I turned to Rob and asked, “Rob, what do you think is the one thing a person could do today, and every day, that is easy to do and that doesn’t cost a lot of money, and that would make that person happier?”

Without hesitation he said, “Do something for someone, something kind.”

What a wise response. Rob Marvin and I were returning from lecturing at the Beat The Boards! MOC course two years ago and happened to be on the same flight home to Chicago. My question was surprising and somewhat out of the blue. I did, however, preface it by telling Rob that I’m exploring what makes people happy, what they remember most positively in their lives when they think back to earlier times, and what they’ll be most proud of towards the end of their lives.

Today’s article is a continuation about healing in psychiatry with a focus on meaning and purpose. How does it relate to my question to Rob and his answer? I contend that one of the quickest easiest ways to add meaning and purpose to life is to focus on others. And increasing one’s sense of meaning and purpose is the quickest easiest way to become happier – or perhaps more relevant to our patients – to counteract depression, hopelessness and helplessness.

One of the detrimental aspects of the DSM-III through DSM-5 symptom-based, atheoretical approach to psychiatric diagnosis, is that it has made it easy to ignore the sources or contributors to a person’s psychopathology. It’s too easy to think, “Oh, you have PTSD and depression. So take these meds and get some CBT.” Now, there is nothing wrong with prescribing meds that can alleviate the symptoms of PTSD and depression and for the patient to complete a course of CBT. It’s undoubtedly a good approach.

What can go missing, however, is a closer look at the specific contributors and consequences of the patient’s symptoms, an approach that can lead to additional interventions that can help further the patient’s self-healing.

Since my focus today is on meaning and purpose and, more specifically, on achieving that through a focus on doing for others, let me provide this scenario to illustrate.

Joe was a 69 year old Caucasian vet I met at the VA. He saw combat in Vietnam where he completed two tours of duty. He had suffered a shrapnel injury to his leg and walked with a limp. He was haunted by continued memories and dreams of seeing his buddies from his platoon killed, sometimes blown apart by mortar fire. He could not relax and was continually on guard. He associated this ongoing tension with having lived for two years in the ‘shadow of Claymores.’ A Claymore is the name of a Scottish sword used in the 1400’s through the 1600’s. It is a large double-bladed and two handed sword that the knight would swing around in an arc and try to decapitate anyone standing within the arc of the sword’s swing. This name was adopted for an anti-personnel landmine developed by the US army that shot out steel pellets in a large arc, cutting down any person within that arc. Basically, think of a shotgun that shoots out across an arc of 60 degrees. Evidently, the North Vietnamese had their own version of the Claymore they obtained from the Soviets, their allies. The US troops in Vietnam would often fear death by Claymore the most.

What most continues to warp Joe, however, even decades post-Vietnam, is not the unceasing personal danger he faced, nor the buddies he saw blown up, but the ‘evil’ he committed in war. He finds this the most difficult to discuss, and most of the guys in his PTSD group don’t know his story, and of course, most of the treatment team doesn’t either. He doesn’t talk about it directly but sometimes hints at it. I remember once I asked him if he wished to discuss what happened in Vietnam with me. He looked out the window for a long time in silence and then said, “no.”

One time he told me that the only reason he is still alive is that he volunteers at the VA, being a peer counselor for the young vets that come in. He said that it gives him ‘a reason to get up in the morning’ and that he also likes that he doesn’t have to think about himself during that time. He didn’t say it but I felt that his efforts in helping other vets was also his way for expatiating his evil deeds, of doing penance and seeking redemption.

So, my point is that part of your power as a psychiatrist is being sensitive to these existential and spiritual needs of your patients, things such as the need for meaning, purpose, and goals or life-focus; also the need to give back to others, to seek redemption and to do penance; and to come to terms with failures, shortcomings and even, for some, evil deeds.

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Of course these are large topics and the question immediately arises, “But how does one address this in treatment, especially for the psychiatrist primarily doing med management?”

I answer this way: first be aware that these aspects of human existence exist and that many of your patients struggle with these aspects. A person can feel when the person they’re in treatment with seems to understand and acknowledge these needs and the struggles surrounding them.

The second thing I can tell you is that there are specific and simple interventions you can recommend that can help a wide swath of the people you’re treating. At the top of my list is to get patients, especially patients without steady work, to volunteer. The best volunteer jobs are those that the patient feels are worthwhile, that have a clear positive impact on others. For Joe, that meant being a peer counselor. For the patient with severe schizophrenia, it may mean serving food and cleaning up after lunch at their day program.

Until next time,

Dr. Jack

LanguageBrief

“It’s Poetry, Baby!”

When we assess which smart phones doctors use to access our online courses, we find that the iPhones are the most popular smart phone model.

The new operating system, iOS 8 has an auto-complete function when typing text messages. When I realized this I started randomly autocompleting messages to my wife and kids. One daughter received, “The only thing is that you can get it together and make me laugh so hard.” She got what I was doing right away and responded with her own semi-nonsensical message.

When I sent the following message to my wife, “I will never understand why you gotta do it again and it would mean the world is a full version of my day before my alarm” she got discombobulated, thinking I was either very critical or had lost my mind. It does sound like Wernicke’s aphasia I have to admit.

My response to her was, “It’s Poetry, Baby!”

I’m now waiting for people to actually start an autocomplete poetry movement. If you have some of your own semi-nonsensical, semi-profound autocompletes, please send them by.