Existential Psychotherapy Part 4: Meaning

Margaret: [00:00:00] My aim with all my therapy patients, and this was true before I was a child fellow, is to make therapy fun before it's anything else. And I think that fun is also part of helping people find meaning again. How to be patient. 

Preston: Welcome back to How to Be Patient season three. We heard your comments of praise, your comments of critique, and we've listened to the ones that we like.

But we are here- ... to talk about existential psychotherapy, part four, the one that everyone has been waiting for, or at least I've been waiting to yap about, joined by my co-host Margaret- Hi ... who is also a psychiatrist in training, but she's actually completed the main part of her training, and I'm still just a resident.

Margaret: Done with adults. You-- They know that. What- Just a 

Preston: resident ... 

Margaret: are people listening for the first time? If you're new here, hi. 

Preston: If you just stopped by, let us reintroduce ourselves. 

Margaret: We just did. You are looking for meaning [00:01:00] in life. We're on the couch, so it's an ex- it's a therapy episode, or it's an existentialism- It is a therapy 

Preston: episode

in this case, but- And we are covering our existence in one hour, so we should actually have plenty of time in the end to talk about other things we want 'cause I'm picturing we get done with this in about 15 minutes. 

Margaret: Well, I'm excited to talk about the survey thing you sent me because I got both, like, a laugh out of it, and I also wanna talk about it, so I'm excited for this episode.

Preston: Okay, let's do it. So, um, like every day, we're gonna start with an icebreaker, and today's icebreaker is what has been your Sisyphean task of the week? 

Margaret: The week just started. Okay. Um, do you have one? You can-- 

Preston: Last week counts too. 

Margaret: Do you have one already? Can you go first? 

Preston: Sure. What, what boulders I've been pushing?

Margaret: Yeah. 

Preston: I've al- honey, I've always got boulders. That's 

Margaret: a nice boulder. 

Preston: Yeah. That 

Margaret: was a Shrek reference. 

Preston: I would say not all-- I don't dread [00:02:00] pushing every boulder, but the Sisyphean task of the week for me has been my plant care. So as spring has been coming around, it's been raining a lot. There's a lot of fluctuations in humidity, and every day I've realized that there's a benefit to rounds because I round every morning on my houseplants and just do a-- It doesn't take long.

It's like surgical rounds essentially. I just kinda stick my finger in the soil. I assess for dead leaves. I see how everyone's doing. I say, "Okay," and then I move on. So that's, that's kind of been my Sisyphean task, but it does, it does give me some joy. Like, I still like rounding on the houseplants. Like, do I sh- do I belong in the hospital?

You enjoy. I like rounding- 

Margaret: You enjoy that ... 

Preston: too much. And I have a little, like, mini greenhouse on my patio that I've called Plant Hospital. 

Margaret: Oh, that's cute. 

Preston: So it's like parts of it are coming back to me. Yeah, I have a whole monitor in there that, that it tracks the humidity and temperature over time, so I can actually see how the humidity fluctuates throughout the day with the sun cycle.

It's kinda fun. Yeah. [00:03:00] Uh, or just nerdy. Those are two ways to look at it. 

Margaret: I feel like, though, that's like you enjoy-- like one must imagine Sisyphus enjoys or whatever the internet misquotes or quotes, right? 

Preston: Yeah. 

Margaret: What is, what, 

Preston: what was- One must picture Sisyphus happy. 

Margaret: Yes. What is one for you, though, that is like, "I wish I could drop this boulder down the side of the mountain and never push it up again"?

Preston: That would be my Air Force JKO trainings. About- 

Margaret: What's a JKO training? 

Preston: It's Joint Knowledge Online is the acronym. Everyone in the-- everyone who's worked a government job is familiar with these. And the thing that, like, sucks about my residency, I mean... Sorry, let me reframe. The thing that's amazing about my residency is that we have the opportunity to work on multiple sites, multiple level one trauma centers, all with their own individual training systems, and each of them has their own training upkeep.

So, you know- 

Margaret: Oh gosh, 

Preston: so you have multiple- I wouldn't have it any other way. Why, why [00:04:00] should my HIPAA training at one hospital be valid at another? That doesn't make any sense to me, so I should redo it three times. That's been my negative or- 

Margaret: That's extremely valid. 

Preston: However you wanna frame it, Sisyphean, um, task.

Those boulders are very frustrating to me, especially when they're like- One must 

Margaret: imagine Sisyphus doing EMR training. 

Preston: Did you see that? There was a tweet where someone said, "What if we created a point system where Sisyphus could earn points for the ways in which he pushes the boulder up the hill or the amount of times he does, and then he could redeem these points for stickers or decals to put on the boulder?"

Margaret: That would work on me.

Preston: It already works on a lot of people. 

Margaret: It already works on me. I literally have star stickers that I use daily. 

Preston: It's like, it's like l- looks down at, at like summa cum laude on your diploma, and you're like, [00:05:00] "This is different, though," right? "This is different." 

Margaret: This is different. This is a really good sticker.

Preston: Yeah. And the boulder, like it's a sick boulder, yeah. Like it-- I got a new skin for my boulder. Now it, now it kinda just looks like a bowling ball. 

Margaret: Now, now you're having a great time, yeah. Um- 

Preston: So, so I'm curious, what's your Sisyphean task, positive or negative or both? Okay. 

Margaret: I'm gonna give you a positive one and a negative one.

A positive one, you know this, our listeners know this from how many episodes we've done on this, but I do think exercise is a positive one for me at this point. Um, like this morning, uh, first of all, shout out our step challenge people as always, but I've officially signed up for my, like, running this summer 'cause, uh, and running I use very loosely, more like jogging.

But I'm doing the Newport 10-Miler in Rhode Island that's on like May 31st, and then me and my friend always do the 10K that's at the Portland Head Light in Maine [00:06:00] And then I'm doing the, like, Acadia Half Marathon in, uh, like the day before my birthday. And like that, between that and then teaching Pilates and like belonging to the yo- yoga studio I teach at, I just feel like it's like something I enjoy every day.

Like even though the first mile always sucks, and even like the first 10 minutes of teaching or like working out I feel like always feels creaky and slow. But I do feel like that's a Sisyphean task that like I have to do both for my brain and just like my overall, like, not having back pain management.

Um, but it's one I really enjoy, maybe similarly nerdily to your, um, houseplant rounding. 

Preston: It's a, it's a Sisyphean task that feels better the farther the boulder gets up the hill. 

Margaret: Yeah. And I... One must imagine that Sisyphus would have loved the marathon. Like, um- Yeah. I 

Preston: think, [00:07:00] like in today's modern world, we have so many of these tasks that we just have to keep up with.

It's like spinning plates. Yeah. So I feel like if Sisyphus was in modern hell, he wouldn't have a single boulder to push, but he'd have an infinite number of plates that he just had to keep spinning. Yeah. And every time you spin a plate, it loses momentum. You have to go back and spin it again. Or like- And you just do that

Margaret: he's like trying to like roll like 10 different barrels up the mountain, so he's just like running back and forth and like pushing them. Then one starts rolling down the mountain while the other one- Yeah ... pushes up. 

Preston: He gives it a big heave, and it goes halfway up, and he's like, "Nice, I can go push another one now.

Oh, that first one's coming back down." 

Margaret: And it's like I'm pulling behind on all my boulders. Um, a bad one, because it's tax season, taxes. Mostly 'cause- Yeah ... like I feel like taxes were com- this is so boring, but like I feel like taxes were complicated for me this year because of like s- like Substack and then like working on...

Substack's different and Etsy's different, and then like random money from social media that is like not very much but like still needs [00:08:00] to be in your taxes and those are like not counted apart. And so I feel like that just fills me with dread when I was doing them. Now they're done. But like that- 

Preston: Yeah.

Uh, like why do they hide- ... taxes ... the tax forms so deep in there? 

Margaret: I don't know. 

Preston: Like it... Like, I don't know why it's so hard to get my tax forms from like TikTok, and it's not, it's not like a, a huge sum of money. 

Margaret: Right. 

Preston: Because it's just like the TikTok creator program. But come on, guys, front and center. You know, like, let's see...

I want my profile picture and then just like click here for your 1099. 

Margaret: Yeah. 

Preston: I'd 

Margaret: be happy with that. Like, does, does it have to be so difficult? Like it feel, it does feel like they're hidden. Well, and like Substack doesn't do... Like it does it through like something called Stripe. Um, and- Yeah, I know. I've heard things about Stripe

then I have to go to Stripe. And then Stripe is like You need to set up your Stripe account. And I'm like, "What?"

So that's not a bad problem to have, like in the, in the scheme of things, enjoying the view from [00:09:00] the mountain that I'm pushing the boulder up. But I- Mm-hmm ... taxes scare me 'cause I'm like, "What if I get it wrong?" So 

Preston: you- I hope, uh, everyone should be done with their taxes by the time they hear this. So get 

Margaret: the taxes 

Preston: in your buddy.

The rest of you committing 

Margaret: tax fraud. 

Preston: Right. That's the easiest way to do it. Well, after we finished pushing our boulders, or we'll take a break from pushing the barrels up the hill to talk about how we find some semblance of meaning after we come back from this quick break.

Margaret: The only person who is more stressed out by our medical training than us is our moms, because they hear every single bad test, every question mark around admissions, and every bad night call. And this Mother's Day, I wanna celebrate my mom by giving her an anxiety-relieving, comforting gift like she gives me.

But this time it's gonna be from Cozy Earth. 

Preston: Sometimes we wanna say more than thank you, and this time a great bathrobe [00:10:00] and slippers is gonna be our way of saying thank you for putting up with us all this time. 

Margaret: One of the great things about Cozy Earth is that everything that they make has a 10-year warranty or 100-night sleep trial.

So just like your mom was there through all 100 nights of night shift that you went through, so will your Cozy Earth robe and slippers. 

Preston: Yeah. And you can get those nights back, unlike the night shift. So let this Mother's Day be a reminder that she deserves care too. Discover a Cozy Earth and how it turns routines into moments of softness and ease.

Head to cozyearth.com and use our code PATIENT for an exclusive 20% off. And if you see a post-purchase survey, make sure you let them know that we sent you. 

Margaret: Because home starts with mom.

Preston: And we are back to talk about meaning, and I really mean it this time. It's gonna be a structured episode to the best of my ability. So to kind of [00:11:00] orient everyone who's not listened to these in a series, there are four fundamental problems of man described in existential psychotherapy. We're reading from this book by Irvin Yalom titled Existential Psychotherapy, and the four problems are as follows: there is death, which is that fundamentally all humans will, will die.

This is a postulate, obviously. It's a theory that we cannot prove, but- 

Margaret: Allegedly we die. 

Preston: So far no one has beat this, so I'm just gonna kinda run with that one. The next being that we are- Hello, it 

Margaret: was just Easter.

Moment 

Preston: of silence. Second being freedom, that we are ultimately free to make our own decisions, and then therefore must be responsible for those consequences. And Thirdly, that we are isolated, so we are existentially alone. That no matter how close you get to another human, you al- you're destined to have your personal private experience of the world, and therefore death, which kind of circles back around to number [00:12:00] one.

And finally, the last postulate is that for some reason, humans appear to require meaning to live. That's the initial postulate. The second part of that is life does not seem to have an inherent purpose or meaning to bestow upon you. So we, we have to determine or discover our own meaning. And, and those two problems are at ends with one another.

It's like saying humans need water to live, but there doesn't seem to be any water in sight. So we can either make it or we can discover it. But you gotta do something. 

Margaret: There's, in theory, water 

Preston: somewhere. In... Yeah. Yeah. In theory. So kind of going back to that first postulate, so that, like, humans need meaning to live.

The implication of that is attempting to live life without meaning causes considerable distress. And I think the best way to describe [00:13:00] that i- is this book, um, Margaret and I read earlier this year, or I guess late last year, was Bullshit Jobs. That is-- That entire book is essentially a thesis on what happens if you try to pursue a meaningless life.

And What If Books Could Kill did an interesting cover on, on Bullshit Jobs. 

Margaret: My fave podcast mentioned. 

Preston: Yeah, I, I thought they had some good takes. There were some things that I wanted to defend the book a little bit on, but we won't get into the nuance of it. The, the point is that, like, a, a bullshit job is a job that basically contributes nothing to society, and the person conducting the job is intimately aware of it to the point where they cannot justify themselves doing the job, but they still have to keep up the charade.

And the entire book is about the psychological injury of living that experience every day. Basically ma- pushing a boulder that hurts every time you push it, rather than one that makes you feel better. So the, the way that we can, can know this actually, or we try to measure it, [00:14:00] is with these different random scales.

And I never came across one of these scales until I was prepping for this pod, which is, like, pretty fun. So one scale, and Margaret's smiling because I sent this to her to take a look at, is the purpose in life scale. And we'll, we'll tag this to the end of the pod. But Margaret, what-- It's essentially like a, a PHQ-9, but for like, do you have meaning in your life?

And I'm curious, Margaret, what were your thoughts about the, the PIL? 

Margaret: Well, I was thinking about, um, the DBT episodes we did and dialectics again, and was just struck that, and granted, you know, this is not the only kind of scale that goes between two extremes, but that it was like the questions The questions are like, where, where...

Like, rank yourself where you are. And it's like, I have no meaning in life. My life is a purposeless wasteland versus, like, that one meme that everyone posts on TikTok that's, like, in, like, [00:15:00] rainbow colors, and it's just, like, a small creature going like... Like, those are the answers. The answers are, like, were, like, happiness versus, like, Eeyore in, like, Inside Out and Winnie the Pooh respectively.

Mm-hmm. And so it was like, I was going through it, and I was like, "I don't know. I feel like I'm hitting a lot of threes because I'm, I'm trying to be dialectic and wise-minded as I fill it out." 

Preston: So yeah. I've, I've got it pulled up. Let me give you all a flavor for, for these different back and forths we're looking at.

So we have, um, after retiring, this is number seven, I would, and one being the lowest, loaf completely the rest of my life, or five or the highest, do some of the exciting things I've always wanted to do. Concerning the freedom to choose, I believe humans are, at the low end, completely bound by limitations of heredity and environment, or on the high end, totally free to make all life choices.

Margaret: Which I feel like that's been the theme of this season. [00:16:00] 

Preston: Yeah. And then, um, the final one, or the final two, facing my daily tasks is either on one end, a painful and boring experience, or on the other end, a source of pleasure and satisfaction. And finally, I have discovered no mission or purpose in life or a satisfying life purpose.

And then you just, you tally it up and just give them a score. So if you had all fives, that's a score of 100, and all ones is a score of 20. So you, you technically can't get a zero on the purpose in life scale. The lowest you can get is a 20. What is interesting about this is that when you look at patients who are in meaningless jobs, they are much more likely to score low on the PIL, or even people that experience other disruptions in their life.

Margaret: Yeah. 

Preston: Um, so- Or 

Margaret: if they're depressed. Like if they have like a biologic depression, um, if, if such a thing as pure biologic depression exists, which I kinda think it does. Mm-hmm. [00:17:00] Um, the other part that's interesting in looking at that and considering, like, the Bullshit Jobs book is, as you said earlier, as people...

Like the person working the job defines it as useless. Mm. So there are people they talk to that he goes to this book, and he's like, "You would think that this, that, or the other person would think this was a bullshit job, but no, they feel it's meaningful, and they're doing X, Y, and Z." Um, and so it's interesting to look at it through that lens and look at the, the, the thing of, like, how does someone make that decision and kinda regardless of the quote unquote objective reality they're living in.

Preston: Yeah. It, it- It's really fascinating to me, and I think as I go further into my neuropsych training, I w- I'm really curious about how depression affects hopelessness. Um, and like I think it'd be s-something kind of fun to maybe understand more. I think there's a fair body of research on it, it's just not, uh, in a place where I can fully understand it, I guess.

I'll have to learn a lot more. That's how I [00:18:00] put it. The, the other... I, and I just kind of looked up some of this stuff really quick. The other interesting correlations with PIL scores are related to stuff beyond mental health issues. So you did a great job pointing out, you know, depressive symptoms, anxiety are associated with low PIL scores, but also, um, physical health risks.

So someone did a study on grip strength, walking speed, and found it to be cor- like low grip strength was correlated with low PIL scores. Um, there's- 

Margaret: We're gonna start a how to be patient hope core protocol inner circle member club. 

Preston: Yeah. H-hop on our Etsy for our grip strength adventures. 

Margaret: Are you just gonna just 

Preston: use one of those as grip strength in our thing?

Go increase your 

Margaret: purpose 

Preston: in life. Don't, don't worry about the correlation causation stuff. That's all just, uh, hullabaloo anyways. The demographic factors, so lower income, fewer years of education, are associated with low PIL scores. And association- Which also 

Margaret: makes sense from a like, did your efforts [00:19:00] reinforce that like effort and autonomy and internal locus of control actually makes things- 

Preston: Are they rewarded?

Margaret: Are they 

Preston: rewarded? 

Margaret: Are 

Preston: they there? Do, do I get a payoff? Yeah. Yeah. And then childhood adversity, um, childhood abuse, loss of a parent, are also associated with low PIL scores. And, and that kind of- 

Margaret: Why do you think that is? 

Preston: I think it's probably just related to, um, your outlook on the world being just or being good.

That has a lot that influences your purpose in life score. The other thing is that feel- like strong feelings of isolation or loneliness are associated with a low PIL score. And we know from the last episode that childhood abuse and adversity in your childhood really impairs your ability to form a needless relationship with another human being that, um, I you, I thou relationship.

So if you struggle to form an I thou relationship, you're more li- likely to experience loneliness, and it's harder for you to find satisfying, fulfilling relationships that contribute to your purpose in life. So that would be my [00:20:00] hypothesis. Who's to say, though? All these are correlations. What if having a low purpose in life just decreases your grip strength?

Who knows? 

Margaret: You hear that, fellas? You will have purpose in 

Preston: life. If you wanna get started 

Margaret: and join Purpose right now. Something chicks love. 

Preston: I wanted to... Gosh, I should have had this page ready. But there's a, a really interesting kind of excerpt from Tolstoy, though- Ooh ... which is, which is kind of actually in direct contradiction to what we're talking about, which is- That a low purpose in life scale score is correlated with, um, like low economic, um, opportunity.

But Tolstoy writes, and I'm gonna paraphrase this because I don't have the page ready, that- 

Margaret: What book is this? 

Preston: Oh, I'm-- This is just Existential Psychotherapy. 

Margaret: Oh, nice. Cool. It's 

Preston: just the book. The 

Margaret: book. I was like- It's, it's the class book ... okay, are we reading War and Peace? What are we reading? 

Preston: Yes. She's a fat one.

Um, I mean, he's a fat one. Or I don't know how to [00:21:00] gender this book. They-- The book is thick- ... is what I'm trying to say. So Tolstoy goes, "I think my gardener must know something I do, because here I am pampered in my house writing books all day," it was someone's dream job, "and he seems much more satisfied with his life than I am."

And there's kind of a deeper aspect to that, and, and I think a lot of people listening to this podcast are-- they're probably familiar with that statistic or... It's often misquoted, but that more intelligent people are more likely to experience depression. 

Margaret: I'm not-- It's not funny. I just-- I feel like it... I'll see it on Facebook and then everyone kind of comments always.

It's like one of those memes that are like 

Preston: Every depressed person is like, "I knew I was smart." I 

Margaret: was smart. "Thanks 

Preston: for confirming that all along." So, uh, uh, anyways, the-there's-- when you, when you kinda think about [00:22:00] conceptualizing meaning, there, there's kind of different layers, and one layer that we get into the book is called the galactic perspective, which is probably what Tolstoy's tapping into.

Yeah. So there, there are a couple of different ways to think about meaning, which is ultimately kinda the, the, the bullet that I'm getting at here, which is what is meaning in your life? Is there personal meaning or is there meaning in the universe? And as people are contemplating different levels of their meaning, it, it seems to not necessarily matter where the meaning comes from as long as you just have it.

So that gardener who's like, "I'm taking care of the lilies, and I'm not thinking too hard about nothing," he's got meaning. You know what I mean? 

Margaret: Mm-hmm. 

Preston: You s- you see what I'm meaning about what he's- Mm-hmm ... he means? But Tolstoy, who's sitting there going, "No, what about our cosmic purpose? Everything I ever do in my entire life will ultimately lead to nothing, and everyone who knows me or who has [00:23:00] known anyone who ever knows me will ultimately die and will all disappear as endless non-consequential specks on an indifferent world."

Margaret: Navel gazers. 

Preston: That's called, that's called the cosmic perspective. Yeah. And you get-- people get stuck there, and I think- 

Margaret: Do they always get stuck there in this way? No. Okay. 

Preston: It's like a tunnel. 

Margaret: But like- 

Preston: Which we'll get- ... 

Margaret: does cosmic 

Preston: mean- Which we'll get to ... 

Margaret: like you are like... Like does cosmic always have to be negatively associated?

Preston: In all the reading I did in this book, it essentially led to negative outcomes. 

Margaret: Gotcha. Okay. 

Preston: Or, like, being stuck there did. It was-- It's really, like, kind of your answer to it. And, and when we get to kind of the end of the episode, we'll, we'll see that the answer that Yalom provides is more from like a Buddhist perspective.

But- 

Margaret: Mm-hmm ... 

Preston: there are multiple ways to answer the cosmic question. Um- 

Margaret: Hmm. Okay ... 

Preston: s-so I guess I know that you, you kinda come from a, a Christian faith, and I had a, a good talk with one of my [00:24:00] attendings about kind of existential psychotherapy and, and these problems, and he said, I think eloquently, that religion offers robust answers to all of the problems of existentialism.

Like, that's, like, like, that's why it offers, like, such catharsis for people. Hmm. So I think it's almost like there's like a parallel track sometimes- Hmm ... where, you know, these, these are problems that we're, like, describing that every human has to come across and then, and, you know, people of faith are like, "Well, like, I've, I've had an answer to that for a long time."

Margaret: Yeah. I think it, I think it does, and I, I don't disagree with that. But I also think that a lot of faith traditions, whether for me it's Catholicism to some extent, uh, but other faith and spirituality traditions, they offer you a way-- Some-sometimes they offer answers, but they also offer you a way of standing in the posture of not knowing and, like, living the [00:25:00] questions as, uh, in that one poem Rainer Maria Rilke wrote in the Letters to a Young Poet.

So this kind of, like, ability to live within a question without collapsing it or live within mystery- Mm-hmm ... um, which can be done without religion, and I think is done well in, in poetry and literature and other kind of transcendental approaches to the world or existentialism. But I would, I would say, like...

I think that's why I'm curious, like, the cosmic question, 'cause I think I don't know this part of existentialism. Like, what is the cosmic question? Like, can you w-reword it so I can understand what it is? 'Cause I think I'm missing that. 

Preston: Yeah. Well, uh, it's, it's not necessarily a question. It's the- Oh, 

Margaret: okay

Preston: the galactic perspective in existentialism, and it's essentially you're viewing yourself in the, like, despair of the thought about how unimportant you are. You, you have a- Oh, okay ... crushing [00:26:00] feeling of, of, like, worthlessness. Like being a tiny speck. Yeah. It's... What I'm talking about is that shudder you get when you're out at a camping trip and you're looking up at the stars and you're like, "Wow, man.

Like, we really are just specks on a floating rock." And you go, it... And, and it's when it transitions from that wonder to like, "Nothing I do really matters then. Nothing I'll ever do matters. What's the point in doing anything?" That- 

Margaret: Oh, okay ... 

Preston: that kind of, like, nihilistic despair That's the galactic perspective that I'm kind of getting at.

And people, they get stuck in there like an eddy in a river, and they can't get out. 

Margaret: It's interesting because, like, the thing that I don't feel... I don't think that my life personal experience, which I can-- I think is the only thing we can kind of speak from and are therefore biased by often, is not having experienced that.

But to your point about, like, religion offers answers or offers a frame, [00:27:00] the way that I view Catholicism and, like, the, the history of Christianity or Catholicism is, like, the awe goes into awe because there's this sense of, like, nature is-- nature and the universe and all of this expansiveness is a sign of something sacred and divine, and you are a part of the sacredness and divine as in Catholicism or Christianity, God becomes man, right?

And so it's because I'm a cradle Catholic and I, like, went to Catholic school, and so this has been, like, kind of drilled into me. Um, it's just interesting 'cause I'm trying to, I'm trying to put my own life experience into it and understand it, and it's-- there's like a sidestepping of that part- Yeah ... for me, I think, because the religion has been there for so long, and doesn't mean I don't have other doubts about suffering.

But it, it's just-- I'm just trying to think through this 'cause I feel like this is a new part of existentialism I'm not familiar with. 

Preston: [00:28:00] Right. So it, it's almost like this, this perspective that may fill others with wonder and then crushing loneliness f- can fill you with a sense of belonging, almost in a way that you, you are recognizing that you're a part of the beauty of God's kingdom.

Margaret: Yeah. Well, and okay, this is the last time that I know we should get on with it, but it reminds me of the poem that everyone loves from Mary Oliver, um, which I'm gonna read because someone DM'd me, or DM'd the podcast page and was like, "I felt so seen that one episode when we were talking about, um, uh, like, Jim Bros and, like, the Sylvia Plath girls."

But so- Mm-hmm ... "Wild Geese," so this just to, to put in perspective 'cause she's not religious, um, is the poem that starts, "You do not have to be good. You do not have to walk on your knees for a hundred miles through the desert repenting. You only have to let the soft animal of your body love what it loves."

It goes on, and then eventually she says, "Whoever you are, no matter how lonely, the world offers [00:29:00] itself to your imagination, calls to you like the wild geese, harsh and exciting, over and over announcing your place in the family of things." So, like, that feeling. And so it is, for me, it is religious, but also, like...

I'm trying to square this with how the existentialists would think about, like, Mary Oliver or think about these other things. But that is my last tangent for this. Sorry. 

Preston: Okay. Yeah, no, and the- these are hard questions, and I, I think that's a, a, a great passage that helps, like, tie together how, how you feel the As one of the wild goose is geeser 

Margaret: Yeah 

Preston: So, um, the, the kind of next part will go into the different frameworks that people tried to, to answer this, this question of, of meaning, both the kind of personal and, and in the world.

And this is at its core, um, the foundation of a lot of philosophies that we see. What, what is the meaning of life? And, and in a lot of ways, what is the [00:30:00] greatest good that we should pursue achieving? And then whatever is the greatest good that we wanna debate about, then we'll, like kind of pursue that. So I'm gonna start out with the number one hater of all this, which is Jean-Paul Sartre, who advocated greatly for meaninglessness.

He actually just wanted to lean in on the complete other side and says, "Life is meaningless." I've actually thought about this cosmic perspective, and I've concluded there's no point in doing anything. Just lean into, to pure nihilism. And I, I wanna take a second to kinda take that stance apart because that is a very common stance that a lot of people will have, especially when they're in kind of th-their own like pit of tribulations, uh, I guess I'll say.

Margaret: What was the purpose of him having that stance? 

Preston: That is the excellent, uh, ex- an excellent observation. Sartre found a lot of meaning in needing to tell other people that life was meaningless, or was meaningless. 

Margaret: [00:31:00] Is that why he- Which is- What is he like, how does he defend it though? 

Preston: Oh. 

Margaret: Like, 'cause like I... Is it just like life is meaningless?

'Cause he obviously did a lot, right? Like you're saying. Mm-hmm. Like, he found meaning in writing and doing all these things. Like, what was like the secondary part of life is meaningless, dot, dot, dot. 

Preston: What? It, it's essentially that because there is no inherent or like prescribed meaning that, that human existence precedes any predefined purpose- Ah

essence, or defined plan- Yeah ... then we're- 

Margaret: Free ... 

Preston: there is, because there is no inherent meaning, then anything we make up, it's like, it's like building sandcastles in the sand. Mm-hmm. And they're just gonna wash away with the tide. So it's all, anything you do is just made up, but you can't call that a divine meaning if you're just making it up.

That's his argument. 

Margaret: Right. 

Preston: And- 

Margaret: But you, 

Preston: you're also free to make- And that's also me paraphrasing his argument. I'm probably getting this wrong because I haven't read a lot of Sartre, but that's, I guess that's kinda my understanding of it. [00:32:00] 

Margaret: But I mean, I guess like the kind of light side of the shadow of that is that you are free to create and live your life however you want to, and that your life is yours, and there's no imposed meaning or value system upon you.

Preston: Right. But there's... You ha- I guess you have to see like the true belief that life is utterly meaningless- meaningless as like zero Kelvin. Because the second you say like, "Oh, life is meaningless, therefore I can do what I want," you- aren't you just describing meaning? Because doing what you want is something that has meaning to you, right?

Margaret: Not necessarily. I could just be doing pure hedonism. 

Preston: But hedonism has meaning. 

Margaret: Hedonism doesn't necessarily have meaning. Hedonism is just that it's like a body sensation, which would be human experience preeminent of like I'm just gonna do whatever feels good in the moment with- without, I don't need to like [00:33:00] inhibit myself or do this, that, or the other, or get in the rat race.

I can just go- Mm-hmm ... and like have a great breakfast at a French cafe and then go like have four affairs and 

Preston: it- That, 

Margaret: that 

Preston: sounds pretty meaningful to me. Like, I think we're, we're giving too much weight to the con- 'cause meaning is just any desire to move your life in any vector or any kind of direction.

It doesn't need to be of like a higher purpose or a higher calling. Does that- 

Margaret: Right. Well, I- 

Preston: So, so like me just doing something for the sake of pleasure, that's like- 

Margaret: Got it ... 

Preston: I'm I have purpose now, right? It's hedonism. So that's, so- Okay ... you can't, like, that's why I'm saying it's, it's like mutually exclusive with like pure un- pure distilled down to its core essence meaninglessness.

Margaret: Mm-hmm. 

Preston: That, that is incompatible with hedonism, which may have different levels of higher meaning or, you know, contemplation of the, the good or the just than some other concepts of meaning, but it still has more than life is meaningless. [00:34:00] 

Margaret: Okay. I, I 

Preston: That, that's, that's ... Y- y- you just kinda see what I'm trying to get at where that's why I'm saying it's like zero Kelvin.

Yeah. Any degree- 

Margaret: But there's like no- ... of heat 

Preston: you put into this, that's meaning. 

Margaret: Yeah. Your sense is like there's just, his view is kind of like there's just like not directionality, and if you start having any, it's kind of like then now you are moving towards something. 

Preston: Right. That's why it's i- it's, it's ironic.

So shouldn't, 'cause, 'cause if life is meaningless, sh- certainly not telling people that life is meaningless is just as meaningless as telling people that they do, so why, why have you done anything? Even, and, and I guess this is to get s- like philosophically snarky, but if you truly believe that life is meaningless and you want to complete suicide, you certainly would think that there's meaning in attempting suicide.

Like, that, that is still a vector that you're moving towards. Okay. So- 

Margaret: But here, here's another quote from, uh, Sartre. Like, "Man is condemned to be free because once thrown into the world, he's responsible for everything he does. It is up to you to give life a meaning." [00:35:00] 

Preston: Yeah. So I'm using some of his e- his extreme views, but he d- he does- Okay

come back around to, to existentialism. 

Margaret: Got it. Okay. So he's just saying there's no meaning, we're done here. Mm-hmm. Everyone- 

Preston: And then- ... go home? Yeah. Like, what, what- I guess to, to be a Sartre apologist, like the, the meaninglessness at the core, that's, that ... What I'm describing is like pure nihilism, which is not what Sartre is.

Margaret: Got it. Okay. 

Preston: But that's if you take that and run into like nihilism, I guess. 

Margaret: Got it. Okay And so now you need to debunk this one? 

Preston: No, uh, I, I think the debunking was essentially saying that, like, if you try to go to life is purely meaningless and will never have any meaning, then that is kind of oxymoronic.

That, that's kind of what it- 

Margaret: Mm. Gotcha. 

Preston: Okay ... that was the point. Because any amount of, like, desire you have to do something is something with meaning. So the, the next kind of framework that we've already teased a little bit is hedonism. So hedonism is the, is seeing life's meaning as the [00:36:00] pursuit of pleasure, in its essence.

And that can be anything from the, like, debaucherous experiences that we classically, like, associate with pleasure, you know, drinking, drugs, sex, gambling. Like, I was just in Vegas visiting my sister this weekend. I think you can find just about anything that you would, like, consider, like, classically hedonistic there.

But hedonism at its core is, like, doing something for the feelings that you'll get out of it. So, um, in the book, uh, um, Yalom argues that even, like, doing, like, charity or something, if it makes you feel good, is at least in part hedonistic because you're obtaining a positive feeling out of doing this thing for other people.

Margaret: Mm-hmm. 

Preston: And I guess hedonism isn't necessarily, like, a philosophy that the wheels will ultimately fall off on. I think if you're, like, looking at the, you know, bestial, uh, drives that you would see in Vegas, that's the only way you live your life, I think it'd be tough. But a lot of, a lot of people really are [00:37:00] kind of driven by, uh, like, hedonistic principles.

Like, even a bucket list is hedonism. It's all the, the fun, pleasurable experiences that you wanna get. And it, it's actually one kind of brings us into Frankl's philosophy, which has three tiers to it, and one of them is hedonism. So- 

Margaret: Viktor? 

Preston: Viktor Frankl, yeah. 

Margaret: Big V. 

Preston: The one and only. 

Margaret: Logotherapy. Number one, number two, number 

Preston: three.

He's our guy. So, um, Viktor Frankl describes three types of meaning that humans take or, or find in their life, uh, three flavors, and the first one we've already described, ex- which he says is experiential meaning, which is what you... what can you get from the world? The world is a fruit tree. What can I harvest and enjoy?

And, and that's kind of, like, the hedonistic perspective. The second one that he describes is the, the creative meaning. So that's, like, what can you give to the world? What can I construct? What... [00:38:00] Either, like, with my artistic works or my legacies, or even just my contributions to the experiences of others and, like, leave my mark on the world.

So tho- those two things are often kind of the push/pull that give people a lot of meaning. But he does describe a third one, and I find this one pretty interesting, which is the attitudinal, um, position towards meaning. A- and I think you're, you're smiling 'cause you're familiar with all these Well, 

Margaret: I just think his book is, like, the best, like, his most, like, Man's Search for Meaning is the, probably the best explanation of all three, but particularly this, like, attitudinal holding when he talks about being in the concentration camps and, like, holding the idea of his wife, who he didn't know if she was alive or dead and thought she was probably dead.

But just the, like, moving towards the image of her in his mind as to a way to get through the camp, even though he kind of, like, knew/thought she was probably dead. Um, I s- um, why I was smiling, not 'cause that's, like, happy, but, like, [00:39:00] he just writes about it from such, like, an experience of obviously horrific situation, but depth of, like, "This is how I use this to get through."

Mm-hmm. 

Preston: And 

Margaret: talking about other people in the camp of, like, "This is what the people who I noticed made it through had." 

Preston: Yeah, absolutely. I think there's... I, I, I don't think there's a, a more unique or, or potent, um, book written about that. And I, I, uh, I take a, I borrow a lot from, like, kind of the, the attitudinal position of meaning because I think I've, in a lot of ways, sometimes find the, the experiential one unsatisfying.

Margaret: Hmm. 

Preston: Um, but the f- but the attitudinal one resonates a lot with me. I, I know when I was a med student and was rotating through the ICU, and I guess even on internal medicine wards, and I was seeing a lot of, um, different scenarios where, where people are coming to end of life care and interacting with palliative care, the, the [00:40:00] largest takeaway I had from that, and something that gives me peace, is this, like, resolution I had that I just wanna, like, face life with dig- face death with dignity.

Not, not with, like, I, I don't want, you know, tubes around me, staying full code, pleading to try everything at the end. I'm, I know death is coming, and I just wanna face it with dignity. And I, and I think it, it was, it's strange 'cause that's the-- I didn't know it was the attitudinal perspective at the time, but that was something that, that gave me a sense of meaning just by, like, coming to that conclusion.

Margaret: Mm-hmm. 

Preston: And, and ultimately, like, that's, that's the primary problem that most people will have to, to find with or apply the attitudinal sense of meaning is towards their inevitable death. But it, but it can apply to any situation that, that you ultimately can't control or can't escape. 

Margaret: Yeah. Yeah. It makes me think of the stuff we've talked about when we did the episode on acceptance and commitment therapy, uh, which has a lot of overlap with this, of [00:41:00] often acceptance and commitment therapy is helpful when we can't change some part of the situation or illness or whatever it is, like whether it's chronic pain or OCD.

Um, and the acceptance or the willingness is kind of accepting that for right now, the experiential part of this is not gonna be the thing that brings you meaning. But the way that you do it Could be. And then the creative part, like also that you were saying could be, but especially like this is how I do this even though, you know, I have chronic pain and I can't move around like I used to.

I can tend a garden up on a shelf in, you know, little individual pots and pans, even though I can't work the land that I used to be a farmer for for the last seventy-five years, I can do this. And I just-- I think it's such an important way of helping people move through the world when they get to points that require that way of surviving, I think.

Preston: Yeah. It, [00:42:00] it really is. And, and I'm, I'm glad it's included because I think intuitively a lot of us can come to the creative and experiential, but it's-- I think the third one is, is the strongest. So- 

Margaret: I mean, I think that's what like modern culture and social media shows the first two. But the last one is something that I think is only celebrated in like the most extreme kind of hope core case videos.

And I think that the world's mental health would be a lot better if that was something that was what people were consuming more often, was this third one of how do I live in a way that, I don't know, is admirable, is good. How do I face 

Preston: the music? 

Margaret: Yeah. Well, but how do I live the thing that I've always been trying to live even when my life is different?

And like how do I stay the course through the end? 

Preston: Mm-hmm. So, uh, i-in summary, uh, we-- from this section, humans need meaning to live is the postulate. You can disagree with [00:43:00] that if you'd like. Uh, and there's no apparent road signs that just tell us we're meaning this way to meaning the next two hundred miles like it's some kind of Buc-ee's or something.

But we have found that humans find meaning in a couple different ways. The, the ways we experience stuff, create stuff, our attitude towards things boils out into hedonism. Meaninglessness in its purest form is a bit paradoxical, but if you're, if you're not too concerned about that, Preston will misquote Sartre probably and lead us on a fun discussion and a hypothetical chase.

But when we come back- We'll talk 

Margaret: about in the Spotify comments. 

Preston: We're-- Find us in the Spotify comments, please. We will ground this a little bit in how do you actually talk about meaninglessness with your patients, because it's certainly fun to chin scratch and talk about all these philosophies, but what happens when they show up in the clinic after these messages?

And we are back, and [00:44:00] we mean it this time. I can say that probably like six... Probably two more times, I think, to make that joke. 

Margaret: They're just like written on a whiteboard behind his desk, and he's just crossing one off each time. Yeah. There, there's a little 

Preston: elf in my window, and he's etch- he's tallying the amount of times I've, I've said we mean it.

And I just did it again. Oh, God. He's crossing it over He's threatening me with his body language. Let's get back to this podcast. So when a patient comes to therapy and they say their chief complaint is meaninglessness, I just have no meaning in my life. Open floor. How do you approach that? Or what are even things that you think about?

Margaret: Oh. I mean, I-- my aim, I don't know that this is right, and I kind of feel like this has been my aim the whole 

Preston: time. There, there's no right or wrong answer here. This is open 

Margaret: floor. Well, I think this might be wrong. Uh, but my aim with all my therapy patients, and this was true before I was a child fellow, is to make therapy fun before it's anything else.

And I think that [00:45:00] fun is also part of helping people find meaning again. Because I feel like the-- when someone comes in, it could mean a lot of different things. It could mean depression. We would work that out. It could mean, you know, horrible grief and trauma. We would work with that in a specific way. Or it could mean just like really like lack of engagement with their life in-- for whatever reason.

But I feel like I have no meaning in my life is this thing that's almost like it's out here, out in the world, like up in the sky. Someone's gonna come and give you this like big grand finish line of now you have meaning in your life. And I think I like to make therapy fun, one, because it makes them come back and be intrigued and be kind of like, "Okay, that wasn't as hard as I thought it was gonna be round one."

Uh, this is before all the exposure therapies and everything, or all the exposure and response prevention where things get hard. But like I think that there's a lot of stuff with meaning where we can-- our field and just people in general can get very like intellectualizing [00:46:00] cognitive pie in the sky. And I-- my personal belief is not that-- is that meaning is found and made as much as it is thought of or believed.

And so I start by making therapy fun so they wanna come back, and I try to make therapy experiential in terms of giving homework and other things over time. And then as we do therapy, reflecting back to them what seems to be resonating the most and kind of lighting them up and helping them find purpose and, and seeing if I can follow their lead like closely and think about them and kind of allow reverie to be the thing that helps me reflect on them and then bring back to them like, "Does this feel like part of something deep in you?"

That is-- that's my approach. Preston- Um- What is yours? 

Preston: Wou-would you be surprised if I said you're exactly right? 

Margaret: I thought you said that wasn't right or wrong. 

Preston: Well, I, I decide that I'm the king here. This is a Preston- I think he's a king ... 

Margaret: episode. All hail the king. 

Preston: Yeah. The... No, [00:47:00] so I, I guess you've already hit on the, the bullets that I was going for, which the, the first one is that the, the problem of meaninglessness cannot be taken at face value when the patient comes in with it as their chief complaint.

So, um- You... It can be a trap for the therapist to want to join the patient in this toil about what is the meaning of life- 

Margaret: Good word ... 

Preston: because spoiler alert, you're not gonna find it. Nietzsche didn't find it, Hume didn't find it, Sartre didn't find it. Like, you with your like- Colsoy's garden 

Margaret: did, though. 

Preston: Yeah.

Yeah, y- you with your like MD or PhD or- With your psychiatry degree. You're not gonna figure it out with this person right now. So, so like- 

Margaret: When did you last have fun? When did you last giggle- And, and- ... listener? 

Preston: So, so it's... This is funny 'cause like this is like the first time in medicine that... Well, maybe not the first time, but, but one of the first times in medicine where we say outright, like, "Don't [00:48:00] accept that at face value.

It's probably something else hiding." So that's kinda how you have to treat meaninglessness at first. Is, is this actually a problem of death anxiety? Is it a problem of isolation, or is it a problem of like, um, freedom and responsibility? So the, the f- Rather than asking directly about the meaninglessness, you, you kind of try to explore the other things that give them distress in their life.

Like, is this person calling out meaninglessness when really they, they don't feel close to anyone, and that's their problem? And, and granted, the two are very intertwined, but is their chief problem isolation, but it's easier for them to say that they lack meaning than that they're lonely? So that's kind of the, the avoiding that first mistake of, "Let me just commiserate with you about how meaningless life is, and let's start there," that's, that's o- one thing that you gotta avoid.

Um, the, the irony of all this is that we've been talking a lot about getting patients to uncomfortably turn their head to look at the problem in these previous three existential [00:49:00] psychotherapy episodes. 

Margaret: Look at your death and acknowledge that you, that 

Preston: you can't survive forever and you will die. Okay, now, now go back and like- Sensory exposure therapy

have some reprieve, you know? Or we're like, "You are, you are free and you can't escape that. Deal with it!" You know, we're like we're... We, we get patients to look head-on at these things. But, but with meaninglessness, you do the opposite. You don't want them to look head-on at it because 

Margaret: it- I... Yeah, I mean, I didn't know we were saying, "

Preston: Look head-on at the other ones."

It's just gonna lead you further into the pit. Yeah. No, I mean- Pit. ... no one wants to look head-on at the other ones, but it's therapeutic to look head-on at those. It's not therapeutic to look head-on at this one. Preston's doing boot camp therapy. 

Margaret: He's like, "Soldier, drive." "You will never live a meaningful life if you can't look death in its face."

Preston: Yeah. Yeah, it was like, it was like one of the quotes from the first one, like, um, "He who... He can only live a meaningful life is he who's prepared to die every day." You know, it's, it's a truth that we see repeated over and over again or, or [00:50:00] at least a pattern, right? I won't go so far as to declare it a truth.

Nothing is true. We, we can't know anything. So the... When you aren't dealing this head-on, what do you do instead? You make therapy fun Which is what what you are already getting at. There, there's a really lovely example in the book where, um, Yalom's talking about this patient that he could not find any rapport with.

And, and it was, it was mutual in a way. He had bad countertransference with the patient, the patient did not have great transference towards him. And the patient he describes was this guy in his mid-30s who was completely isolated, and all he would do whenever he had free time was tinker on his stupid computer, is how Yalom saw it.

He had this giant supercomputer- Oh, he would hate, 

Margaret: he would hate people in 2026. I thought 

Preston: you'd crash out. 

Margaret: He'd be like, "This is why 

Preston: you 

Margaret: have the loneliness and mental health crisis." But, 

Preston: but this patient [00:51:00] is like a special level- Yeah ... of computer science guy. Like, it was an IBM type supercomputer, like a, like a mini engine in his office, like it's a big thing.

And he was, he was like, "So what do you like to do for fun?" "I tinker with my computer." "Do you hang out with anyone?" "No, I tinker with my computer." And then that was their back and forth, and Yalom's like, like, "I hate you." Like I think he didn't say that, but I think at one point he was like, "I didn't like the patient."

He was like annoying him. And he finally swallowed his pride and started actually asking him, "What do you actually tinker on when you're tinkering it, with it? Like what, what, like let me come alongside you and try to figure out what screws you're twisting or, or what modifications you're making." And he came to realize that the tinkering in a way was actually a great creative outlet for the patient, in that he was coming up with new ideas how to optimize the computer and make it better, and I can, you know, it can run X [00:52:00] programs at a faster speed this way, or I can add this adjustment to it, or maybe if I install this fan it will be quieter.

So, uh, but I have to do it creatively 'cause these problems like contradict each other. So once he realized that the patient like was finding meaning in this, so there's that creative meaning, he's constructing something and sharing it with the world, that, uh, that Frankl talks about, then, then he was able to get to know the patient better and then channel those aspects of meaning into other ways, other forms of engagement.

So Yalom actually says the step one is don't buy in and face the question head on, and step two is try your best, even more than, than other ways, to get to know the patient really well. And really try to dig in and find w- anywhere in their life that they have little sparks or like little like tinders of that- 

Margaret: Sparks

Preston: those three categories of meaning, and then fan them, you know? Yeah. Like I found the spark, like [00:53:00] like let's get this burning a little bit. You do have meaning when you work on your computer. How can we channel that into other things? So that, uh, I mean, that's exactly what, what you're describing right now.

And, and And the thing that I would say is to, or that I got from the book, is to, to look at the most banal things that you may have grazed upon the first time and kind of go back and say like, "Why does this person do that?" Be, be very non-judgmentally curious as much as you can. And the, this kind of gets into actually a, a concept that Frankl describes when he tries to approach the problem meaninglessness with patients, which is called dereflection.

Margaret: Hmm. 

Preston: Is that anything you've, you've come across before? 

Margaret: Mm-mm. 

Preston: So e- essentially, it's the idea that when you are in your circle of meaninglessness, despair, you focus a lot inward on yourself. And the point that he tries to [00:54:00] make to dereflect to patients is to get them to immediately focus on others. And that's ultimately the best way that we found at least to come out of that galactic perspective tunnel, is to stop focusing on yourself so much and focus on others, and bring the perspective outward again.

And you... and it's not helpful to be like, "Oh, like think about how meaningful it is to focus on others." It's literally just like almost like distracting a child. Like, "Look at this." Yeah. "Let's, let's talk about that." And then before you know it, you are, you are finding a sense of meaning. 

Margaret: No, it's like you have to go underwater into the experiential versus being like on like, on a dry boat looking down into the water and being like, "Look, there are fish down there."

It's like, no, you have to like get in the water and- Mm-hmm. I think one of the things that for me is both really fun about therapy but also really interesting is that ability for whatever reason, in ways my brain works well and does [00:55:00] not work well, probably a combination, like that thing of getting into an experience and being lost in it has always been very easy for me.

Um, not great in other, in any other instances. But like with patients, it's interesting to see people's different, you know, to continue the metaphor, their ability to actually like not stand outside of experience and look in on it or judge it or like... And you know, there's all sorts of pathologies we could name that, but to actually get into it.

And I feel like for me, one of the... And sometimes this happens in exposure, like in response prevention therapy, that there'll be that moment where you're saying like you get that spark, whether that's joy or just like aliveness. And to me, that is like the best part of being a therapist or a psychiatrist is when you do get those little glimmers with people, especially the ones who started therapy like maybe this guy that, um, Yalom describes, like where they, they really-- You can't feel their aliveness within...

You can't feel it within [00:56:00] them. Maybe they can't feel it. Maybe they can't share it. I don't know. 

Preston: Yeah. It's not prima facie, as Yalom would say. He, he loves that phrase. 

Margaret: What does that mean 

Preston: again? It's just Lat- It's, it's Latin for like- The, the n- the main face of it 

Margaret: Uh-huh. Oh, okay. Yeah, yeah. Yeah. It's 

Preston: not front and center, yeah.

Margaret: Do you know what I mean, though? Do you know that feeling? 

Preston: I know, I know exactly what you mean. Yeah. And like, that's, that's why I'm using the analogy of, like, when you're on a camping trip- 

Margaret: Yeah ... 

Preston: and you're, like, using the flint, and you're just trying to get a spark to land somewhere, and then you're looking through, you're looking through all the tinder, and you're like, "Oh my God, this single piece of grass is, like, starting to burn a little bit."

And then like, let me do everything I can to, like, encourage this flame to build up. Yeah. So it's, it's like when I'm with a patient, I'm at the campsite, I'm looking for that little ember, and let, let's go. Yeah, we got something. Let- like, let's cook with this. 

Margaret: Let's cook. Let them cook. 

Preston: The discussion in the, in the book actually takes a, another turn towards poetry, and there's this poem that I was really moved by, by Basho, um, Basho, who's a, a Japanese [00:57:00] poet from the 1800s, and he wrote this haiku called...

I don't know if it's called anything, something about nazuna. Anyways, the haiku goes like this: "When I look carefully, I see the nazuna blooming by the hedge." And that's it. That's the whole haiku. And, and I find that so beautiful, and I know it sounds kind of silly, but nazumo, or nazuna, it- it's, it's like shepherd's grass or shepherd's ear or something.

It- it's like a dandelion. It's a weed. And, uh, what he's saying with this poem is, "I'm observing the most banal, often overlooked piece of nature, and I'm excited to see it." And, and the entirety of the poem is just me looking at this weed, and it's finally in bloom. What do you know? And, and I think that that, in its core, is, is de-reflection and [00:58:00] focusing and engagement in your environment.

And, and that's kind of why I sent you that meme yesterday, which I'm gonna ask the producers to make it the thumbnail for this episode. Which is, it's the, the bell curve meme where We'll... Put... I'll, I'll share. I love that meme. We'll put it on the screen right now. That format. But essentially, on the on, like, the 5% IQ, where there's, like, a, the fool, he's like, "Nice weather we're having today."

And the middle IQ is like, "No, we need to talk about meaninglessness and freedom- ... and the ultimate question. What are we all gonna do?" And then it goes to, like, 99th percentile- I saw that ... IQ, and he's like, "Nice weather we're having today." 

Margaret: It really is. That, that meme is always... It always is correct. Because you gave me a poem, I'm gonna give you one that is, is exactly like this, which is also Mary Oliver, uh, which is called I Go Down to the Shore, and it's, like, eight lines.

"I go down to the shore in the morn..." She lived, by the way, in Cape Cod in Provincetown. "I go down to the shore in the morning, and depending on the hour of the waves are rolling in or moving out, and I [00:59:00] say, 'Oh, I'm miserable. What shall, what should I do?' And the sea says, in its lovely voice, 'Excuse me, I have work to do.'"

And I just love it. Just love it So 

Preston: good It's 

Margaret: like, it's like- 

Preston: That's really good ... 

Margaret: it's like, "Excuse me, bitch, I have work to do." I 

Preston: asked you a question. I need to sh- I, I have some patients that would benefit from that poem. I may share it with them. But yeah, the, like, the, the ultimate thing that you get at is that you're not gonna answer the question, so stop focusing on yourself so much.

Because whether you like it or not, whether you asked for it or not, you're alive. So now what? Look, there's Nezuma blooming by the hedge. The... And, and this is kind of when Yalom gets into this, the ultimate answer or the best way to help your patients being, um, with a kind of the Buddhist perspective, and this is actually the last sentence of the book, which I, I felt poignant enough to include here: "The question of life is, as the Buddha taught, not [01:00:00] edifying.

One must immerse oneself in the river of life and let the question drift away." 

Margaret: Beautiful. 

Preston: Or in other words, 42, like, like in The Hitchhiker's Guide to the Galaxy. 

Margaret: I haven't seen it, but I'm sure our listeners 

Preston: have. Oh. But it, it's the same idea. Everyone, it was so obsessed, they made this perfect super computer and asked it, "What is the meaning, uh, like, what is the answer to life?"

And then it's like, um, the computer goes, "I'm gonna need to think about that." And then they come back, like... They're like, "How long do you need to think?" And he's like, "Mm, two million years." And they come back, like, two million years later or, like, 40,000 years later, however long it is, and they're like, "Okay, what is it?"

And, like, the entire planet's gathered around the computer. They're all ready to celebrate. It's like a national holiday. They're like, "We're getting the answer today." And they're like, "Do you have the answer, computer?" And the computer's like, "I do, but I don't think you're gonna like it." And they're like, "Anything is fine.

Just tell us." And it goes, [01:01:00] "42." The crowd drops silent. And someone in the back is like, "What?" And they're like, "Yeah, 42." And they're like, "We asked you what the answer to life is," and then, and the computer's like, "It's not a very good question." 

Margaret: Yeah. "

Preston: I'm supposed to answer a question, but, like, like, where is even the question in this?"

Margaret: First ChatGPT. Just having 

Preston: a back and forth, and then they abandon the computer or whatever. So- Wait ... some of the characters- 

Margaret: What does ChatGPT answer if we ask it that question? 

Preston: Oh, that... Yeah, a-ask it right now. I'm curious. 

Margaret: Can I do it from, like, 

Preston: Google? What if, what if ChatGPT just says, "I'm working. I got stuff to do."

It's just like the ocean. 

Margaret: I'm working. It probably... I mean, you know? That would be cool. 

Preston: Dude, I bet you it's a... It's like, "Wow, Margaret, what a thoughtful question. You're really thinking about the hard stuff right now." 

Margaret: And that's not only deep, it's also insightful. And 

Preston: it, and, and that counts. 

Margaret: What? And, and that count with an em dash with a little sparkle emoji.

What is the... What was the [01:02:00] question from the movie? 

Preston: What is the answer to life? 

Margaret: I'm using the browser version of this, so no one in our comments hate on me for using AI one time. What is the answer to life, right? 

Preston: Mm-hmm. 

Margaret: It's thinking. We're gonna go on this two million year commercial break. It's 

Preston: like, it's like I'm gonna need to think about that for a while.

Margaret: Okay, wait. It said, "The classic answer, thanks to The Hitchhiker Guide to the Galaxy, is 42. Of course, that's a joke," blah, blah, blah. "If you're asking more seriously, people usually land on a few big IDs, ideas. Meaning is something you create, not something handed to you. Relationships and connection tend to matter most.

Growth, curiosity, and experience give life depth, and purpose can come from helping others, building something, or understanding the world. So the real answer isn't a number. It's something you define over time." 

Preston: And that's what matters. Thanks, chat. 

Margaret: Thanks, ChatGPT. You 

Preston: did it through this whole episode. So th- this kind of brings us towards the end of the, the main part of the podcast.

We are gonna hop into Patreon world for a little bit to do [01:03:00] some kind of reactions to one of my favorite speeches. We were originally gonna, gonna look at Frankl interviewing a patient, but I couldn't find any of that, and I just found a bunch of choppy clips of him kinda just doing back and forth with reporters, essentially hashing out the ideas we've already talked about.

So decided to go with something a little bit different, but we are gonna skidaddle off to Patreon, and then we will be back to close things out. 

Margaret: You can catch the next part of this on Patreon. 

Preston: It's patreon.com/happypatientpod. You guys missed a, a fun, nice little video about goldfish in water and whatever else.

Thunder. We talked about the meaning of life. How's the show? Let us know what you think. We wanna hear positive things, and Shahnti wants to hear negative things- You can be mean on Shahnti's channel. ... 'cause she, she wants us to be better. But we're, we're complacent. We're happy the way we are. If you do wanna say anything, you can go on Instagram and TikTok @humancontentpods or contact the team directly at howtobepatientpod.com.

You can see more from me and Margaret. I'm on YouTube at [01:04:00] itspresro and Instagram, and Margaret's @badarteveryday on Instagram, TikTok, TikTok, Substack, and anywhere else we've linked her in the show notes. She's, sh- it's kind of like a Where's Waldo of the internet, where, where is Margaret? It's, she's somewhere.

Margaret: Mostly 

Preston: Substack these days. But there's probably gonna be a link. 'Cause there's no 

Margaret: ads. 

Preston: So yeah, mostly Substack these days. You heard it here first. Shout out to all our listeners leaving kind feedback and awesome reviews, like Brewster in the Spotify comments, who said, "Love The talk about acrylic nails for skin picking and scratching.

Margaret: Okay. 

Preston: Go watch the- Okay. Go watch the grab bag episode. We do have some, like, kind of fun tips in there about, like, just random off-the-wall stuff. Like, if you're worried about skin picking and scratching, you can wear acrylic nails and it's... You're not gonna feel that feeling on your nails as much, and also does less damage.

Who would've thought? That's fabulous. Margaret would've thought is the answer. 

Margaret: Preston, in our last episode, we'll be wearing acrylics. Baddies. [01:05:00] I'm sorry. 

Preston: Thanks again for listening. We're your hosts, Preston Roche and Margaret Duncan. Our executive producers are me, Preston Roche, Margaret Duncan, Will Flanary, Kristin Flanary, Aron Korney, Rob Goldman, and Shahnti Brooke.

Our editor and engineer is Jason Portizo. Our music is by Omer Ben-Zvi. To learn more about our program disclaimer and ethics policy, submission verification and licensing terms, and our HIPAA release terms, go to howtobepatientpod.com or reach out to us at howtobepatient@human-content.com with any questions or concerns.

How to Be Patient is a Human content production.

How to Be Patient. Thank you for watching. If you wanna see more of us or if you wanna see... This is Lilac. She's my cat. She's gonna be waving her [01:06:00] hand at one of the floating boxes, which will lead to more episodes. Lilac, point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there.

They pr- they probably exist for real. But in the meantime, I'm just gonna pet Lilac, and then I'm gonna go dance in the background.

How

Margaret: to 

Be Patient.