Sick mature woman lying in bed  – worried husband holding hands

What does it mean to live and die? Those are two separate questions but the answers tend to be linked. Questions of the meaning of living and dying are deep and broad questions. The answer may seem simple if you believe in theism, that is, you believe in a personal God and the purpose of your life is to please God, the questions may seem very easy to answer. But if you try to live each day to do a good job of achieving a goal such as pleasing God, helping others, or getting rich, you still need to give thought each day to how to best to that for that day. Your choices each day will be rooted in the meaning that life has for you or what your brain remembers about your aims and priorities.

The meaning of a loved one dying is equally complex. It may seem simple in that you will greatly miss the family member or loved one you lost to death, but little by little each day you will learn more about how your mind and body adjust to the loss. After such a loss, your self-identity changes as you adjust to living without that special person.

And if you are dying in a hospice, what does your death mean to you and your loved ones. Does it mean a peaceful transition? If so, what will be left of you? What do you think your dying means to those you care about?

Our answers to all these questions help to uncover who we are and what is deeply important to us. Thus, it should not be surprising that one increasingly common type of professional help is called “Meaning-Centered Counseling and Therapy.” The remainder of this brief article discusses the ideas of three people who specialize in this approach. One is a pioneer in grief therapy, Robert Neimeyer; another is a chaplain for hospices, Kerry Egan; and the third, Viktor Frankl, pioneered the concept of meaning for personal living as well as for therapy.

 Meaning Therapy for the Living Who Grieve

Professor Robert Neimeyer, a pioneer in grief therapy, increasingly uses meaning-centered techniques in his practice. In a chapter of the edited volume, World Suffering and the Quality of life (Springer, 2016), he portrays suffering following the death of a loved one using a “meaning systems perspective.” Dr. Neimeyer notes that research across a range of bereaved groups (e.g., young adults, older adults, parents, African American survivors of a loved one’s homicide), has found complicated grief associated with an inability to find meaning in the aftermath of loss. The overall intent of his work is “to pave the way for more nuanced research on the global suffering engendered by bereavement and on the effectiveness of interventions to ameliorate it.” Given the burgeoning research in this area, many remain optimistic about the potential contributions of a meaning systems perspective as an integrative frame for studying suffering.

In another edited volume, Alleviating World Suffering, to be released in the first quarter of 2017, Robert Neimeyer brilliantly shows how profoundly grief therapy can be enhanced by focusing upon the perceptions of meaning of those in bereavement. Dr. Neimeyer continues to pioneer ways to help those suffering from a major loss by meaning-based techniques such as: restorative retelling, directed journaling, imaginal dialogues, and other meaning-based strategies to reconstruct their world of meanings.

Dr. Neimeyer promotes the view that grieving involves the attempt to reaffirm or reconstruct a world of meaning that has been challenged by loss. He links an anguished search for meaning to complicated, prolonged and life-limiting forms of grief. He then presents several concrete implementations of this perspective in case vignettes of interaction with grieving clients. The chapter closes with the conclusion on the role and limits of meaning reconstruction as a framework for pluralistic practice in alleviating grief-related suffering.

Informal Meaning Therapy for the Dying

A new little book, On Living, by Kerry Egan (2016 by Penguin Publishing) offers so much insight about living and dying that it deserves to be highlighted among the hundreds of books on suffering. While it is written by a chaplain who sat and listened to hundreds of dying people, the stories she tells are more for the living. Chances are it will give you additional wisdom on the meaning of living and dying.

Despite her role as a chaplain, Ms. Egan notes that she rarely discussed God or religious subjects with her patients. Mainly, when people could talk at all, they discussed their families, “because that is how we talk about God. That is how we talk about the meaning of our lives.” Family is “where our purpose becomes clear.”

A major side story in the book consists of the author’s brush with drug-induced psychosis that lasted many months and while ruthlessly traumatic, led to insights that enhanced her understanding of people whose stories she told.

Although trained as a chaplain at Harvard Divinity School, she does not reveal religious leanings. Even when a family asks her to pray, she adapts her prayer to the spirituality of the dying. Her conception of her role is to comfort by listening.

On caregivers, she said that “pretending they have superhuman strength…deprives them of the help they need.” In addition, she argues that “it deprives the dying of the comfort and companionship they need.”

One of elderly caregivers uttered this deep truth: “It’s a beautiful life and then you leave it.” This wisdom came after watching mortuary attendants struggle for a half hour to get her beloved, overweight husband lifted out of a third-floor apartment with no elevator.

Kindness from another, the author says, is the best way to alleviate the suffering of the soul.

Ms. Egan writes about grief with poetic style. “Grief has a life…. Sometimes it undergoes a quick and startling metamorphosis.” Sometimes it changes slowly and “one can see the changes only looking back twenty years.” Suffering grows and becomes diffused with grief. It diffuses “across the memories that surround the loss. It becomes less concentrated and therefore more bearable.”

She concludes that “We do not get to cut off someone’s suffering at the pass by telling them it has some greater purpose, Only they get to decide if that’s true.”

The author’s view is that “Attempting to find or make meaning is the central task of the spiritual life.”

Listening to stories of those in hospice is so essential because they define themselves by the stories they choose to tell. It is “bull” she says that loss, tragedy, and trauma don’t define you.”

One shining light reveals how much of our lives reside “in the gray,” the area outside the “black and white.” Because we trudge through the gray so often, our stories often involve the struggle with forgiveness. She writes “The spiritual work of being human is how to love and how to forgive,” which is doubly important because people most “long to be loved and to be forgiven.”

After hundreds of clients and stories, she concluded from hospice work that “a person can, in fact, live too long.” She does not elaborate on the implications of this conclusion, but I believe that long periods of extreme, worsening suffering or years of living without consciousness and memory argue for new policies that allow for exceptions to natural ending of life.

Linking Hospice to Grief Therapy

Kerry Egan reveals in her book, On Living, how a chaplain or hospice worker can quietly use meaning-based techniques to calm the spiritual-affective state of the dying and their families. Her magnificent little book shares incredibly moving stories that show how the dying and their families can continue to discover meaning in their lives during and after a major loss. This discovery process can be not only comforting but a shining light to the survivors.

The institution of hospice in Western societies has grown into an organizational arrangement largely separate from medical and mental therapeutic institutions. But the writing above of Ms. Egan and Dr. Neimeyer show that important benefits would accrue from more cooperation and sharing. This is particularly true when the therapeutic model used is that of meaning-making. Construction and reconstruction of personal meaning should not be seen only as individual therapy. In hospice cases, group or family therapy could be an effective part of the process of bereavement, particularly when it utilizes meaning-centered goals and techniques.


Meaning-Centered Living

       Many books have been written about the importance of meaning and purpose for living a good life. The chief architect of the idea was Viktor Frankl, a Jewish doctor from Austria. He wrote the “bible” on meaning-centered living while barely surviving life in concentration camps. In 1946 after the end of the war he published the book Man’s Search for Meaning—An Introduction to Logotherapy, which became a world-wide best seller and one of the most important books in psychology. After selling millions of copies, it remains a best-seller on Amazon.

Frankl’s book developed the idea of optimism in the face of tragedy based upon the human ability to turn suffering into accomplishment and to take responsible action. His core ideas of meaning-making were that humans have a “will to meaning,” a need to love, and the ability to transform suffering into deeper meaning in life. These and related ideas pioneered by Frankl remain the definitive resources on the power of a meaning orientation in everyday life. His ideas remain the core of more recent approaches to reduction of personal suffering through self-reflection on implications of one’s personal meanings in life.