Memorial Sloan Kettering Cancer Center in New York has begun a new program "to help cancer patients find a sense of meaning, peace and purpose, even as the end approaches.
“For many cancer patients, the biggest challenge is, ‘How do I live in the space between my diagnosis and my eventual death?’” says William Breitbart, a Memorial Sloan-Kettering psychiatrist who developed the program, known as meaning-centered psychotherapy, and has tested it with more than 300 patients since 2000.
Dr. Breitbart based his program in part on the writings of Viktor Frankl, the Austrian psychiatrist who survived Auschwitz with the conviction that people can endure any suffering if they know their life has meaning. The eight-week program helps patients with Stage 3 or 4 cancer reconnect with the many sources of meaning in life—love, work, history, family relationships—and teaches them that when cancer produces an obstacle in one, they can find meaning in another.
“We help cancer patients understand that they are not dead yet,” says Dr. Breitbart. “The months or years of life that remain can be times of extraordinary growth.”
Session five focuses on encountering life’s limitations, and Frankl’s message that even when everything else has been stripped away, people can still choose their attitude toward a situation and the meaning they take from it. Discussion questions include: what would be a meaningful death?
“We tread lightly here; this is not supposed to be a scary session,” says Shannon Poppito, clinical psychologist who led many of the sessions. She says that what troubles many cancer patients most is not the fear of death, but unresolved issues from the past. It’s never too late to resolve them, says Dr. Breitbart, who notes that in Tolstoy’s “The Death of Ivan Ilyich,” the main character becomes the person he wants to be in the last five minutes of his life.
And simply experiencing life can be meaningful. For session seven, patients are asked to list things they love or find beautiful. Ms. Wilker talked about her husband and her 28 nieces and nephews and 62 grandnieces and grandnephews. She also talked about the view from her apartment that she was enjoying again and the Greek statue of Winged Victory that she had seen in her 20s in the Louvre.
“I realized that I didn’t have to work so hard to find the meaning of life,” she says. “It was being handed to me everywhere I looked.”
In the final session, group members present a “legacy project” that symbolizes the meaning they’ve found and want to pass on.
It’s paradoxical,” says Dr. Poppito, who is now in private practice, using meaning-centered therapy to help patients face a variety of life transitions. “You’d think that once people have found this new meaning in life, they wouldn’t want to let it go. But knowing their life has meaning and that it will continue beyond them seems to lessen that white-knuckle grip on life and give them a sense of peace.”