A Case Study in Meaning and Purpose

All forms of depression diminish meaning and purpose. A subset of depression is caused by a lack of meaning and purpose, which eventually leads to feelings of hopelessness. The following is such a case.

Sherrill was a 45-year-old divorced parent of two young children, who lived with their mother. He had a history of short-term relationships before marrying the love of his life a decade ago. Things started going wrong in the marriage soon after the birth of their first child. Sherrill worked hard in a successful family business, but he hated the job and felt unappreciated by his father, who started the business. He felt doubly unappreciated by his wife, who felt emotionally isolated in the marriage. They saw several marriage counselors before she initiated the divorce three years ago. Sherrill didn’t want the divorce but chose not to contest it.

He’d spent the last three years on various medications and in treatment with several psychodynamic and cognitive-behavioral therapists. He described these experiences as increasing his self-knowledge with no improvement in his dysphoria. As he put it, he learned all the reasons he was in a hole, but no one could help him get out of it.

In the beginning of our work, he weaponized, as a form of self-criticism, the behaviors that help people recover from depression.

“I don’t appreciate anything or anyone. I withdrew from all my friends, and I prefer it that way. I own that I mistreated my wife, but the marriage ended because she didn’t appreciate me, how hard I worked, all that I’d given her. I resent everybody who works under me, and I resent my people-pleasing father because he undermines my authority. He made me take on the family business when I was young, and now he torments me with his permissive attitudes toward our lazy workers.”

We ruled out physiological causes for Sherrill’s malaise with a comprehensive physical, including blood and hormone tests. Everything was normal. We instituted a regimen of walking 30 minutes a day. He continued to reject therapeutic interventions for depression.

We caught a break at the end of our third session. A bright reddish-orange beam of light streamed through my office window. I went to the window and invited him to join me to admire the extraordinary sunset. He reluctantly agreed. We watched for a few seconds before he said:

“It hurts to look at something beautiful.”

“The pain is telling you to open your heart — just a little — to really see the sunset. That’s all; you don’t have to commit to keeping your heart open. Just for now, try to really see it.”

He cried as we watched the sun fall beyond the horizon.

I asked him to agree to an experiment. He cringed when I mentioned the word, “appreciate,” but he agreed to write down three thoughts of “opening his heart” to another person or to beauty in nature or creative arts or spirituality.

The following were Sherrill’s appreciative thoughts:

“I can imagine opening my heart to my daughters.”

“Tell me about that.”

“I like to see them happy and curious.”

I asked when he saw his daughters happy and curious.

“When I pay attention to them.”

"What else might you appreciate?”

“I like classical music. And folk music from my country.”

Fortunately, I had a playlist that featured Bach and Mozart. He said he would add his favorite folk music to it.

Again, I asked what else he might appreciate.

“I used to like thinking about nature, flowers, and trees and stuff. The ocean, too.”

“Try to think about them right now, with your heart open.”

For homework, I asked him to think about things that help him open his heart, and see if behaviors start to occur to him.

Sherrill’s Appreciative Behaviors

1. Walk in nature, in the woods a few miles from my house
2. Visit the art gallery downtown
3. Listen to music
4. Meditate and pray every day
5. Try to be more open to the people who work for me
6. Open my heart to my daughters and my ex-wife.

His next homework assignment was to think of ways he could protect the well-being of his daughters. I gave him a few hints to think about.

Sherrill’s Protective Behaviors

1. I will nurture the physical needs and emotional desires of my daughters by providing for them, playing with them, listening to them, and letting them know they are important to me.
2. I will reassure them and calm any anxieties and fears.
3. I will encourage them to learn and pursue their dreams.
4. Of course, I’ll show them love and affection.

Depression Essential Reads

When the Brain Has Difficulty Listening to the Heart

Understanding Depression and Managing It Effectively

His next homework assignment was to think of ways he was connected to people besides his daughters.

Sherrill’s Connection Thoughts

1. I am part of a family, community, and nation.
2. I’m part of humanity and the spiritual universe.
3. I will renew old friendships and take an interest in new people I meet.
4. I will accept people for who they are and not try to judge them.

Once he was able to jump-start his innate capacity to create value, hope, and meaning, a renewed sense of purpose followed. He identified an immediate goal of getting well. At that point he was receptive to traditional cognitive-behavioral interventions for depression, to which he responded beautifully.

Most depressions are not caused by loss of meaning and purpose but nearly all feature such loss as a symptom. Attention to the meaning and purpose of our lives is healing as well as motivational.