What would you do if you were diagnosed with an advanced terminal cancer? Would you want to hasten your death?
Dr William Breitbart works at the Memorial Sloan Kettering Cancer Center in New York. He works with dying cancer patients in a program he developed called meaning-centered psychotherapy. The program originated out of his early career experiences working with AIDS patients. He consistently found that people wanted to die. People who had three, even six months to live, wanted life to be over.
Breitbart found that patients who wanted to hasten the end of their lives even after being treated for depression or having their pain controlled had lost their sense of meaning. Humans are uniquely aware of their existence. It is meaning-making that separates us from other species.
Meaning comes from our sense of connectedness and offers us a route to transformation. A sense of meaning is the trail we feel under our feet. It tells us in visceral terms: you have a choice, you can change.
Facing death is a transformation. But Breitbart has seen in his work that meaning, even in the final stages of life, provides the vital “why” for his patients. Meaning-centered psychotherapy’s aim is to help people find their why, so that even in the face of a death sentence they have something to live for. Compared to control groups, his patients have significantly lower physical distress and significantly higher levels of well-being.
As we write this, Dave’s mother is facing a diagnosis of advanced terminal cancer. She describes her PET scans as “lighting up like a Christmas tree.” Of course she wants more life, she tells us after she made the decision to decline chemotherapy. She knows what she wants in the time that remains. She wants to focus on the people around her and not on her disease.
Dave’s mom’s sense of meaning is very much intact. It helps that she is both a very spiritual person as well as having a strong religious faith and a belief in an afterlife. She finds meaning in conversations with people at church, from watching her grandson play in a band (even when the concert is on Zoom), and in the arrival of the first hummingbird of the season in her garden.
Meaning-making is uniquely human. Our drive for meaning drives everything we do, including how we orient towards each other and how we handle adversity. Humans have a will for meaning. We have a drive to find meaning in existence, to choose our attitude toward suffering, and to decide how to respond to uncertainty.
Breitbart’s core idea is that we all have two “existential obligations.” First we have to survive. But then we have to create a life that is worth living. Meaning-making is how we find the things that are unique to us as individuals. Without meaning, we are the same as all other biological intelligence around us and are just trying to stay alive. Meaning is the human life force.
Great Human Strength: Our search for meaning gives life purpose. Our shared sense of meaning binds us in common experience and enables us to solve problems together.
Great Human Weakness: Without a sense of meaning, we can lose the will to live. Without a shared sense of meaning or purpose we are unable to cooperate.
Machine Opportunity: Designs which help us solve problems together.
Machine Threat: Designs which erode our ability to cohere around a shared problem or goal.
