Introduction
For much of human history the experience of a large majority of ordinary people was that life was often precarious, influenced by the fluctuations of war, famine, or the spread of diseases (Fernandez-Armesto, 2001). The advent of industrialization which brought people from agricultural communities to the urban centers in Europe and America often exposed people to new health risks or produced sordid living conditions in which life expectancy actually fell1. For example, people employed to grind blades in the cutlery trade in Sheffield, United Kingdom often died from lung diseases when they were still in their twenties due to the dust that they inhaled while at work. Cholera, typhoid, and tuberculosis often resulted from people living in overcrowded, poorly maintained environments. Poor housing, diseases, as well as high female and childhood mortality rates created the impetus for the development of the nascent caring professions in the late 1800s: nursing, social work, midwifery, and, by the early 1900s, occupational therapy. Although the thesis in this book is that daily occupations, including work, leisure, and self-care can be used as sources of meaning in peoples’ lives, the argument that work is a source of meaning may be challenged given the poor conditions in which many of the workers still live today. In the 1900s, for many people, the building of cities offered different ways of surviving and defined an existence that was in contradiction to the philosophy of work. Large numbers of city inhabitants were involved in criminal activities, and an underworld culture of alternative values expressed in the language of that context developed. The resulting social differences between the mainstream culture and the underworld still remain important today (Linebaugh, 1991).
Victor Frankl
Before making any attempt to explore how various daily occupations can be used in meaning-making, in this chapter we will discuss in general the notion of meaning itself. In this regard, we begin with an examination of the work of Viktor Frankl. This charismatic psychotherapist became known for his work on the meaning of human life. He began working as a youth counsellor and as a doctor in the 1920s in a Viennese hospital department that catered for women suicide survivors. His experiences, and particularly those under the Nazi regime while he was living in the Theresienstadt ghetto and then during a period of incarceration in a series of concentration camps, became the basis for his work on the human search for meaning as the major motivator in life. These ideas led to the development of logotherapy, an intervention designed to combat meaninglessness and nihilism. According to Pytell (2007, 2000), Frankl’s first book was dictated in 9 days, yet the uplifting messages it contained turned it into a best seller. Frankl’s story was that he survived the horrors of the Nazi concentration camps because he had something to look forward to, a goal for which to survive. Consequently, in logotherapy, he suggested that humankind can overcome its worst fears (as he did) if only ‘each of us does his best’ to pursue a worthy goal in life (Frankl, 1992, p. 154). This is the basis for our recommendation in chapter 7 that people articulate personal mission statements clearly, so that these personal missions in life can be the basis for establishment of worthwhile goals to pursue in life, leading to a meaningful existence.
Criticism of Frankl
Frankl grew up in a comfortable Viennese Jewish family and had been educated as a doctor. Initially he was a follower of Freud’s psychoanalytic tradition, and later of Adler’s teachings. Even though he could have escaped the holocaust altogether, he found himself remaining in Nazi Austria to look after his parents at the beginning of the war. Pytell (2007, 2001, 2000) asserted that Frankl survived by co-operating with the Nazis in experimenting on the brains of Jewish suicide victims, activities in which his peers refused to engage. He was later confined in the concentration camps where he worked as a doctor. Pytell (2007) noted that it may be unreasonable to criticize Frankl’s actions in the hindsight of an historical perspective gained in times of peace, considering that these were the actions of a person trying to survive under extremely terrifying circumstances.
Nonetheless, the reader is cautioned to bear in mind that the personal story Frankl frequently told could be selective and misleading, although as it remains without doubt the story of a holocaust survivor, it contains meaning and truth. Pytell (2000) suggests that Frankl’s work likely dramatizes his survival, representing his own rather than ‘Man’s’ cry (Frankl, 1992) for meaning, an unheard cry at that (Frankl, 1978). None the less, Frankl’s (2000, 1978, 1969) writings gained wide acceptance over time, especially his observation that the contemporary society was sick due to the loss of meaning in people’s lives. He referred to this condition of meaninglessness as noogenic neurosis. He described it as an existential vacuum resulting from a loss of touch with the natural environment; loss of grounding in traditions, religious practices, and philosophy; and the lack of a self-transcendent connection to something larger than ourselves. Symptoms of the malady were boredom and meaninglessness which were expressed through aggression, addiction, depression and suicide (Frankl 1992, 1969).
In this book, we use Frankl’s notion that human beings are primarily motivated by a search for meaning in life. We agree that a lack of meaning in life can plunge one into a sense of emptiness (Frankl’s ‘existential vacuum’) and subsequently into a lack of a sense of well-being. This lack can in turn lead to self-destructive behaviors such as addictions and even suicide. However, rather than subscribe to Frankl’s pathologization of meaninglessness as a disease, we prefer to follow Maslow’s (1970) suggestion that the search for meaning is actually a search for personal growth. We then propose that occupational therapists and scientists can help people realize this search for growth and ultimately for meaning in life by enabling them to carefully select occupations in which they participate every day of their lives.
Frankl’s ideas as a guide to meaning-making
Our discussion of Frankl’s theory is consistent with McNamee’s (2007) suggestion that: ‘Human beings are meaning junkies. It is not enough for people to just experience the world as it is; we are desperate to make sense of it’ (p.1 of 15). However, McNamee’s perspective of ‘meaningfulness’ is not existential, but seems to belong to a Western middle class understanding of life meaning found in the puritan values of hard work and healthy leisure which evolved over the 19th century (Flanders 2006; James, 2006). The dominance of this perspective of meaning originated from the growth of the middle classes during the 19th and 20th centuries, when there was a demand for a variety of professional occupations consistent with a rapid economic development. Such professional disciplines included engineering, teaching, medicine, and banking among others. The professionals defined themselves by their work, and were eager to distinguish themselves from the laboring classes in the neighbouring streets. These distinctions were based on a range of values: cultural, spiritual, educational, and familial. They were visible in the evident disparities in health between the wealthy and the poor.
The poor were very often held to blame for their own condition. Eugenic ideas of natural fitness and unfitness for genetic survival were used to spread fear that the healthy and wealthy might be contaminated by the rising numbers of diseased and impoverished people (James, 2006, Werskey, 1994). During that time in Britain, a third of the population was barely able to feed itself properly (Marr, 2009; Werskey, 1994). Even today, while there have been overall improvements in health, significant differences in life expectancy – between 71 for men and 78 for women in Glasgow compared to 85 for men and 87 for women in Chelsea and Kensington - remain the same as they were in the 1930s (National Records of Scotland 2011; Thomas, Dorling, & Smith, 2010). These disparities are still held to be natural [and perhaps pre-ordained] (Dorling, 2011). Under these circumstances of gross disparities, many working class people related ‘meaning’ to the value of their experiences and their place as witnesses to history. Their perceptions of quality of life were recorded in written autobiographies (Ragon 1986; Vincent 1981) as well as in folk songs (Buchan, 1997; Copper, 1975; Lloyd, 1969).
