I am a clinical psychologist and have worked in the UK for several years in a variety of settings within the National Health Service (NHS).

During my time working in a community mental health team I worked with people with a wide range of symptoms of anxiety and depression. The standard treatment of choice for people with such symptoms, as far as the NHS and the National Institute for Health and Clinical Excellence (NICE) are concerned at least, is cognitive behavioural therapy (CBT), possibly combined with psychotropic medication. In my experience there are a large proportion of people who are greatly helped using this approach.

However there was a group of people for whom I found it extremely difficult to work using CBT. For these people there was often no obvious cause or trigger for their emotional distress. They were nonetheless troubled by what many described as a crippling feeling of anxiety or even of doom and dread. A recurring theme in what these people often said they wanted and needed was some sense of meaning in their lives. As far as they could make out it was this that was the underlying cause of their distress.

It’s difficult to admit but there were definitely times when I would dread these particular sessions. For weeks I battled on using a cognitive behavioural approach. Whilst such an effective treatment for so many forms of anxiety and depression, with someone afflicted by a more generalised existential anxiety it got me nowhere. In fact I just backed myself into corners. I found I was working with people to identify core beliefs that I then couldn’t challenge, because arguably they were true. Life is transient. It will one day end. It’s meaning, if there is one, is not known.

I felt helpless. How could I help them find meaning if they weren’t able to find it for themselves. What could I offer them that would be of real, practical value, but that would not seem patronising? They didn’t have especially low self-esteem or difficulties in their relationships with others. They weren’t especially inactive or avoidant of particular places or people. They certainly weren’t deluded – you could even argue that, if anything, they saw the world and the universe more clearly than the rest of us.

Looking back now I can see that they were struggling, in varying degrees, to come to terms with what the existential psychotherapist Irvin Yalom called ‘the givens of human existence’; death, meaninglessness, existential isolation and responsibility.

Over the years since I moved on from this job, I have spent a lot of time thinking about meaning; what it is and how we find it. This has been partly in relation to these patients who I felt so powerless to help, but it has also been in relation to my own life. Whilst pregnant with my first daughter, and for the first year or so of her life, I found myself preoccupied and obsessing over just these questions myself.

This blog is dedicated to those people, and others like them, who are looking to try to make sense of their lives. I hope that here they may find the beginnings of answers to some of the questions that they have, and that they might feel reassured that they are not alone in asking them.



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