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View From the Other Side of the Stethoscope

The Healing Power of “Meaning” for Clinicians

Harpham, Wendy S. MD, FACP

doi: 10.1097/01.COT.0000688440.34625.1a
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Yes to Life: In Spite of Everything
Yes to Life: In Spite of Everything:
Yes to Life: In Spite of Everything
Wendy S. Harpham, MD, FACP
Wendy S. Harpham, MD, FACP:
WENDY S. HARPHAM, MD, FACP, is an internist, cancer survivor, and author. Her books include Healing Hope—Through and Beyond Cancer, as well as Diagnosis Cancer, After Cancer, When a Parent Has Cancer, and Only 10 Seconds to Care: Help and Hope for Busy Clinicians. She lectures on “Healthy Survivorship” and “healing hope.” As she notes on her website (wendyharpham.com) and her blog (wendyharpham.com/blog/), her mission is to help others through the synergy of science and caring.

As clinicians watch this pandemic play out in their practices, many are looking for words of wisdom. A slim book of three newly translated lectures by neuropsychiatrist and Holocaust survivor Viktor E. Frankl answers the call: Yes to Life: In Spite of Everything.

Some of Frankl's insights may help you deal with the unexpected hardships of your work: disrupted routines, increased demands, derailed plans, new limitations, financial losses, increased vulnerability, and a heightened sense of uncertainty. Other insights may help you address concerns about delays in cancer research or the problem of patients avoiding medical care. Still others may help you find hope of a better tomorrow.

Frankl delivered these lectures in 1946, while preparing his seminal book Man's Search for Meaning only 11 months after liberation from a Nazi concentration camp. The 41-year-old professor personified resilience, having teetered on the brink of death from starvation and still grieving the murder of his parents, brother, and pregnant wife. At the podium, he unveiled the source of his fortitude: a hopeful outlook premised on a belief that all life can be meaningful.

Clinicians' situations are not that of shell-shocked survivors of World War II who'd lost almost everything and suffered at the hands of the worst of humanity. The essence of Frankl's ideas, though, are timeless and useful for anyone whose circumstances smother happiness or a sense of purpose.

For example, clinicians wearying of the current working conditions or feeling pessimistic about the future of their practice (or of medicine) might ask in a fleeting moment of despair, “What's the meaning of all this?” Frankl's mind-bending response is to challenge the question itself. He urges readers to “‘...Perform a Copernican revolution,’ a conceptual turn through 180 degrees, after which the question can no longer be ‘What can I expect from life?’ but can now only be ‘What can life expect of me?’”

I confess to reading that page a few times before grasping the notion of life questioning me. My reward was that it set the stage for understanding how meaning can give rise to resilience and joy. Frankl's feast of vignettes, perspectives, and insights made a convincing case for Nietzsche's maxim, “He who has a why can bear almost any how.”

Frankl outlines three routes to meaning. The first is action. Core clinical acts—making diagnoses and prescribing or administering therapies—are saturated with meaning. As aspiring premedical students attest, even the most routine interventions done with expertise and compassion are meaningful. That is, unless stress and exhaustion combined with the frustrations of infection-control measures and telemedicine obscure that meaningfulness. Idealized role models can make anything short of perfection (or short of cancer care before coronavirus) feel inadequate.

To help, try changing your vantage point and creating cognitive distance from the grind by asking, “What is life asking of me now?” That long-view perspective may help you see your hardships as modern in detail but no more challenging than adversities endured generation after generation. Maybe they'll feel less like burdens and more like the defining challenges of this era. Maybe not.

Another way that asking yourself “What is life asking of me?” may help is by firing up an ingrained sense of responsibility. Throughout the book, Frankl highlights “duty” as a priority. When life calls you to task, Frankl notes, it never demands perfection or even success. Life asks that you respond by doing your best with what you have, knowing that the outcome is uncertain.

In times of uncertainty, Frankl insists everyone has a duty to know what's happening, what is likely to happen, and what can be done. If things go badly, “I didn't know” or “I couldn't do anything” don't cut it. Quoting Rabbi Hillel: “If I am not for myself, who will be for me? If I am not for others, what am I? And if not now, when?”

What if you feel helpless to change system-wide problems? Hope and optimism are the bread and butter of motivational speakers. Frankl surprised me by offering pessimism as a powerful motivator to keep trying. Like adrenaline, pessimism can enable us to respond to threats and challenges with strength and courage we didn't know we had.

Action is one route to meaning. The other two are equally important even though mentioned only briefly here. Meaning arises from appreciating nature, art, and relationships. You can find meaning by stopping momentarily to soak up something beautiful. Study a wall hanging in your clinic or hospital. Peer into your patient's eyes, the crinkles around your own eyes conveying the smile concealed behind your mask. Watch your colleagues working together at a bedside or consulting via Zoom. Each tableau is beautiful...meaningful...a reminder that you are alive in this crazy world and that life is good.

Frankl's third route to meaning—suffering—can help through tough times, too. On days when action and appreciation feel beyond reach, choose to endure. Suffering has meaning when you remember that you don't know what good things tomorrow might bring. Enduring means staying in the game to see tomorrow's possibilities for new meaning through action and beauty.

Yes to Life is a provocative invitation to think about what you believe and what you can do to get through tough times. Its brevity invites you to linger on phrases or re-read pages that interest you. In your pursuit of providing compassionate care under trying conditions, you may find just what you need in a phrase, an insight, or this poem by Rabindranath Tagore:

I slept and dreamt that life was joy.

I awoke and saw that life was duty.

I worked—and behold. Duty was joy.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
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