Davis group focuses on finding meaning
in the face of suffering
“When we are no longer able to change a situation, we are challenged to change ourselves.”
— Viktor Frankl, “Man’s Search for Meaning”
They gather on Monday afternoons in the serene quiet of Pamela Cordano’s office in the converted house on the corner of Fourth and F streets in downtown Davis.
Here, under the guidance of Cordano, a psychotherapist who specializes in illness and grief, a disparate group of eight people search for meaning in lives changed by both.
Some are working through the grief of lost loved ones, others are grieving the loss of a life once led — a life markedly changed by chronic or degenerative illness that limits their ability to do many of the things that once defined who they were.
One was a civil engineer and a runner, until multiple sclerosis robbed her of both. She found herself lying in bed for a year wondering, “What am I now, if I’m not a runner or an engineer?”
Another woman is in a wheelchair, able to move just her jaw and the fingers of one hand. A genetic condition has progressively immobilized the rest of her, she said. “Everything else is frozen … like a statue.”
As her condition made it increasingly difficult to work, and then impossible, she struggled to find meaning in life.
“If you define yourself by what your job is, and you have no job, what is your meaning?” she asked.
Finding that meaning, Cordano says, is an antidote to the despair produced by grief or loss.
“When we experience a significant loss or threat in our lives, our perception narrows, and we lose access to the fuller picture of ourselves and our circumstances,” she says. “Working with meaning gives us access to deeper and authentic parts of ourselves which are coherent, vital and resilient.”
Said one of her patients: “I can find things that make my life still meaningful and somehow my life may be meaningful to someone else.”
The late Viktor Frankl inspired Cordano to pursue what she calls “meaning work.”
Frankl, an Austrian neurologist and psychiatrist, lost most of his family, including his pregnant wife, in the Holocaust and endured three years in concentration camps himself. His book, “Man’s Search for Meaning,” published not long after the war ended, has profoundly influenced people the world over with its message that people have the ability to endure any suffering if they know their lives have meaning.
“Perhaps no one has taught me more about our uniquely human ability to discover and sustain meaning in the face of life’s inevitable tragedies,” Cordano says of Frankl.
But it wasn’t Frankl alone who led Cordano to this work of helping people find meaning.
In 2008, she came across the results of a clinical trial at Memorial Sloan Kettering Cancer Center in New York that looked at outcomes for “meaning-centered” group psychotherapy for patients with advanced cancer.
The trial objective was helping patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose even as they approached the end of life.
Patients with advanced cancer were assigned to either a meaning-centered psychotherapy group or a more traditional cancer support group that tends to deal with more practical issues like dealing with doctors and symptoms and pain.
Patients were assessed before and after completing the eight-week program and again two months later. Assessments included measures of spiritual well-being, hopelessness, desire for death, optimism, pessimism, anxiety, depression and overall quality of life.
The outcomes of the trial were significant for those in the meaning group.
“After just eight weeks, patients reported improved quality of life and sense of meaning as well as decreased anxiety, hopelessness and desire for a hastened death,” Cordano noted.
The improvements were even more significant two months later, but there was no significant improvement on any of these variables for patients participating in the traditional support group.
That’s not surprising to one of the women in Cordano’s Davis group.
After being diagnosed with multiple sclerosis, she said, “I was in a support group and people would come in and describe their ailments and the emphasis was on what was wrong and how bad we felt. It wasn’t uplifting in any way.”
People couldn’t move on from the fact that life had been unfair to them, she added.
Dr. William Breitbart, the Memorial Sloan Kettering psychiatrist who conducted the meaning-centered trial, did so based on the work of Frankl, and on the concept of despair.
At the heart of despair, Brietbart has written, is a profound loss of meaning in one’s life. But meaning-centered psychotherapy, his trial found, reduced despair, enhanced meaning and as a result, reduced hopelessness, depression and more.
“The concept behind Dr. Breitbart’s clinical trial was very exciting to me,” Cordano said.
A year after learning about the clinical trial, Cordano gathered a few volunteers from her practice, including people with advanced cancer, serious illness, disabilities and grief, and started the Meaning Group in Davis. She intended to follow the eight-week program used in the clinical trial, but seven years later, the group is still going strong.
So profound was the work and its impact on their lives that no one wanted to stop.
The group, which still has three of its original members, meets weekly in Cordano’s office.
On a recent Monday afternoon, they trickled into the room one by one. The six in attendance that day came from a range of backgrounds. Their ages and the reasons they were there varied, but they are a close-knit group.
“The best thing is the social aspect,” said one group member. “Checking in with everyone once a week.”
“But beyond that,” he added, “it’s good for me to think about what’s meaningful.”
So what does it mean to look for and find meaning?
Frankl, says Cordano, identified several universal sources of meaning that are available to everyone, no matter what they are facing:
- Love: the strongest bond between people and what leads to inspiration and sacrifice;
- Experiences: everything from beauty to music to nature;
- Actions: our work, causes, creative projects and hobbies;
- History: our meaningful stories and memories, the legacy we wish to leave;
- Attitude: courage, gratitude, generosity, kindness and compassion;
- Suffering: what we learn and how we grow from facing life’s unavoidable limitations.
Meaning doesn’t necessarily equate to happiness, Cordano notes.
“Funerals can be meaningful,” she said.
“And it’s not about positive thinking. It’s more about being in touch with what’s going on around you and being aware of the responses you feel. It’s about identifying what is uniquely meaningful to each of us.”
Said one group member: It’s redirecting your attention from your pain or discomfort to focus on what’s around you.
“It’s not just about, ‘My feet are numb. I can’t see out of my eye,’ ” she said.
She told a story about a recent chance encounter with a homeless woman in Sacramento. After giving the woman some money, she received in return an origami crane the woman painstakingly made out of a Splenda wrapper. It sparked a conversation, a connection, something that she would have missed out on entirely had she not been made open to the encounter through her focus on finding meaning in life’s small moments.
“That moment made me feel amazing for days on end,” she said. “This group makes me open to those experiences. You have a more positive effect on others and they on you.”
Moment to moment
Cordano is inspired by the courage and creativity she sees in the group members.
“Over the years we have come to understand that experiencing meaning happens in moment-to-moment ways,” she said. “Some group members have strengthened family relationships. Some practice mindfulness, attending to the little things that bring joy. Some focus on kindness, looking for ways to hold others’ well-being in mind.”
One group member, diagnosed with incurable cancer, acknowledged “moments where my knees weakened with the illumination of my mortality.”
But working with Cordano and the group, she said, has given her skills to focus on what is most meaningful now.
“It has helped me learn how to be present, how to sit with fear, pain, fatigue and not be overwhelmed by it,” she said. “It is an ongoing and ever-changing practice of learning to accept what is and to find ways of staying connected more fully to who I am.”
“This group is the treasure of my practice,” Cordano says.
“People ask, ‘Isn’t that group depressing?’ And I say it’s the least depressing (thing I do). I’m a better person, wife, mother and therapist because of what I do here.”
Cordano plans to continue with this group but doesn’t expect to add to it or to add more groups. However, she will be conducting one-day workshops on meaningfulness beginning in September.