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Scott Webb: Determining our meaning or purpose in life and being able to articulate it are difficult for many of us to do. Many of us need the assistance of someone like our guest today to find meaning when things are good, but especially during times of tragedy and hardship.

I'm joined today by Dr. Jack McLane. He's a psychiatrist for the Red, White, and Blue Program at Sierra Tucson. This is Let's Talk: Mind, Body, Spirit by Sierra Tucson. Sierra Tucson ranked number one Best Addiction Treatment Centers 2020 in Arizona by Newsweek. I'm Scott Webb.

Doctor, thanks so much for your time today. We were just speaking before we got rolling here about what an interesting conversation this is, about what is meaning and how do we find meaning, how do we find our purpose? And I'm really interested to speak with you today. So just kind of as we get rolling here, why does meaning matter when it comes to treatment?

Dr. Jack McClane: I think that's a great question. And it's something I think is actually really important to keep in mind. The first thing is treatment's hard. Most people aren't coming to see our Tucson or any residential treatment facility if the changes they wanted to make in their life were easy in the first place. And, you know, we could take examples, you know, like somebody who's addicted Xanax or somebody who is coming here for our Trauma Track to deal with trauma that they've kind of put off most of their life working with or somebody who is so depressed that they've reached the conclusion that life's not worth living anymore and is suicidal. These are just a couple examples, but we could come up with a lot of different reasons that people might come into treatment in the first place. And no matter what, we can be sure that parts of it are going to be hard and, you know, suffering is going to occur.

And so what I think is really crucial is that people have a reason to suffer. You know, that if we have something bigger than ourselves to suffer for, our suffering suddenly becomes meaningful and it can even become noble. And so that's one of the reasons why meaning really does matter and why it's important to keep in mind when you're doing something like entering treatment.

Scott Webb: Yeah, I think you're so right. I mean, I think getting folks to walk through the door is a challenge, right? And as you say, when we're dealing with trauma and things like that, those are those sort of chronic things that a lot of us don't deal with and a lot of us put off, you know? And so when we walk through the doors of Sierra Tucson, there's a lot to unpack, right? And I'm sure you have some examples of times where the focus on purpose or meaning has really made a difference.

Dr. Jack McClane: You know, I think I've seen hundreds of times here at Sierra Tucson, where knowing what you were coming to treatment for, knowing the big picture behind it, really made all the difference in the world to a person. But the first time I really became aware of this was back before I worked here. I was just a first-year resident. I was a psychiatric resident. You know, I just recently finished med school. And that month, my rotation was working on a geriatric psychiatric unit, right? So a geri-psych unit. And these are units normally filled with older people, but the other group of people who end up on these units sometimes are those who are more medically complicated and they have a different ratio of nurses to patients, so they can put more medically complicated people on these units.

Anyway, so I was a first-year psych resident and one of my patients who I would round on every morning was a young woman. And I changed a few details of the story for anonymity, but it was a as a young woman and she was 19 and she'd had a serious suicide attempt. I'll leave out the details, but it left her badly disfigured and she'd been in the ICU. She nearly died. She'd been in the ICU and then stepped down to the regular part of the hospital and then was transferred to this geri-psych unit, because she was considered still too medically complicated to be on the regular adult psychiatric unit.

And I would come in and I would round on her every day. And it was virtually impossible to get her to engage with me. Every morning, I would come in and, you know, she would just be lying in bed. And, if she would answer my questions at all, she would give kind of one-word answers to the questions and made really poor eye contact, and was just deeply despondent and was at a place in her life where she was still wishing the suicide attempt had worked. You know, she was wishing she had died and regretted the fact that she hadn't.

You know, every day, I'd kind of think about the next meeting with her and try to figure, you know, if there was a way that I could engage her somehow. And I remember it was a Friday. And I think it was the second week I'd been on the unit and I knew there was very little programming over the weekend and there wasn't much to do. And, you know, I was imagining her just, you know, essentially laying in bed for the next 48 hours on a unit with, you know, most of the other people had dementia and she couldn't really talk to anybody else there. And so I gave her a copy of this book, Man's Search for Meaning, which was something I had just read and had made a big impression on me.

And I want to stop for a second and talk about the book, before I go on with the story. It was written by a doctor named Victor Frankl. And he was an Austrian neurologist and psychiatrist, and he was Jewish and he was captured by the Nazis during World War II and was taken to a series of concentration camps. And Victor Frankl ended up surviving. And then after he got out in 1946, in fact, one year after the war was over, he wrote this book, Man's Search for Meaning. And in the book, he tells his story of being in the concentration camps. And he also puts forth his theory for why he survived and why some people survived and some didn't. And he ultimately believed that those who survived were those who had a greater purpose that they were striving for, that they were those who had meaning in their life.

And so for instance, for him staying alive and he had a reason to suffer through the concentration camps because he'd just been married nine months before he was captured and, you know, he wanted to see his wife again. He had a book that was really important to him that he'd been writing and he felt like it was important that he finished writing this book. And maybe more than anything else, you know, he was a doctor and he would have a reason to wake up and get out of bed each day, because he would make his rounds and care for other prisoners there as best as he could. So he had a reason to keep enduring the suffering that was going on day to day. And he really came to believe that, overall, the people who did survive the camps were those who most knew what it was they were living for, what it was they were suffering for.

And so I actually want to take a second and read a passage from the book. And so this takes place, in Man's Search for meaning after he's just been talking about what he would observe in people a few days before they died. And he said everybody knew who was about to pass in the camp because you'd see very similar telltale signs in someone two or three days before they ended up dying. And they were sort of signs that this is a person who had given up and no longer had a purpose worth living for. So again, he's just been talking about that and I'll go ahead and start reading from there.

"So as we said before, any attempt to restore a man's inner strength in the camp had first to succeed in showing him some future goal. Nietzsche's words, 'He who has a why to live for can bear with almost any how,' could be the guiding motto for all psychotherapeutic and psycho -hygienic efforts regarding prisoners. Whenever there was an opportunity for it, one had to give them a why -- an aim-- for their lives in order to strengthen them to bear the terrible how of their existence. Woe to him who saw no more sense in his life, no aim, no purpose and, therefore, no point in carrying on. He was soon lost. The typical reply with which such a man rejected all encouraging arguments was "I have nothing to expect from life anymore." What sort of answer can one give to that?

What was really needed was a fundamental change in our attitude toward life. We had to learn ourselves and, furthermore, we had to teach the despairing men that it did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life and instead to think of ourselves as those who were being questioned by life daily and hourly. Our answer must consist, not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual.

These tasks and therefore the meaning of life differ from man to man and from moment to moment. Thus, it is impossible to define the meaning of life in a general way. Questions about the meaning of life can never be answered by sweeping statements. Life does not mean something vague, but something very real and concrete, just as life's tasks are also very real and concrete. They form man's destiny, which is different and unique for each individual. No man and no destiny can be compared with any other man or any other destiny. No situation repeats itself and each situation calls for a different response. Sometimes the situation in which a man finds himself may require him to shape his own fate by action. At other times, it's more advantageous for him to make use of an opportunity for contemplation and to realize assets in this way. Sometimes man may be required simply to accept fate, to bear his cross. Every situation is distinguished by its uniqueness, and there's always only one right answer to the problem posed by the situation at hand.

When a man finds that it is his destiny to suffer, he will have to accept his suffering as his task, his single and unique task. He will have to acknowledge the fact that even in suffering, he is unique and alone in the universe. No one can relieve him of his suffering or suffer in place. His unique opportunity lies in the way in which he bears his burden.

For us as prisoners, these thoughts were not speculations far removed from reality. They were the only thoughts that could be of help to us. They kept us from despair, even when there seemed to be no chance of coming out of it alive. Long ago, we passed the stage of asking what was the meaning of life, a naive query which understands life as the attaining of some aim through the active creation of something of value. For us, the meaning of life embrace the wider cycles of life and death, of suffering and dying.

Once the meaning of suffering has been revealed to us, we refuse to minimize or alleviate the camp's tortures by ignoring them or harboring false illusions and entertaining artificial optimism. Suffering had become a task on which we did not want to turn our backs. We had realized its hidden opportunities for achievement, the opportunities which caused the poet Rilke to write, "How much suffering there is to get through!" Rilke spoke of "getting through suffering" as others would talk of "getting through work." There was plenty of suffering for us to get through. Therefore, it was necessary to face up to the full amount of suffering, trying to keep moments of weakness and tears to a minimum. But there was no need to be ashamed of tears, for tears bore witness that a man had the greatest of courage, the courage to suffer. Only very few realize that. Shamefacedly, some confessed occasionally that they had wept, like the comrade who answered my question of how he had gotten over his oedema by confessing, "I have wept it out of my system."

The tender beginnings of a psychotherapy or psycho-hygiene were, when they were possible at all in the camp, either individual or collective in nature. The individual psychotherapeutic attempts were often a kind of "life-saving procedure." These efforts were usually concerned with the prevention of suicides. A very strict camp ruling forbade any effort to save a man who attempted suicide. It was forbidden, for example, to cut down a man who was trying to hang himself. Therefore, it was all important to prevent these attempts from occurring.

I remember two cases of would-be suicide, which bore a striking similarity to each other. Both men had talked to their intention to commit suicide. Both used the typical argument -- they had nothing more to expect from life. In both cases, it was a question of getting them to realize that life was still expecting something from them; something in the future was expected of them. We found, in fact, that for the one, it was his child whom he adored and was waiting for him in a foreign country. For the other, it was a thing, not a person. This man was a scientist and had written a series of books, which still needed to be finished. His work could not be done by anyone else, any more than another person could ever take the place of the father in his child's affections.

The uniqueness and singleness which distinguishes each individual and gives a meaning to his existence has a bearing on creative work as much as it does on human love. When the impossibility of replacing a person is realized, it allows the responsibility which a man has for his existence and his continuance to appear in all its magnitude. A man who becomes conscious of the responsibility he bears toward a human being who affectionately waits for him or to an unfinished work will never be able to throw away his life. He knows the why for his existence, and will be able to bear almost any how."

Thanks for bearing with me for that passage. And, anyway, I had given this book to that young woman on the geri-psych unit. And this is a person who I never even had a real conversation with. And I'll remember the rest of my life coming back in on Monday and seeing her early in the morning and instead of this person laying in bed, not talking to me, she was sitting up and she was so excited to talk about this book and she'd read the whole thing over the weekend.

And I remember I'd been really nervous to give a book about such a dark subject to a person who is in a dark place. And I wasn't sure if I was doing the right thing or not, you know. And I was shocked by how much she responded to it, you know? And I don't think if it had been, you know, a different kind of subject matter, you know, if it wasn't something that was so big and so heavy, it would have resonated with this person who was in such a dark place. And her and I ended up talking, like I finished my rounds and finished my notes and I came back and I saw her again at the end of the day before I left. And, you know, we talked about the book for like two hours and that was kind of the beginning of her wanting to live again, you know, and I watched her over the next couple of weeks re-engage with life more and more. And a lot of it was just based on her starting to look for what did matter for her in life. And so that was the first time I sort of saw how powerful this idea could be.

Scott Webb: I wanted to follow that up and ask you about someone who says that they just don't have a purpose in life. And I feel like we've probably all known someone, whether it's a family member or a friend, what do we do? What do we say, doctor, to someone who says, "I have no purpose in life and I don't know how to figure out what mine is?"

Dr. Jack McClane: Whenever I meet people here at Sierra Tucson and I do an initial evaluation on them, I ask all the regular questions, you know, "Hey, what brought you in?" And I'll go through a review of systems and ask about specific symptoms of depression or anxiety. I'll ask about their family history and their medical history, and I'll ask them about their hobbies and, you know, try to understand, you know, who they are as a person. But somewhere in there and normally towards the end, I'll ask them if they have a sense of purpose in their life. And it's kind of a big question. And I think people kind of fall into three categories when I ask them that.

There's a group that just right away says like, "Yeah, I have a sense of purpose" and they can even tell you what it is. And when I'm working with that person, I kind of feel like my job is to help them practically put that purpose into action, you know, help them brainstorm like, "Well, okay, you know, how can you live your purpose?"

And then there's another group that says to me, "Yeah, I feel like I have a sense of purpose. I feel like I have meaning in my life," but they can't really articulate what it is. And with that group, I feel like the job is really, "Okay. Let's start brainstorming, you know, what this purpose might be, what this meaning might be."

And then I think there's a third group that will just often just kind of quietly say, "No," that their life doesn't have purpose, doesn't have meaning. And I've always been struck with how much sadness is embedded in that "no" so often. And not all the time, but often if you talk to this third group and you questioned them, you kind of explore the answer a little deeper, you'll find out that they're kind of existentialists and they sort of believe ultimately that there is no meaning at all to the universe, you know. And with this group, I think one of the things you can do is sort of put forth the idea that, sure, you can make, and they often will make kind of a logical argument that there's no such thing as universal meaning. But what I like to point out to them is that just because you can't come up with a universal answer to what is the meaning of life, you know, it doesn't mean that there isn't unique individual meanings. And so, I ultimately believe that existentialism is a philosophy of personal responsibility and that those who hold the belief that there's no universal meaning, they're really charged with that responsibility. They're charged with the task of finding out their own unique meanings.

Scott Webb: I think all of us would want to know, and I definitely want to know, doctor, how do we put this stuff into practice? How do we get real and get out of our heads and get to living?

Dr. Jack McClane: Some people you can just sort of pose this idea or put this idea forth to them, ask them, "Hey, go think about what really matters to you," you know, and they'll come back and they've kind of got it figured out. But there's a whole bunch of different exercises or techniques you can use to start brainstorming, and figure out what do you really value in life? Like what do you personally, intrinsically, authentically really value in life? And like I said, there's a lot of exercises you could do it.

One that I really like, and I use all the time with people is I'll have them imagine it's their 80th birthday party. And you know, they're 80 years old and they're sitting there with all their friends and family and neighbors and coworkers they'd worked with for years and, you know, maybe grandkids or great grandkids or whoever, all the people who were really important to them and matter to them in life. And those people are all sitting around and they're taking turns giving little speeches for the birthday party and talking about this person at their birthday. And I'll ask them like, "Well, what kind of stuff would you want these people saying about you? When you're 80 years old and the people who you care most about in the world are around, what are the types of things that would be really meaningful to you to hear them say?" And you can kind of take that as a place to start, you know, figuring out, "Well, maybe these things they're saying about you, those are the things that really matter to you in life. Those are the things you really value," you know? So that's just one example.

Another one I'll use sometimes is I'll have people imagine they just won the lottery and they just won $500 million or something. And I say like, "What do you do tomorrow? You know, what do you do with this money? What do you do the rest of your life, you know, now that you have this extraordinary wealth?" Maybe that's some of the stuff you actually care about.

You know, and like I said, there's a lot of different ways you can do it. Some people will have people write personal mission statements or they'll write a personal constitution or there's a lot of different techniques. But I think ultimately what you want to do is you kind of want to break down what does a person really value, right? And you can even come up with values in different aspects of their life. You can have one value for their romantic relationship, you know, or relationships and another value for their work and another value for their community and another value for their friends and family, right? And so you can break it up into a bunch of different kinds of domains, a bunch of different areas in life. And once you figured out what they value in these different areas of life, you can have them start setting long-term goals based on those values. And so we can take a second and define, you know, values and goals here where a value is something that always stays the same and you can't check off a list. You know, it's an abstract thing that you believe in. And a goal is something concrete that you could check off a list and say you've accomplished.

And so the important thing is that when people are striving for their goals, those goals are really based on the things they value, you know? So the example that's given all the time might be that like a person values always going north, but their goal is to reach Canada, you know, Canada can be checked off the list or you could say a person really values their family, so their goal is to be at every one of their kids' soccer games. You could say that Victor Frankl really valued his marriage and being a good husband. And so his goal was to survive the concentration camps and be there for his wife afterwards.

Scott Webb: I'm sure you have some take-home points or some resources besides the book, which we mentioned is available on Amazon. I'm sure you have some other resources for folks who want to find their own meaning, articulate their own meaning and really sort of continue this conversation in their heads.

Dr. Jack McClane: Besides Man's Search for Meaning, which I, gosh, I really recommend for everybody, a lot of the ideas, especially about goals and values I mentioned were taken from a type of therapy called acceptance and commitment therapy. It's a type of cognitive therapy that owes heavily to Victor Frankl and took a lot of ideas from him. And there's lots of wonderful books on ACT or acceptance and commitment therapy. But one of my favorites is called The Happiness Trap. It's a really easy to read book and really accessible. There's hundreds of resources out there, but that's one I would recommend.

And then the last thing I wanted to mention, and I think in ways this sort of sums up the talk, and this also appears in the Frankl book, but he quotes in it the writer Dostoevsky. And in it, Dostoevsky says, "There's only one thing that I dread, not to be worthy of my sufferings." And so last night when I was thinking of, you know, what I was going to talk about on this podcast, I knew I wanted to include that quote and I wanted to end with it. And I was trying to come up with something smart to say after it. And what I realized was I couldn't do any better than Dostoevsky. I could not come up with a pithy answer for afterwards. So, you know, I just wanted to kind of repeat it, "There's only one thing that I dread, not to be worthy of my sufferings."

Scott Webb: This has really been a great conversation and we hope it helps listeners. You've given us great resources and great suggestions about how to find meaning, to articulate meaning, how to begin the process of really understanding ourselves and thinking about ourselves, not the big picture, but just our own little piece of this and what our meaning is, what our purpose is, what's specific to us. So I've really appreciated this conversation, Dr. Jack, and you stay well.

Dr. Jack McClane: Thank you so much.

Scott Webb: For more information, visit sierratucson.com or call (800) 842-4487. Sierra Tucson, we work with most insurance.

And if you found this podcast helpful, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.