Chasing Happiness

In medicine, whether due to observation bias, coincidence, or a higher power, we sometimes would see clusters of specific and similar patient presentations. Just within the past few weeks, I’ve been seeing an unusually large number of patients facing existential anxieties. As I work predominantly with the geriatric population, this feature, at baseline, is already more commonplace than in other veins of psychiatry. However, it’s only in the recent years did I garner an interest in existential psychotherapy which may now be opening my eyes to these issues more acutely (e.g., there is a component of observation bias).

Pop culture has long since explored the concept of midlife crises, often depicted as a protagonist awakening to the somber feeling that their lives are devoid of direction, substance, and motivation. And when overcome with ennui, said protagonist usually appears lost in understanding their own self. One of the greatest existential anxieties that we come to face as humans is the confrontation of our meaning or purpose (or lack thereof). While this concept seems so commonplace, it continues to act as a plague on the quality of life for so many people.

Viktor Frankl, esteemed author and psychiatrist, developed the concept of an existential vacuum, a state of deep and profound sense of meaninglessness. This state is further characterized by feelings of emptiness, directionless drifting, numbness, and futility. Essentially, it is a state of depression directly influenced by the measure of meaning and purpose in our lives. What point is there to my life? What point is there to any number of small and seemingly non-consequential actions?

He postulated that existential vacuums are created when one abandons their instincts, loses the societal structure that provide the framework for one’s values, and adopts a reductionist perspective to one’s lived experience (”that’s just how it is”). Such vacuums often emerge alongside phase of life transitions as one’s pre-existing role in society fundamentally undergoes destabilization and perhaps permanent change.

Take, for example, parents who confront the realities of an empty nest as their children leave for college: symptoms of depression may creep in as they lose the structure and identity associated with caring for children. Who am I now and what am I to do with my time and energy? The answer seems glaringly obvious, which is to find new things of value or meaning to supplant what was lost.

As I meet with patients facing the very real and difficult life transitions, of which there are many in older age, I start with them the same simple analogy. Early in life, we are saplings with a focus on setting roots of family, friends, school, career, hobbies, so on and so forth. With time and care, these individual roots strengthen and solidify. The strength of these roots serve as an anchor during times of great turbulence. Through even the harshest of seasons, our being and sense of self can achieve stability.

But as is part of the natural life cycle, whether intentional or by chance, some roots will wither and die. As the foundation weakens, even the slightest wind may come to sway and shake us. For some, these shifts may even uproot their fragile base altogether. The solution toward stability is then to either strengthen the remaining roots or to cultivate new ones. And with that, the turbulence of life can once again be endured.

Though simplistic, this metaphor has resonated with many of my patients, but I presume because it serves as a reminder of their resilience, rather than as sagely advice. In addition, they are reminded of the importance in adopting responsibility for their actions, in finding humor in even misfortune, and above all, in the active pursuit of purpose. One of my patients, in all their despair, once wondered out loud to me if they would ever find happiness again. After an examination of their current role, they came to the appropriate conclusion that finding meaning is the true objective—and happiness a natural byproduct.

After all the riff raff and abstract psychological babble, my patients inevitably ask “so what should I do?” I usually laugh at this question because who am I to tell anybody what to do? Besides, one of my mantras is that we needn’t impose upon ourselves the often unforgiving nature of “should.” As one of my past mentors would wisely tell his patients, “Stop shoulding all over the place!”

But in all seriousness, I usually tell them to engage in some form of giving. For many, this takes the form of volunteering or charitable donation to a cause they believe in. For some, this may look more like investing in or helping the people and relationships around them. These avenues may have clear benefit such as distraction, momentary joy or pleasure, and even a nice return on investment. However, years of research have shown that altruism leads to a heightened sense of satisfaction, helps to build psychological resilience, and provides an unshakeable source of meaning.

Peter and I have often talked about looming phase of life transitions as a necessary and vital part of life. We are certain that together, we can weather the many tribulations to come. However, I am happier even that I have a partner whose core will not be shaken in the face of difficulty. Much of that is owed to his adherence to well-defined values that underlie all his relationships, hobbies, and career. And though uncomfortable to think about, his world will not capsize should we break up, nor would I want that. After all, it gives more credence to the fact that we choose each other every day.