deep sense of purpose and meaning in life. The study showed that people who had high levels of eudaimonic wellbeing showed favorable profiles with low levels of inflammatory gene expression and exhibited a strong expression of antiviral and antibody genes. For the pleasure seekers, the opposite was true; those with high levels of hedonic wellbeing showed an adverse gene-expression profile, giving high inflammation and low antiviral/antibody expression.” Human experience specialists can begin to make the case that there may be an “invisible” upside to living our life purposes.
We might fancifully call this invisible upside “genetic happiness.” A writer might struggle writing his novel and as far as he can tell writing it is making him sad and ill, so poorly is the novel going and so much work does it require. Yet his mental and physical health may be better than if he wasn’t making the attempt. To continue our fanciful way of saying it, his genes may be singing and dancing, profoundly happy knowing that their host is living one of his life purposes. Maybe this is true and maybe this isn’t, but isn’t it worth considering and isn’t it worth researching? What if our mental health really is contingent on us attempting the things we say that we value? Such attempts may not matter at all from some universal perspective but they may matter a great deal to the individual.
Human experience specialists, in addition to speaking in a language that promotes a focus on life purpose, meaning, and value, might also suggest all sorts of tactics that help the people they work with identify their life purposes, live their life purposes, create meaning, maintain meaning, and get their values and principles onto their daily to-do lists. I mentioned earlier that we need tactics rather than taxonomies, and nowhere is that need greater than in the areas of meaning and life purpose. The people we are serving do not need and can’t make any use of abstract philosophical discussions. Instead, they need tactics and specifics.
For instance, a human experience specialist might suggest that people learn “the new habit of quick meaning repair.” Every day we’re bombarded by small and sometimes large threats to our experience of life as meaningful. Maybe you’re a writer and get a particularly painful rejection. Suddenly writing and even life itself may seem that much less meaningful. Or maybe you’ve invested meaning in your home business. Just as you’re about to launch your product, you notice that someone has beaten you to the punch. You’re likely to experience that bit of bad luck as a blow to your sense of the meaningfulness of life. Here’s where a new habit of quick meaning repair would come in supremely handy.
First, you recognize that something important has happened. You admit that an existential blow has occurred. Second, you feel the feeling. Emotional health isn’t helped by denial. Third, you remind yourself that meaning, because it is a psychological experience, is a wellspring and a renewable resource and that you can make new meaning as soon as the pain subsides. Fourth, you actually make new meaning by taking appropriate action. You send out your novel again or you actively market your product despite the new competition.
When a meaning crisis occurs, we become emotionally unwell, usually calling the experience “depression.” Rarely do we recognize that a negative meaning event has occurred and that, in order to feel better, we must take action by making new meaning. It is therefore highly useful to acquire this four-step habit: understand what’s happened, feel the feeling, pledge to make new meaning, and make some new meaning. All of this a human experience specialist might teach. No need to invoke Hegel, Kierkegaard, Sartre, or Camus. By creating simple, sensible, effective tactics, a human experience specialist can prove of great help even in the elusive territories of meaning and life purpose.
Another simple tactic, one that a human experience specialist might teach, is to suggest that a person create a menu of meaning opportunities (having first explained what that phrase means); envision a day that includes some meaning opportunities along with life’s other tasks, chores, and responsibilities; and then try to live such a day. As simple as this tactic is, it represents valuable, even life-changing work that people rarely attempt. Here is the report of a participant in one of my life purpose boot camp classes after spending a week with the above assignment.
“I have considered myself for quite some time to be a ‘meaning’ sort of person, that is, on a quest to find and live a meaningful life. But in thinking about meaning opportunities I began to realize that I had not deeply or practically considered what ‘meaning’ is or what it entails to live a meaningful life. My past efforts have very much been focused on a kind of heavy-handed ‘making meaning,’ often with inconsistent, disappointing, or confusing results. Shifting to ‘an opportunity mindset’ was huge for me. There was a wonderful feeling of relief. Not every attempt to ‘find meaning’ has to succeed! We have opportunities, and some may pan out, and others may not; and eliminating the sense of failure if meaning isn’t experienced takes the pressure off from the get go.
“As I say, realizing that the menu includes opportunities as opposed to guarantees took the pressure off. I was then much more able to approach this exercise in a fun, curious and expansive way. When I first sat down, I started with general categories (spending time with family, watching a beautiful sunset, etc.). But as I was going about my day, I became mindful in a much more specific, practical way of moments occurring that were meaning opportunities. I also knew that the exercise was rumbling around somewhere in the background of my brain. I’d be driving or doing something else other than this exercise and all of a sudden a specific experience would pop into my brain and shout, ‘that was a meaning opportunity!’ I loved this!
“I also realized that much of my day is spent in nonmeaning opportunity things. I particularly struggle with shifting from the way of life I’ve lived until recently (a workaholic unfulfilled lawyer) to a new way of living a flourishing and meaningful life. At the bottom line, I hit the question of how do I make an income to support myself when the items on my meaning opportunities list seem mostly intangible (a heartfelt conversation with my son, belly rubs for my dog)? As I’ve struggled with this issue this week, one exciting alternative came to mind. I’m going to try to take my current period of unemployment as a super-large meaning opportunity to chart my next course and to pay real attention to the idea that we pick our own life purposes. By engaging with this simple exercise of ‘creating a menu of meaning opportunities’ I feel like I am getting closer to the underneath of things.”
It is easy to paint a picture of a contemporary “meaningless” day. You wake up, get on your treadmill of obligations, get into traffic, spend an hour getting to a job that does nothing for you except pay the rent, spend eight or more hours there, get back into traffic, arrive home, fret about dinner, handle some more obligations like bills and family crises, and try to find a program on television that will take your mind off the fact that you have not lived any of your life purposes or made any meaning on that day. The reality of this sort of day demoralizes people everywhere, and the specter of it haunts young people who want something different but have no idea what that different life might look like.
Given these realities, it is clear why so many people opt for denial. Nevertheless, mental health service providers must not be afraid to face these client realities. Yes, there may look to be few good answers. Yes, this may go far beyond “diagnosing and treating” made-up mental disorders. Yes, this may take a provider into territory that he is not trained to navigate and which he may not be navigating that well himself. But to ignore his client’s meaning and life purpose needs is preposterous and ignoble. Our human experience specialist of the future will go right there and say, “We have some really difficult things to look at, ready or not.” Our specialist may not be ready, and the person sitting across from her may not be ready either, but the inquiry will nevertheless begin.