Finding Meaning in Life

Among all the questions we ask ourselves during moments of introspection, the most significant is likely the following: How can I find meaning in my life? Many who ponder this question turn to the classic world for answers. Plato believed meaning came from the pursuit of knowledge and the understanding of “pure forms,” the perfect abstractions of real-world virtues, objects, and ideas.1 The subjectivists believe that a meaningful life is built simply around fulfilling one’s self-appointed goals.1 There are as many different answers to this question as there are individuals pondering it, yet a common thread runs through most schools of thought: A meaningful life is one that considers “fulfilling higher order purposes, meriting substantial esteem or admiration, having a noteworthy impact, transcending one’s animal nature, making sense, or exhibiting a compelling life-story.”1 Modern thinkers argued that meaning refers in great part to whether and how a life fits within a broader frame of reference, and that finding meaning is nothing other than developing a narrative of one’s life, about its source and its destiny.1 Aside from being an irresistible puzzle for philosophers, the problem of meaning has real-world implications for health. Higher levels of meaning are associated with increased physical, psychological, and mental well-being, self-esteem, coping, and adjustment after stress. Conversely, meaninglessness has been associated with depression, general psychological distress, and physical illness.2 Indeed, answering this question has never been more important. In 2018, Ribeiro et al. reported that the prevalence of burnout among plastic surgeons and residents was 32% and 36%, respectively.3 In 2021, the Medscape National Physician Burnout & Depression Report demonstrated an overall 42% rate of burnout among physicians, with a peak of 51% among women physicians during the pandemic.4 But how can we translate philosophical exposition to actionable information? Smith provides a literature-informed framework that emphasizes four pillars to the meaning of life: belonging, purpose, transcendence, and storytelling (Fig. 1).5 Belonging refers to a sense of unity with others, such as a close-knit family unit, support group, professional organization, or sports team. Purpose refers to an overarching, self-directed, thematic goal that one strives toward. Transcendence refers to the moments in life that elevate one’s experience of or perspective on life beyond the mundane. Finally, storytelling is the active, introspective weaving of life’s events into a narrative that reinforces and builds on the other three pillars. The purpose of this article is to examine these pillars and provide examples of how one may build them into his or her personal and professional life.Fig. 1.: Meaning-in-life flowchart.BELONGING Studies have demonstrated a strong positive correlation between a sense of belonging and the perception that life is meaningful. In a series of four experiments, Lambert et al. demonstrated that priming individuals with a sense of belonging had a preferentially greater positive impact on their sense of having meaning in life than when they were primed with feelings of social support or esteem among their close friends and family.6 This is to say that over and above the positive effects of being complimented or supported by others, a sense of belonging and compatriotism with others—other than one’s family—lead to a greater sense of meaningfulness. Belonging itself can come in many forms. Individuals may gain a sense of belonging through strong and stable friendships with others who share common interests or goals. For example, athletes and the devout gain a sense of belonging through dedication to their respective teams and places of worship. Surgeons may capitalize on this finding and seek a sense of belonging through activity in local, national, and international professional organizations. Fostering a sense of belonging has a significant amount to do with being open to others and embracing groups.7 Building friendships, being active in professional organizations, and creating or joining special interest groups at work or in one’s community can all be excellent ways to foster belonging. Ultimately, reminding oneself of the aspects of one’s identity that are shared with others, and experiencing the coherence of one’s goals with the goals of a larger group is the essence of developing belonging. Another means of fostering belonging, especially in the professional setting, is to signal acceptance. As an individual, this requires actively listening to co-workers and ensuring that one does not alienate others based on perceived differences. As an organization, this means creating an environment that encourages equal participation from all, in which there are no such things as dumb questions, and where robust and thoughtful collaboration between employees is encouraged. PURPOSE Purpose, like belonging, is a core facet of meaning. Martela and Steger defined purpose as a “central, self-organizing life aim that organizes and stimulates goals, manages behaviors, and provides a sense of meaning.”8 Fulfilling higher order functions, making a noteworthy impact, and exhibiting a compelling life story all speak to having purpose in life. Aside from being a facet of meaning, purpose has been shown to be adaptive in and of itself. Kashdan and McKnight showed that a sense of purpose offsets deficits in well-being, especially during adverse or difficult times, by increasing self-esteem and other positive emotions.9 An example of a purpose-driven life is that of Mother Teresa, the Albanian-Indian nun who was canonized in the Roman Catholic Church for her work with the human immunodeficiency virus/acquired immunodeficiency syndrome–, leprosy-, and tuberculosis-stricken indigent population of Calcutta from the 1950s to her death in 1997. Other examples may be a surgeon who dedicates his or her life to the treatment of pediatric skeletal deformities in developing countries, a mathematician who dedicates his or her life to developing a proof for the famous, as-yet unsolved problem of the Reimann hypothesis, or a parent who describes purpose in life as raising his or her children. One can have multiple purposes as well, which may be exemplified by the dedicated surgeon who is also a parent. Although recognizing that a life driven by purpose is often an espoused goal, determining how to build purpose in one’s own life is definitely an ethereal ideal. One approach is to simultaneously answer a goal-oriented question to uncover a long-term goal, prioritize values, and identify skills. One might start by considering, “If I could change one thing about the world with a magic wand, what would it be?” A question like this prods an individual to focus on the goals that he or she deems most important, however unrealistic those goals may be. Further reflection forces the individual to consider concrete steps that can be taken to achieve or get closer to the identified goal.10 For a surgeon, the question can be reframed as “What do I want my career to look like in 5, 10, or 15 years?” In this way, a seemingly unreachable ideal becomes an attainable long-term goal that can be achieved through the application of sustained, stepwise effort. Creating long-term goals, such as developing a novel surgical treatment for a disease or becoming a department chair, and working toward them through concrete actions over time builds a sense of purpose and progression. The second principle behind developing a purpose in life is prioritizing values.11 Answering the question posed in the prior paragraph may be difficult for those who have many different causes that are equally important to them. For example, one may equally value career advancement, raising a family, and volunteering to help the sick or elderly. Prioritizing those values, therefore, is just as important as identifying them when it comes to setting a mission in life. Aside from careful introspection, surveys such as the Valued Living Questionnaire, Portrait Values Questionnaire, and Personal Value Questionnaire can all be used to help individuals decipher what is most important to them, just as these tools have been used in the research realm. In the career setting, prioritizing values requires determining which aspects of a practice one wants to cultivate. Teaching, research productivity, clinical volume, and complexity can all be valued differently by individual practices. Carefully prioritizing these various endeavors focuses the surgeon to exercise more control over his or her career trajectory. To cultivate purpose, one must identify his or her skills.11 Although prioritizing values and setting a long-term goal can be done independent of one’s preexisting skills (thereby motivating the individual to potentially learn new skills), the opposite approach can also be taken. One may start by identifying the skills he or she has already spent time and effort to develop, and then reflect on how those skills can be brought to fruition on a problem of particular interest. A publicly available, free questionnaire such as the Values in Action Character Strengths Survey can help an individual determine his or her personal strengths and skills. In the career setting, the identification of special areas of interest within one’s overall field and the honing of skills related to that special area of interest help a surgeon to gain a unique perspective on patients and the field as a whole. Finally, a less obvious but nevertheless important step toward cultivating purpose is to develop and practice gratitude.11 Research has demonstrated that reflecting on moments when one has felt a sense of gratitude can lead to “upstream reciprocity,” in which the individual feels a need to pay back the person who helped the individual directly, or “pay it forward” to society as a whole.10 This motivation can be a source of purpose in itself. In the work setting, gratitude expressed by supervisors gives employees increased self-worth, self-efficacy, trust, and an increased willingness to help one another.12 As a surgeon in charge of managing a team that may include midlevel providers, residents, medical students, medical assistants, and office staff, the regular expression of gratitude for a job well done is a no-cost way to improve team functionality. A simple way to do this may be to publish a monthly newsletter highlighting and thanking one or two exceptional employees for their performance, ensuring that performance reviews always begin by supervisors thanking employees for their service and specific good deeds, or in the case of students, expressing thanks during feedback sessions for work completed. In turn, a well-functioning team can establish a sense of belonging in its members to motivate the surgeon in achieving his or her long-term goals. TRANSCENDENCE Themes of transcendence are important in the discussion surrounding meaning. A sense of awe, accompanied by a momentary loss of sense of self and a feeling of being part of something greater than oneself make up the key aspects of transcendental experiences. Individuals may experience transcendence in a variety of ways. For instance, Piff et al. demonstrated that transcendental experiences can be induced through interactions with nature.13 Indeed, numerous studies have demonstrated that awe can be induced through proximity to physical vastness. This vastness can come in a perceptual form, such as viewing the aurora borealis, or in a conceptual form, such as one’s first exposure to a salient theory or work of literature that seems to explain the universe.14 Transcendental experiences, when induced in individuals, are associated with decreased self-awareness, reduced self-conscious emotions, and lowered priority given to self-relevant goals. It is this tendency for transcendental experiences to momentarily diminish focus on the self and instead direct mental energy toward others and the outside world that connects the concepts of transcendence and meaning. This other-centered state of mind is helpful when developing long-reaching aims and a purpose in life. Cultivating transcendental experiences can be a useful tool when developing purpose in life, but aside from exposing oneself to vast physical or conceptual phenomena, which may not be possible on a day-to-day basis, how can one cultivate transcendental experiences? To answer this question, it is important to realize that self-transcendent experiences lie on a spectrum. Yaden et al. described how such experiences can range from minor, such as losing oneself in a piece of music or attending a religious service, to major experiences that are associated with a complete dissolution of the sense of self and a sense of feeling at one with the universe, such as what may be experienced when standing on the summit of Mount Everest, or which has been reliably reported in the literature after exposure to psilocybin and other psychedelic agents.15 Although we would hesitate to recommend scaling Mount Everest as a means of attaining meaning in life, there are other more ordinary practices that contain aspects of self-transcendent experiences, namely, practicing mindfulness and facilitating flow. Vago and Silbersweig showed that mindfulness training through meditation and mindfulness-based interventions, such as mindfulness-based stress reduction therapy, can lead to the cultivation of states of mind that reject self-centered needs by developing prosocial skills such as empathy and altruism.16 The self-transcendent aspect of mindfulness is found in its “decentering” aspect, which is the feeling gained through meditation that one is an outside observer to one’s own self. This fosters the meditation practitioner to disconnect from negative thoughts and emotions. For those unable to access therapists specializing in mindfulness, smartphone apps such as The Mindfulness App, Mindfulness Daily, or Headspace can provide a means of practicing it. Another route to self-transcendent experiences is the cultivation of flow. Flow is a mental state defined as focused absorption in an interesting or challenging task. The “flow state” was most famously described in athletics as a state in which an athlete loses his or her sense of time, achieves total calmness and focus on the task at hand, and performs at an extremely high level.17 Flow can also be achieved in more mundane tasks, such as managing spreadsheets at work or engaging in a challenging puzzle. Surgeons may experience flow during productive days in the operating room while engaged in challenging but enthralling surgical cases. The loss of self-consciousness is most closely connected to self-transcendence. The regular experience of flow has been associated with increased self-determination and intrinsic motivation, both of which are essential to developing purpose and, therefore, meaning in life. Flow itself can be cultivated through practicing mindfulness, which can be helpful in improving one’s ability to focus on a task. Embracing challenging rather than easy tasks both at work and at home is also an important aspect of experiencing the flow state. Finally, one might keep track of when and where one naturally enters flow states over the course of a day or week and try to replicate those conditions more frequently in one’s life. STORYTELLING Storytelling, although described here as the last of the four pillars of a meaningful life, is no less important than any of the preceding three. By building a narrative of one’s life, one can reflect on prior experiences and tie them together into a coherent account of why and for what reason those experiences occurred. A successful narrative is one that ultimately ties back into an individual’s purpose in life and creates an extra dimension of meaning separate from that found in individual actions or experiences within that life. An unsuccessful narrative is one that externalizes all failures and negative experiences in an attempt to explain them away rather than learn from them. Keeping a journal, conducting clinical or basic science research, and mentoring others are all ways to practice storytelling. Taking time to reflect on the past and record these reflections for posterity can be a useful way to build a running narrative of one’s life without missing out on smaller key details that may be lost over time. Furthermore, an individual can return to those recorded reflections at a future date to make sense of them in light of new life experiences. In the career setting, journal keeping may be too disruptive during the course of a busy day. However, taking time to reflect on accomplishments and successes—in addition to challenges and failures—at regular intervals helps a surgeon to assess his or her progress toward fulfilling long-reaching goals and aims, and take steps toward furthering that progress. Writing down these reflections, when possible, helps the surgeon maintain a running record that is not subject to the vagaries of memory. Conducting research is also a means of practicing storytelling. Clinical and basic science research is a form of storytelling about disease processes, treatments, and patient outcomes. Understanding the limits of knowledge within one’s area of interest, developing relevant clinical or quality questions, and designing appropriate studies to answer those questions build a narrative over the course of a career that not only benefits the surgeon through recognition and academic advancement, but has the potential to care for society. This melding of purpose and storytelling adds substantial meaning to one’s career. Finally, mentoring others is an important, indirect means of storytelling. Mentoring requires drawing on life experiences and lessons learned to guide others in developing their own life purposes. Being an effective mentor requires understanding one’s own life journey; doing so is the only way to provide valuable advice to others yet to have the same experiences. Practicing mentorship is a good way to practice narrative building and can be as meaningful for the mentor as it is for the mentee. What it means to live a meaningful life will continue to be studied and debated, but it is clear that finding meaning is important. Higher levels of meaning in life are associated with better mental health, higher self-esteem, and better coping and adjustment after stress. Conversely, meaninglessness has been associated with deleterious consequences.2 Yet, how can one find meaning in life? By developing a purpose, developing a sense of belonging, cultivating self-transcendent experiences, and actively building a narrative of one’s own life to make sense of life events. These principles should be cultivated and actively applied in one’s personal life and in one’s career to attain meaning in our existence. DISCLOSURE Dr. Chung receives funding from the National Institutes of Health and book royalties from Wolters Kluwer and Elsevier. Dr. Dwivedi has nothing to disclose. ACKNOWLEDGMENTS The authors would like to thank Meghan Cichocki for contributions to the development of this article. They appreciate the peer review and edits from Mike Stokes, staff vice president of communications at the American Society of Plastic Surgeons.