Creating your soul in every moment: Meaning, creativity, and attitude.

Those of us engaged in clinical research and the compassionate clinical care of patients with life-threatening illnesses often find ourselves confronted with basic questions of the nature of human existence, and in particular how one creates and lives a mortal human life. We are human beings caring for human beings who are facing death as a more imminent and immediately concrete concern. Personally, I find it necessary to constantly struggle with understanding the nature of human existence as a way to find an attitude or approach to dying patients that is therapeutic and represents some advance in psychosocial and spiritual interventions in palliative care. Readers of Palliative & Supportive Care may be familiar with my regularly appearing essays and editorials dealing with existential and spiritual themes. I take the opportunity of each upcoming issue of Palliative & Supportive Care as a way to expand on a recent epiphany or new understanding of a concept I thought I understood before, but now understand in a new and possibly more unique and clinically helpful way. Such is the case with this editorial. I had a new understanding of the nature and importance of “attitude” as a source of meaning and the role it plays in human existence. Some of you may be familiar with meaningcentered psychotherapy (MCP) for advanced cancer patients, a novel intervention our research group developed and demonstrated to be effective in diminishing despair in a series of randomized controlled trials (Breitbart, et al., 2010; 2012; 2015; Breitbart & Poppito, 2014a,b). MCP for advanced cancer patients was adapted from Viktor Frankl’s seminal work on meaning and his logotherapy (Frankl, 1959). Central to both Frankl’s work and MCP is the concept that there are several predictable and easily accessible sources of meaning in human life, which include: “creative sources” of meaning (e.g., work), “experiential sources” of meaning (e.g., love), “attitudinal sources” of meaning (e.g., turning a tragedy into a triumph), and “historical sources” of meaning (e.g., the legacy you are given, the legacy you live, and the legacy you give). Most of us live lives of meaning without consciously being aware that we are utilizing these sources of meaning. When plunged into turmoil by a terminal cancer diagnosis, it appears to be helpful for patients to have these sources of meaning delineated, described, experienced, and brought to conscious awareness so that one can “reach” for “each” source of meaning when overcome by a sense of loss or disconnection from the experience of personal meaning. “Creative sources” of meaning are especially important to human existence and are central to the existential obligation (understood as the concept of “responsibility”) that each human being experiences when they become aware of their existence. Driven by both biology and existential imperative, once we realize that we exist, we must respond to the fact of our existence by “creating a life.” We each are driven to create a unique life, with direction and meaning, and growth and transformation, to become an effective and useful member of a larger culture or society in a world that we imbue with meaning. What drives this need or will to create a life has been the subject of much philosophical debate. Is it the will to meaning? Is it love or procreation, or mere survival? My understanding of creative sources of meaning has evolved over time and is reflected in not only the content of this editorial, but in the process of creating this editorial as well. For much of the last 10 years spent in the development of meaning-centered psychotherapy for advanced cancer patients in the Psychotherapy Laboratory I lead at Memorial Sloan Kettering Cancer Center, I had thought of creative sources of meaning as those aspects, values, efforts, etc., that go into the process of creating one’s life. Frankl would often refer to “work” as the central creative source of meaning. But counseling advanced cancer patients, for whom work was no longer an available expression or source of meaning, I realized that work could not possibly be Palliative and Supportive Care (2015), 13, 1139–1140. # Cambridge University Press, 2015 1478-9515/15 doi:10.1017/S1478951515001133