If I had my way, I would prevent all my patients from reading Kierkegaard.
Justin (not his real name) is my age, 37, and has contemplated suicide for most of his life. Then a week ago, he says he climbed onto a bridge and was going to jump onto the oncoming traffic, but then decided to come to the hospital instead. One last try, he said.
“When I was 10, my mother told me, ‘Justin, you missed your true calling in life. You were meant to be an abortion.”
He was born an only child to parents who were depressed and preoccupied, and probably had a loveless marriage.
He recalls, “I would sit at the dinner table and my mother would pass the dishes around, my father would eat silently, and their conversation seemed scripted, polite but without any love. I wanted to slit my wrists, because I knew that I was not wanted. They tolerated me but did not love me.”
He says, “I don’t have anything, Doctor. I don’t have a wife, no kids, my job sucks and everything is meaningless. I am not going to be a Jonas Salk, or write the great American novel. People like Henry Ford, or Da Vinci, they had a purpose, they added to the world, their presence made a difference. I am insignificant, my life has no meaning, and death is inevitable.”
“So why postpone the inevitable?” I ask. Probe the wound, release the pain in a safe environment.
He looks up. “Yes, what’s the point? I have no meaning, my life has no meaning.”
“But isn’t that true for most people?” I ask.
“Well, you are a doctor, you help people, you are probably married, have kids, someone loves you.”
“We are both going to the same place,” I reply. “Death is inevitable for all of us and in the backdrop of eternity, my life has no meaning either.”
He shrugs. “I just know that I didn’t ask to be born. Nobody will care when I am gone. When I leave here, Doc, I will go home and find out what the drop should be, calculate the length of the rope and then hang myself.”
He has been in the hospital for a week. He is on antidepressants but they are not working. His problems go back to his childhood, to his genes, his biology, and his upbringing.
From what he says, his mother was depressed. Maybe his father was too. And so Justin was born into a world that was oppressive and humorless, without meaning.
“Half my life is over. I might as well end it all,” he says, and waits to see how I might deal with his anguish. And then adds, “If you discharge me from here, I will kill myself.”
He is here because he wants help. And yet, he is sure that nothing can change his perspective that life is meaningless and not worth living.
His ambivalence, his plea for help combined with his fatalism and his barely repressed anger at the world, have alienated him from the staff. He evokes anger and frustration from the staff. I feel it too. He wants help. He says he wants to kill himself, and so he has to stay in the hospital. But at the same time he says that nothing can help him short of answers to life’s ultimate questions – What is the meaning of life? What is our purpose? Why are we born?
How can I answer his questions? He is a victim of prosperity, in a sense. If he had to toil just to keep food on his table, he would not have wanted to kill himself – his natural drive for self preservation would not allow him to think of suicide. I have never seen a poor man suffering an existential crisis – his angst is different, the object of his worries more tangible.
When your belly is empty, you know what will bring you contentment. But what will fill the emptiness of your soul?
I take a few moments to process my frustration, to remind myself that I am feeling a negative “countertransference” – the feeling that can be evoked in a psychiatrist by a patient, and is often a reflection of what the patient is feeling himself. If I feel frustrated with a patient, then it’s likely that the patient is feeling that frustration. Like mirrors facing each other, emotions are reflected from patient to therapist and back.
When in doubt, reflect his feelings. If they are accurate, he may not feel so alone.
“On the one hand you want to live,” I say, cautiously. “Otherwise you would not be telling me that you wanted to kill yourself. On the other hand you don’t see the purpose of living and you want to die. You are angry. You feel that the world owes you an explanation for your existence and that if the world cannot provide it to you, you want to die. You see the world as uncaring and unfeeling, meaningless and desolate.”
“Yes, that’s right.”
I take a deep breath. “By your logic, the world is meaningless, Justin. But in that sense, it is meaningless to everyone.” I point to the stack of books by the side of his bed. “That is what the existentialists were grappling with, that we are born into this world alone, and we will leave alone. That there is no meaning, other than the meaning that we create. Meaning is not something that awaits us, but something that arises as a result of our life.”
“So, what’s the point then?”
“The world is not rejecting or unfeeling. It’s just neutral, a blank canvas on which we create our meaning and our purpose with each moment of our lives. Accepting that it’s equally meaningless for everyone can be difficult like it is for you right now.”
He is listening intently and I continue. “Or it can be liberating, because everything is equally meaningful if you can only allow yourself to experience it. You are free, if you can experience life, immerse yourself in life and when you look back at your life someday, you will see that it has meaning.”
I feel like a used car salesman, except I am selling a philosophical perspective rather than a car.
I can sense his ambivalence weakening.
But he adds, “I question everything. I question why I am here, what is the point of this or that, what is the point of anything?”
“Everything you do is part of a larger picture, like millions of pixels that come together to create a painting. And since only you can live your life, only you can create your meaning.”
“I will think about it,” he says.
And for today, that will have to be enough.
Ultimately, man should not ask what the meaning of his life is, but rather he must recognize that it is he who is asked. Viktor Frankl