There are a handful of junctures in life when a person’s sense of purpose is prone to twinkle and fade. In unemployment or professional stagnation; in financial or romantic straits, or after the death of a loved one; and, predictably, in retirement. To that point, the program Experience Corps seems to have stumbled into an elegant solution. For the past decade, the nonprofit has paired people ages 55 and older with students in kindergarten through third grade who need academic help. Across 19 U.S. cities, volunteers have taken up literacy coaching and proven that in their spare time they can significantly increase students’ test scores and morale. Which is great, of course. But the unexpected side effect of the programs was that the adults experienced significant health improvements, both mental and physical. The tutors’ rates of depression fell; and their physical mobility, stamina, and flexibility increased. They also showed improvements in executive functioning and memory.
One of the drivers of those health benefits, according to Eric Kim, a doctoral candidate examining the intersection of social connection and physical health at the University of Michigan, is that the tutors developed a renewed sense of purpose in their lives. In research published today in the journal Proceedings of the National Academy of Sciences, Kim and colleagues found that people with greater senses of purpose in life were more likely to embrace preventive healthcare: things like mammograms, prostate exams, colonoscopies, and flu shots. In the study, people rated their own sense of purpose on a multidimensional questionnaire that included incisive prompts like, "I sometimes feel I've done all there is to do in my life" and "I enjoy making plans for the future and working to make them a reality." Even after the researchers accounted for socioeconomic factors that predict a person’s likelihood of getting preventive care, people with purpose in their lives were clearly more engaged in their own health.
The idea of cultivating purpose as a means of improving a patient’s health is not ingrained in U.S. medical practice, but it isn’t novel. Viktor Frankl, after surviving Nazi concentration camps, wrote in 1946’s Man's Search for Meaning that his fellow prisoners tended to lose their sense of purpose first, and then get sick, and then die. He proposed that people live longer when they have a greater will to live; that a person might actively cultivate purpose—carefully distinguished from pursuing happiness—as a tenet of physical health. Still, modern doctors are not trained (or reimbursed) to counsel patients on their purposes in life. But the idea, which might seem sappy or self-helpy—a vibe that rightly engenders dismissiveness because of its appropriation by unscientific profiteers—could be concretely beneficial. The U.S. healthcare system spends more than twice as much per patient as almost every other wealthy country, owing in part to a lack of emphasis on, and compliance with, preventive health services. A stitch in time, as they say, saves the exorbitant hospitalization and surgical costs of draining an infected laceration.
So some of the roughly $3.8 trillion in U.S. medical spending could be defrayed, it seems, with purposeful cultivation of community and meaning. Only around 4 percent of U.S. health expenditures go to prevention, and most adults are delinquent in their recommended health screening. Those statistics converge with past research that shows that purpose is associated with things like exercise and intentional relaxation. Researchers at Rush University Medical Center in Chicago found that greater purpose in life was associated with a reduced risk of Alzheimer’s disease. Kim’s own past research has found that a sense of purpose predicts fewer subsequent strokes and heart attacks.
"I know when I go to the doctor, they do depression screening,” Kim told me. “But just because a person doesn't have depression doesn't mean they have a high sense of purpose.”
Frankl, who was a psychotherapist and student of Freud in Vienna, did have an approach called logotherapy—a strategy to discover meaning that centered on the tenet that all life is meaningful, if not recognizably. But logotherapy often involved rigorous psychotherapy, often in groups, often undertaken for many years. As Victor Strecher, a professor of health behavior and health education at University of Michigan School of Public Health and co-author of today’s study, notes, that is just not practical for most people today. Randomized control trials have recently shown that purpose can be cultivated with months of group psychotherapy. A study earlier this year showed success in people with cancer. But commitment, access, and compliance are hurdles. So Strecher has taken up purpose cultivation as the thrust of his career in recent years. Or, in his words, "What would Victor Frankl do now?” What would be the postmodern approach to helping people develop greater purpose?
"I think we're in an increasingly nihilistic world,” Strecher said, where it’s not necessarily standard to aspire to “something beyond just watching the Kardashian sisters on television and seeing what they're doing." When we spoke, he cited Nietzsche offhandedly, in his warning that as God dies in our lives, as we leave our families—in other words, as we modernize—people have to start finding their own meaning and values. And Emile Durkheim, who wrote in 1897’s Suicide that as we no longer live in the same villages as our families, growing disconnected, we’d increasingly kill ourselves.
But don’t despair, because as we are connected and calm, we see increases in purpose. Elizabeth Blackburn, a professor in the department of biochemistry and biophysics at University of California, San Francisco, won the 2009 Nobel Prize in Medicine for her work relating psychological stress to physical aging. When our telomeres—the protective caps on the ends of chromosomes, like the plastic caps at the ends of our shoelaces—shorten, our chromosomes fray, and we tend to get sick and die. An enzyme called telomerase (which Blackburn shares credit in discovering) slows that process. She has known for years that people who are under more stress tend to have shortened chromosomes. In one project, she put people into a three-month meditation program and found that, compared to a control group, the meditators had longer telomeres and increased telomerase activity.
But she also found that the meditators had an increased sense of purpose in life. “It was the purpose, not the meditation itself,” Strecher explained, that was increasing telomere activity. To his interpretation of the study, meditation was a mediator that created greater purpose; and then it was the sense of purpose that was related to telomerase activity.
“So, one approach, potentially, is meditation,” Strecher said. Specifically, in this case, Blackburn used something called loving-kindness meditation. The name probably isn't helping anyone overcome their aversion to new-age therapies, but it's pretty straightforward: You bring in a person who you dislike, and you start expressing love and kindness to them. In Strecher’s estimation, “It's a very difficult thing to do.”
Strecher just returned from Mannheim, Germany, a city he describes as “really interested in developing greater purpose." Before that, he was keynoting the Bass Pro Shops Wellness Conference in Springfield, Missouri. Everywhere, people seem to want to hear messages of purpose. (And not only, in the case of corporate conferences, because employees who have greater purpose and meaning in their lives are more productive.) As a lighter accessory to corporate keynotes, Strecher has also created an app called On Purpose that, along with its accompanying graphic novel, is intended to help people develop meaning and purpose in their lives. The app monitors the extent to which a person’s daily living is aligned with their purpose by measuring sleep, physical activity, diet, mindfulness, and creativity in association with 15 core values, like kindness, compassion, and security. The book is partially a personal story, related to the loss of his 19-year-old daughter Julia, who had been one of the first heart transplant recipients. When she died four years ago, Strecher lost his own sense of purpose in life. “The only way I could regain it was to think beyond myself,” he said, “beyond my grief; get over my own ego.”
In the spirit of keeping things upbeat and engaging, the protagonist in the novel is a dung beetle—a bespectacled Jiminy Cricket-like sage named Winston. Strecher chose to make him a dung beetle because the insect is the model for khepri, the scarab god in ancient Egypt charged with rebirth, transformation, and transcendence. "If you think about dung beetles,” Strecher said, and I did, “they push this giant ball of shit up to 100 yards in a perfectly straight line; it's the most purposeful thing you'll ever see in your life.”
And so, as dung beetles have their fecal orbs, so too can we all find some purpose in life that is bigger than ourselves.
As a behavioral scientist in a school of public health, Strecher was long used to helping people manage their weight, quit smoking, or manage diabetes. His methods, like most health professionals, focused on emphasizing the negative long-term outcomes. Cancer. Heart disease. Death. He'd never really thought that much about ego or purpose or transcendence. But as he started learning more about them, he said, it turned out there was a really important, growing body of science behind it.
"If things like purpose in life are rejected simply because they are philosophical ideas [not generally associated with the science of medicine],” he said, “that's a problem."
Put that way, it seems obvious. But notable scientists like the physicist and outspoken atheist Laurence Krauss have argued otherwise. On Wired’s Geek’s Guide to the Galaxy podcast in June, he said, “I don’t know if this phrase is an oxymoron, but to be a sensible theologian—or at least one who has a pretense of being scholarly—you at least have to have some vague idea of what’s going on in science. How old the universe is, etc. But to do science, you don’t have to know anything about theology. Scientists don’t read theology, they don’t read philosophy; it doesn’t make any difference to what they’re doing.”
Krauss went on to decry the “awful people who promote things like that silly, nonsensical book The Secret,” Rhonda Byrne’s best-selling 2006 self-help book that argues that desires affect the universe through the power of positive thinking. “That is the worst garbage,” he said, “the worst misrepresentation of science mechanics. It’s fraudulent, it’s a lie, and people should ignore those people, and moreover ridicule them.”
Strecher’s work, even as it treads in the realm of positive psychology, doesn’t rival Byrne-level promises. But it was still an odd coincidence that Strecher found himself sitting next to Krauss on a flight from Germany last month. Rivaling Krauss in verbosity and conviction, Strecher told him he had a bone to pick, and began arguing that we should be thinking about big ideas in the realm of science: That medicine can’t disregard something just because it’s not easily measurable. For example, stress, which you can't quantify, can be just as dangerous as junk food or cigarettes. And, according to Strecher, Krauss acquiesced to that.
This point is one for cultural change in medicine, I think, and the embrace of a holistic approach that includes not just the scientifically-grounded diagnostic tests and treatments that doctors recommend, but the abstract concepts that might explain why those science-based recommendations go ignored and unused.
"What if doctors had a prescription pad that just helped people develop greater purpose in life?” Strecher posited. “I think we need something like this right now. We need a different direction in terms of how we think about health.” I think a lot of people would prefer a pill.
