The Psychotherapy Laboratory within the Department of Psychiatry and Behavioral Sciences at MSKCC was established about 12 years ago. I have been the Director of the Lab from its establishment. In addition to developing interventions for anxiety, depression, and PTSD, we have studied a whole group of existential problems that had as yet no established interventions. Some of these problems are constructs such as despair, suffering, loss of dignity, demoralization, hopelessness, and loss of meaning in life. On the surface, it doesn’t sound like much fun to research these subjects, and the fact is that many of our colleagues started to call us the “Laboratory of Despair.” But the fact is, these are extraordinarily challenging, exciting, and critically relevant areas of clinical intervention research.
Despair, for instance, is an interesting concept. Etymologically, the word comes form the French: de (meaning without) and espoir (meaning hope). But espoir also means to inspire or spirit.
For us, Despair became a term we used for that state in which our cancer patients lost the “essence of what made them human.” Often at the heart of Despair was a sense of profound loss of meaning in one’s life when confronted with a cancer diagnosis that forced one to confront mortality. We needed an intervention for that; there was no medication for that problem.
Loss of meaning and hopelessness are two profound and related clinical problems that often lead patients to desire a hastened death or request physician-assisted suicide. In fact, in a series of studies that we conducted in terminally ill cancer and AIDS patients, we discovered that a desire for hastened death was highly correlated with undiagnosed and untreated depression, and depression was the sole cause of desire for hastened death in about 50% of patients. We conducted studies examining the effects of treating depression in cancer and AIDS patients with both depression and desire for hastened death. We found that successful treatment of depression led to the disappearance of desire for hastened death. With further research we found that hopelessness and loss of meaning were independent and synergistic contributors to desire for hastened death; they accounted for the vast majority of those with desire for hastened death who were not clinically depressed. We came to call this triad of hopelessness, loss of meaning, and desire for hastened death: Despair. We had no treatment for Despair.
There is no medication for loss of hope and loss of meaning in life. In response we developed a counseling intervention we called Meaning-Centered Psychotherapy (MCP), inspired by the work of Viktor Frankl, a Vienesse psychiatrist who survived the Auschwitz concentration camp. He developed a theory that the need to find meaning in life was a primary motivating force of human behavior. He developed a form of psychotherapy he called logotherapy that focused on meaning.
We looked at Frankl’s work, specifically some of his concepts of the importance of meaning and the common sources of meaning. We developed a brief seven session psychotherapy for patients with advanced cancer, aimed at raising awareness of the importance of meaning and the common sources of meaning in life as a way to enhance meaning. We conducted a series of studies showing that enhanced meaning buffered against depression, hopelessness, desire for hastened death; enhanced quality of life; and reduced symptom burden distress. So our MCP therapy focused on helping patients more fully understand the experience of meaning fulfillment.
We also utilized individual sessions to focus on the common sources of meaning which include:
- Experiential sources of meaning (e.g. love, connectedness)
- Creative sources of meaning (e.g. work, what you care about in the world, who you are in the world)
- Legacy (e.g. the legacy you inherit, the legacy you create, the legacy you leave behind)
- Attitudinal Sources of meaning (e.g. choosing the attitude you take toward suffering or limitations in life, turning a tragedy into a triumph)
We’ve studied Meaning-Centered Psychotherapy in four randomized controlled trials (three funded by the NCI), and we’ve been able to show that MCP, in both group and individual formats, reduces Despair and enhances meaning. As a result it reduces hopelessness, depression, desire for hastened death, and physical symptom distress, and improves quality of life.
Meaning-Centered Psychotherapy is now being replicated in several countries around the world and in five languages. It is also being adapted as an intervention for breast cancer survivors, for caregivers of cancer patient, for bereavement, and for adolescent and young adults with cancer. We’ve just received funding from the National Cancer Institute to train clinicians from all across the United States in MCP. Treatment for Despair will soon be more widely available to those who need it.
Feature image credit: Old man in park. Photo by Burim. CC BY-SA 3.0 via Wikimedia Commons.