Live with Meaning Despite Existential Dread

Many of my clients prone to depression find themselves imprisoned in a labyrinth of existential dread related to an array of serious and actual threats. These might include:

• Pollution and global warming

• Political divide

• Financial decline in our country

• Threats to healthcare

• Threats to minority populations, namely targeting diversity and LGBTQ identified individuals

• Rise in gun violence

• Other environmental disasters like the floods in Texas

From a cognitive behavioral standpoint, we see multiple common cognitive distortions at play:

• Cognitive filter: we have a bias towards familiar thought patterns and content. Depressive individuals are prone towards focusing on the negative and filtering out the positive.

• Dichotomous or Black-and-White Thinking: If something is bad (which we've already established that people with depression are more likely to attend to, focus on, or notice considering their cognitive filter), then it is dichotomously bad and polarly opposite to the good outcome. In other words, people with depression and anxiety have difficulty seeing the gray area.

• Catastrophizing: if things are dichotomously good or bad, people with depressogenic thought patterns also jump to conclusions about how bad the consequences will be. There is an assumption it will be catastrophic.

Locus of Control and Responsibility is another cognitive model for depression. It is an overestimation of what we are responsible for, and if we lack control over that - if we cannot have influence over something we take responsibility for - we are setting ourselves up for depression. This would result in a learned helplessness (yet another theory of depression): when we have continued to try to change something negatively impacting us and learned we have no influence over it, we eventually fall into a depressive apathy.

This cognitive style is an over-controlled one, or, in terms of Blatt's polarity, focused on self-definition rather than relatedness.

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Challenges in Therapy

A rule of thumb is therapy is working from surface to depth. In other words, we must acknowledge, validate, and empathize with the current state before moving on to deeper layers or other content. In other words, validate and empathize with the client's worry, acknowledge their compassion and value system, without encouraging or condoning a depressogenic stance.

Once we've done this, we can start to challenge the cognitive distortions. However, there can be pitfalls. If we have not adequately validated (per paragraph above), this will seem insensitive to a topic that is dear to our client's value system - and likely our's too, as therapists tend to be sensitive to these topics as well. We must be clear that challenging the intensity of their focus on this is not diminishing its value. One one to think about this is starting with challenging the cognitive filter: what else is there in the world? It doesn't change how bad or concerning this thing might be to acknowledge that there are good things too. In terms of a mental image, we can imagine a visual of this problem - it is right in the face of the client - but if they zoom out, the problem hasn't changed, only our perspective in allowing us to see more of the entire reality of our world.

One response to challenging this cognition is that it doesn't matter - this bad thing is so bad that it will ruin the future and destroy all that is good. For example, "why would I bring children into this dying world?" This response highlights to two other cognitive distortions: black and white thinking and catastrophizing. "Yes, this could be catastrophic, but I don't think we are ready to call the match yet. Could the joy of having kids, for both them and you, still be worth it despite an uncertain future?" While we could argue some problems are worse than they've ever been, existence - both in the human blip of time and far beyond - have seen dark times and good ones follow. An analogy might be a depressed person saying "I need to break up with you to save you from me (my depression)," and they partner saying, "I'm an adult and offended you think you need to make that choice for me." Likewise, the depressive stance that all good things are null is not theirs to make - sure, they may not want to have children, but there are still beautiful and joyous things in the world that are completely available for them to partake in if they so choose.

This still leaves the question of locus of control and responsibility. The problem with the over-controlled cognitive style is that the black-and-white thinking cognitive distortion also applies to the self, per Blatt's polarity highlighting the importance of self-definition - we might call this perfectionism and involves high standards and expectations in areas of the person's individual value system. Someone who values work ethic becomes a workaholic because they struggle to live in the grey area. Someone who is focused on environment and pollution has trouble accepting that doing their part is all they have control over and can take responsibility for. Of course, we each draw this line differently - maybe most of us recycle at home, some of us might bring home cans or bottles if we are out in public and cannot find recycling, others of us go into public spaces and clean on occasions like Earth Day. However, we must find a reasonable line - reasonable as in it matches our person values system and is something we can plausibly do without failure and learned helplessness. We must set a reasonable bar and learn to accept it.

Once we do so, and do our (reasonable) part, we must practice mindfulness to relegate focus on the negative to a confined chunk of mental real-estate and spend the rest of our time and mental real-estate on what is good in the world.

Other actions: grief, processing and advocating

In addition to the existential and cognitive work described above, there still may be a need to process grief about the state of things. Often grief and trauma results in a psychological impasse or limbo because our former presumed vision of the future is seemingly irreconcilably fractured from a new (frequently less positive) image of the future. Once we have accepted our role (locus of responsibility), we can grieve the current state and possible future outcomes.

One area in which people do have control and responsibility without devoting their lives to, say, collecting all the trash off of the US highway system, is advocacy. This could be joining or starting groups, which often also helps with interpersonal needs, or letter-writing to politicians. Letter writing can be therapeutic in-and-of itself, let alone being a good source of agency.

Live with Meaning

While I identify with existential philosophy and therapy on a personal level, by no stretch of the imagination would I consider myself specialized or an expert. Existential philosophical opinions of meaning range from absurdism and that life is essentially meaningless to positing we must actively go out, find and make meaning. Other perspectives include that meaning is sort of right in front of your eyes.

There is significant risk, I think, in the notion of finding meaning. That conquest can be set in motion by obfuscation of what is meaningful from what should be meaningful. When we act on what should be, we act on external rules, expectations and motives, or extrinsic motivations, rather than intrinsic. Consequently, the outcome isn't finding meaning, but seeking approval. In other words, it is a narcissistic self-object need that occludes or eclipses our ability to perceive actual things of potential meaning. It often sounds like "if I do something large and grand, it must help people and I will be lauded, and then I will feel good. Right?" However, at the end of the day, the good-doer who flies under the radar can be both more important to society and find more meaning doing so.

I have multiple clients who are or were coaches as a major part of their career. During moments of meaninglessness - mostly shaped by depression from meaning being occluded by extrinsic motivators - we reflect on the meaningful interactions they had with swaths of young-minds over many years. We reflect on the importance of their coaches in building of their esteem and shaping how they treated themselves and others, how a good coach changed their lives, careers and impact on others. My wife works in Sexual Violence Prevention Education and one of the few interventions shown to reduce sexual violence is the program Coaching Boys to Men. Moments of genuine conversation with young men significantly alter the way they treat others down the road. Not only does this reduce sexual violence - an act that removes by trauma contributors to society (people who experience sexual violence experience not only immense personal detriments, but also their ability to contribute positively to society can be at least temporarily diminished), but also we know people "pay it forward" and treat others the way they were treated - they treat others with the same genuineness and kindness the coach showed them.

We all have discrete moments in our lives and days that we can stop, slow down, truly listen and show someone they are important, and this sends ripples of goodness into our future.

I consciously practice this multiple times throughout the day with my clients and children. To shut out everything in my world to give full attention to the other. To enter their world. This communicates on a deep level that you care and the other matters. But guess what else? It also often brings us meaning.

In other words, meaning is in genuine human connection, and is waiting right in front of us. We can get this through having a meaningful occupation, but it isn't through achievement or recognition. It is about impacting others on an individual level or personal meaning we find in the work.

As a psychologist, I've had the opportunity to work with many supervisees. One thing we find is that there are regional "styles" to psychotherapy created by this network of mentors, and those mentees become mentors and also pay-it-forward. This is not primarily shaping skills, but shaping individuals. Each therapist who is positively impacted by a mentor may go on to positively impact dozens of mentees and hundreds of clients. Are we alone making sure the world keeps spinning - inflicting measurable change directly on the things my depressive clients are worried about in the world? No. But it is a drip in the bucket. It is my drip. It is what I can control. It is what I can contribute. It is what I can be responsible for. And I have to be ok with that.

In fact, I cherish it.