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What’s the Meaning and Purpose of My Life?

What’s the Meaning and Purpose of My Life?

Is love a human need? How about achievement? How do we achieve “self-actualization?” What about Maslow’s hierarchy of “needs?”

Hi visitors, here’s a cool email question about the meaning and purpose of life that I got from a highly esteemed fan.

Hi David,

Looking at the comments thread on your home page, I had a question based on some comments from others. Is it important to know the purpose of your life in order to feel self-contented and happy?

I could not come out with an appropriate answer for myself. Is there really a way to find out what the purpose of your life is, or does it really matter? And even if it does matter, what do we do if we find out our purpose? Maybe that’s not practical in today’s materialistic world.

I read an article on Abraham Maslow’s hierarchy of needs pyramid. From the bottom to the top of the pyramid, he lists

  • physiological needs
  • security needs
  • belongingness and love needs
  • self-esteem needs through accomplishments
  • and finally, self-actualization.

Here’s my question: Can humans be really happy without any or even many of these missing needs?

Practically, I see it as difficult. But, by cognitive theory it seems to be possible at least to the level of not disturbing ourselves for the missing needs.

To make it short my question, in essence, is this: What can be the true drivers of happiness in today’s times while at least one or more needs is challenged in this need hierarchy, especially love and relationship needs along with the realization of our full potential.




Hi Rajesh,

Thanks for another cool question! I can only ramble a bit and give you my take on it.

I recall reading about Maslow’s “needs” theory in college, in a class on so-called “third force psychology.” The writers in that movement focused, if I recall correctly, on achieving peak experiences, as opposed to becoming less depressed or anxious. At the time, I like the class and found it inspirational.

However, my thinking as a cognitive therapist, and now as a TEAM-CBT therapist, has evolved a great deal from my thinking during my college days. I have discovered that some of these “needs” are not really “needs,” but wants, although this is, of course, extremely controversial.

Individuals who I have treated who thought of love and achievement as “needs” have been very depressed, and sometimes even suicidal. If you read my book, Feeling Good, you’ll find sections on the so-called “Love Addiction” as well as the “Achievement Addiction.”

One potential problem is that if you tell yourself that you “need” love or achievement to feel happy and fulfilled, you may set yourself up for intense anxiety and depression when you are rejected, or when you fail. In addition, it is not really true that adult humans need love or a certain level of achievement to feel happy and fulfilled. Of course, to some people, what I am saying right now will seem like the darkest type of heresy!

In the chapter in Feeling Good on the “Love Addiction,” you can read about a woman who was dumped by her husband, so he could have an affair with his secretary. She was devastated and told herself, “I need John’s love to feel happy and fulfilled.” This thought triggered intense depression and hopelessness.

I encouraged her to do an experiment to test this belief, using the Pleasure Predicting Sheet. She discovered, much to her surprise, that simply being by herself, and treating herself in a loving way triggered high levels of satisfaction. In contrast, a lunch with her husband turned out to be one of the most miserable experiences of her life.

This gave her morale a tremendous boost, because she realized she did not actually “need” her husband’s love. Being around him was clearly NOT a source of happiness or “self-actualization.” She began dating and soon fell in love with a fellow who was far more suitable for her. And of course, the moment she no longer “needed” her husband, he begged for her to return. Instead, she filed for divorce.

This happens almost every time. When you “need” things, they tend to be elusive; when you no longer “need” the universe, the universe will come to you.

Her husband called and said he was enraged with me, because he’d referred his wife to me and had asked me to take care of her in case she became suicidal. I told him, “I did, I did!”

So, to answer your questions from my, admittedly controversial, perspective, there is no one “meaning” or “purpose” in life. Instead, there are an infinite number of meanings and purposes that present themselves in the experiences we have at every moment of every day. For example, right now I am answering your question, and enjoying this dialogue. That’s enough “meaning” and “purpose” for me for the moment. When I finish this blog, I will find some other activity, or purpose.

And as far as “self-actualization” goes, that just sounds to me like another perfectionistic trap. Right now, I’m too busy having fun to care about “self-actualization.” I think life, and the many rewards of life, can be found in the here-and-now, in our moment-by-moment reality, and not so much in the clouds of abstraction.

As a psychiatrist, I don’t usually approach these things from an overly general or philosophical perspective. Instead, I ask my patients to pinpoint one specific moment when they were feeling anxious or depressed on the Daily Mood Log. Then I ask them to rate their negative feelings and record the negative thoughts that triggered those feelings. Then we can identify the many cognitive distortions in those thoughts.

At that point, I bring the patient’s resistance to conscious awareness and melt it away, using Paradoxical Agenda Setting Techniques, like the Invitation Step, the Miracle Cure Question, the Magic Button, Positive Reframing, and the Magic Dial. At that point, we use several methods to challenge and crush the negative thoughts. This usually leads to a rapid and fairly complete elimination of the negative thoughts and feelings, and often ushers in fairly intense feelings of joy.

That’s just a brief overview, of course. If the patient has Self-Defeating Beliefs that get in the way, such as the belief that he or she “needs” love, approval, achievement, or perfection in order to be “worthwhile,” then we sometimes modify those beliefs as a part of Relapse Prevention Training.

Achievement can be very rewarding—but it does not make you more “worthwhile” and is no guarantee for happiness. Same goes for love, approval, perfection, fame, status, or wealth. There’s certainly nothing wrong with love or approval, but it does not make you more “worthwhile.”

One last point is this: physiological needs are true needs. We do need food, air, and water to survive. Without them we die. So the basis of Maslow’s pyramid is valid. But most of the rest of his pyramid consists of wants, not needs. My take on it! Some will probably insist I’m a quack!

You might think of security as a “need.” For example, if you were in a dangerous situation, such as a war zone where bullets were flying, and you had no protection, you could die.

But Maslow includes financial security, health and well-being as “needs.” Well, if you listen to the podcasts featuring live work with Marilyn, you will discover that she experienced “self-actualization” after a diagnosis of stage 4 lung cancer. But if Dr. Matthew May (my co-therapist) and I had taken the path of believing that she could not feel happy and worthwhile without good health, this “need” approach might have doomed her to ongoing severe depression and anxiety.

And I’ve treated many people with intense anxiety and depression who feared going bankrupt. Five of them actually DID have to declare bankruptcy while I was treating them. And you want to know the really odd thing? The day they went bankrupt, every single one of them recovered! Their feelings of depression and anxiety were not caused by their lack of financial security, but rather from their distorted negative thoughts, thinking (wrongly) that they’d be worthless and unlovable if their business failed. That’s why their negative feelings disappeared–they discovered that their fears were baseless.

By the way, people elevate all kinds of things to the level of needs. For example, someone wrote to me earlier in the week, quite irate, because he did not believe that thoughts create emotions. He said the facts of your life create your feelings.

My goodness! I don’t think he’s read any of my books or listened to the live therapy with Marilyn! I’ve really addressed the idea that our feelings result entirely from out thoughts, and not external events, so many times! But many people still don’t “get it!” And some don’t want to get it!

He gave the example that if your IQ is only average, or even below average, you cannot be happy, since you might want to study physics, but you’re not smart enough to do that!

This actually happened to me in college. I thought it would be super cool to major in physics, but the kids in my class who were majoring in physics—Phil Allen, Farzam Arbab, and Joe Stiglitz—had IQs far above mine, and it simply was not a smart option for me. So, I majored in philosophy instead, which was a lot easier for me. And I’ve loved the road I’ve traveled!

Think about this: Half of the people in the world have IQs below 100—that’s the half-way point, by definition. Half of us have IQs above 100, and half have IQs below 100.

Does this mean that half of the people in the world are doomed to depression? That sounds totally nutty and simply doesn’t accord with the facts! But when you tell yourself that you “need” this or that to feel happy, you turn yourself into a victim.

The fellow who wrote to me was pretty indignant and seemed intent on proving how “wrong” I was! As I’ve said, these issues are sensitive and highly charged for many people, and controversial, to be sure.

That’s why I don’t evangelize too much. I treat people who are suffering, people who are motivated to change. If someone wants to view love or achievements as “needs,” and if this belief system is working for him or her, then that’s totally fine by me.

One last point, just to be safe. I mentioned that love is not an adult human need. When Aaron Beck first made that claim in one of the weekly seminars I was attending as post-doctoral fellow in psychiatry at the U. Penn. Medical School in Philadelphia, I practically fell off my chair and had the thought: “He must be some kind of sociopath to believe such a horrible thing!” But over time, I discovered he was right, and that insight saved the lives of quite a few rejected, lonely and suicidal people I have treated over the years.

When I say that love and achievement are not “needs,” people get annoyed with me as well. Some skeptics remind me about infants with the “failure to thrive” syndrome—they don’t develop properly without love, without being touched, that sort of thing. I think that line of research is valid. For infants, love and nurturing do seem to be human needs. For adults, I think it is more productive to think of them as “wants.”

A Cool Upcoming Workshop for you!

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Is Love an Adult Human Need?

Is Love an Adult Human Need?

Hi Dr. Burns,

Hope you have time for another question. Maybe you can post this on your site.

In your Intimate Connections book you say that many people believe that they need a romantic partner to be happy (which you think is a false belief). Doesn’t this imply that people are either happy or unhappy, which is, or course, all or nothing thinking? Doesn’t happiness exist on a spectrum, from say 1 to 10?

Shouldn’t the question be, “Do people need a romantic relationship to achieve a certain level of happiness?”

To achieve a happiness level of 10, do people need a partner? If they could achieve a 10 without one, why would they bother attempting to then obtain one. Why bother trying to find a girlfriend if you’re not going to be any happier? How happy can one be without one?

Shouldn’t you change your statement to: people assume they can only achieve a happiness level of about a 2 without a partner when in actuality they can achieve a level of about a 7?

What are your thoughts?


Hi Richard,

Happiness, like all emotions, exists on a continuum, and you could measure it on a scale of 0 to 100, for example. So sometimes we are not happy at all, and other times we may be extraordinarily happy. The same is true of sadness, anxiety, anger, discouragement, shame, and so forth. Emotions do not exist in an All-or-Nothing way.

Our culture definitely teaches us that we need love to feel happy and fulfilled. In one of her famous songs, Barbara Streisand’s sings that “people who need people are the luckiest people in the world!” So most people naturally assume that we “need” love to feel a high level of happiness and fulfillment.

When I first heard Dr. Aaron Beck assert that love is not an adult human need in one of the weekly seminars I was attending during my research fellowship at the Penn Medical School, I had the thought, “My gosh, he must be a sociopath to say such a thing!”

But I decided to test what he was saying, spending more and more time alone, just to see what would happen. I did it as a series of experiments, using my Pleasure Predicting Sheet. It consists of several columns, and in the first column you schedule a variety of activities with the potential for pleasure, satisfaction, learning, personal growth, and so forth. In the second column, you record who you plan to do each activity with. Make sure you schedule some activities that you will do on your own, as well as activities you will do with others. In the third column, you predict how satisfying or enjoyable each activity will be, from 0 to 100.

Now you are ready for your experiment. Go ahead and do each activity, and after you’re done, write down how satisfying it turned out to be, between 0 and 100, in the fourth column.

When I did this, I was shocked to discover that I could be maximally happy when doing things by myself. This was a revelation to me, and at first it was hard to accept. These experiences definitely changed my thinking. But the conclusion was absolutely consistent with the basic premise of cognitive therapy, that our thoughts, and not external events, create all of our feelings, positive and negative. I have treated large numbers of people who were extremely depressed, even suicidal, who were very loved; but their minds were loaded with negative and distorted thoughts about themselves and their lives.

I am only touching on this topic in a superficial way here. You can read more about this notion in the first section of Intimate Connections, which is all about learning that you can be happy when you are alone. You can also read more about this in the chapter on “The Love Addiction” in my first book, Feeling Good: The New Mood Therapy. And you might want to watch the reality TV show, “Alone,” which just completed its third season. It’s all about being stranded in the wilderness alone for prolonged periods of time, to see how long you can survive. The winner receives $500,000.

The topic is extremely controversial, like so many topics in mental health / psychology. And everyone is pretty sure they are an expert who knows “the truth.” So the post might fire up some controversy.

At any rate, you asked why anyone would want to have a boyfriend or girlfriend, or friends at all, if you can be completely happy when you are alone. Well, there is a difference between “needing” something and “wanting” something. For example, I might want a fancy new sports car, but I don’t “need” one to be completely happy.

From a practical point of view, I have treated large numbers of single men and women who were having a terrible time in the dating world, and usually they were telling themselves that they “needed” love to feel happy. This made them come across as “needy,” and their neediness forced people to reject them. That’s because of the “Burns Rule,” which states that “people only want what they can’t get, and never want what they can get.” So if you need someone, you become what they can get, and they won’t want you.

So I always encouraged these single individuals to overcome their fears of being alone before I would teach them how to get people chasing after them. And this was nearly always effective. Once they no longer “needed” people, but had learned how to love themselves first, then they were far more successful in the dating world.

So that’s why all the chapters on flirting and such in Intimate Connections follow the initial section on learning to be happy when you’re lone.

Personally, I love to be alone! And many of the happiest moments in my life where moments when I was lone.

And I also love to hang out with others, and I love to give and receive love from those I’m close to as well. And that includes my family, students, friends, and even, or especially, our beloved cats!

Well, there my answer, Richard, but I’m sure we’ll get a ton of comments from folks who, like yourself, are hooked on the idea that we “need” love to feel maximally happy! I have created dozens of techniques to help folks overcome the fear of being alone, but that is perhaps for another day.

Oh, one last thing. If you have a firm belief that you cannot be happy when you are alone, it may function as a self-fulfilling prophecy. For example, I once treated a woman who’d been rejected by her husband, who was having an affair with his secretary. She told me she had proof she couldn’t be happy when she was alone, because she was alone and constantly miserable, for example when eating dinner.

I asked her what she had for dinner the night before. She said she sat in a chair facing the wall and ate a peanut butter sandwich.

I said, “Well, maybe that’s why you were feelings miserable. What would you have for dinner if you had invited your favorite person in the world for dinner? For example, some celebrity you intensely admire?”

She said she’s buy the best food at the grocery store and prepare a gourmet meal, with candles, music, etc. I suggested she might try doing that for herself, as an experiment, using the Pleasure Predicting Sheet. She predicted that shopping, cooking, eating would be 0% to 5%, a scale from 0% to 100%, because she’d be alone.

She also had a luncheon scheduled with her husband later in the week, and had predicted it would be 95%, since she wouldn’t be alone. She fantasized they’d talk about getting back together.

But she was shocked by the results of her experiments. Shopping and cooking a gourmet meal for herself were 95% satisfying. And then she sat down with herself, with music and candles, and ate the dinner, and it was 100%. She said she got so high—no drugs or alcohol, mind you—that she took herself out dancing (in the living room), and just loved being with herself. This blew her mind.

The luncheon with her husband was also mind-bending. He spent the entire lunch talking about what a wonderful lover his secretary was, and how they’d divide up their belongings for the divorce. And of course, he was an attorney, and his suggestions involved pretty much everything for him and nothing for her.

In the Outcome column of her Pleasure Predicting Sheet she recorded 0%. The data were simply not consistent with her belief that she “needed” her husband’s love to feel happy and fulfilled.

Then she asked me what she should do next. I told her that now that she no longer “needed” love, it would be pretty easy for her to do some flirting with attractive men she met, and I told her that as soon as she found someone she really liked, and she no longer even wanted her husband back, I promised her that her husband would then come crawling back to her.

And that’s exactly what happened. She met a handsome hunk of a guy who was also recently divorced, and they fell madly in love. That very day her Ex called and said he’d changed his mind, and begged for her to accept him back. But she didn’t. She told him she was far happier without him, and wanted the divorce to be accelerate.

Her husband called me in a rage. He’d referred his wife to me initially, because he was afraid she was suicidal, and he’d asked me take care of her. He shouted in the phone, “I told you to take care of her!”

I replied, “I did, I did!”

If you’re interested, you can read more about the story in Feeling Good. She was one of the first people I treated with cognitive therapy, way back in the early days! But I’ll never forget!



Hi Dr. Burns,

Thanks for your response. Here is mine.

You keep drawing a distinction between needing and wanting.

I don’t see the importance of that. You say you don’t need a sport car to be completely happy, but you may still want one. If you could be completely happy without one, why would you want one?

Also, in order to be completely happy (long-term, not just for a few seconds) what does one need? Do you agree with many psychologists that to live the happiest life you need four basic things:

1. enjoyable work

2. good friends

3. good hobbies

4. good romantic relationship


Thanks, Richard!

Excellent response! Can I post your response, and my email on my website, as part of the post, with or without your name? Beyond this exchange, that would be the end of the posting of exchanges, however, as it gets too long, perhaps.

Personally, my answer to your excellent question is no, but that’s just my take on it, and not some absolute truth. I don’t see these as “needs.” But you can set it up like that if you want, and think of these things like enjoyable work, hobbies, love, and friends as basic human “needs,” and this might not be a problem for you. As a “shrink,” I don’t try to teach people about some “right” or “wrong” way to believe or think about things. I simply try to help individuals with problems they are having.

Lots of people do not have enjoyable work, and yet they are quite happy. They see their work as a way to earn money, and they do things that are more interesting to them when they are not at work. There is no rule that says everyone “must” find enjoyable work.

When I was in college, I did construction labor in Phoenix for two summers. It was pretty demanding work, with pick and shovel, and also lots of sweeping with a big broom, and it was hot that summer, with little no shade on the construction sites. The temperature in the shade was usually 105 degrees, and the temperature in the sun where we were working was typically 135 degrees. One of the laborers I worked with was named Carmen, and he was constantly telling me I did not use the shovel or broom correctly, and he would show me better ways to dig or sweep.

I would not say that the work was “enjoyable,” but I was very grateful to have a job and the chance to earn some money. The hourly wage, due to the union, was $3.10 per hour (Local 383 of the AFL), which seemed like a fortune to me, since we did not have much money. Another summer I had a job filing checks in a bank, which was boring, but tolerable, but definitely not “enjoyable.” I did try to make it interesting, however. For example, I tried to learn about the lives of the other construction laborers I worked with, since in my upbringing I did not have the chance to meet lots of people who were doing construction labor for a living. I felt a bit intimidated, but they were all really kind to me, and I worked as hard as I could.

Many people, and perhaps most, do not have jobs that are especially enjoyable. Now, if they tell themselves, “Oh, an enjoyable job is a ‘need,’” then they might feel unhappy and pressure themselves a great deal, thinking they have somehow fallen short of some basic human need.” If they wanted help with their negative feelings, and only if they wanted help, we could use a great many of the TEAM-CBT skills to help them, and this would likely be a really easy problem to solve. But if they were not asking for help, then I would simply “Sit with Open Hands,” since I have no special expertise in what people in general “should” or “shouldn’t” think or believe. My task is to help individuals who are struggling with depression, anxiety disorders, relationship problems, or habit and addictions, assuming they want help.

The most fundamental error in psychotherapy, in my opinion, is trying to help someone who is not asking for help, as this nearly always triggers resistance and a kind of log jam between the patient and therapist may develop. Of course, if someone is ambivalent, and wants to dialogue about that, it can be very productive, and there are tons of TEAM-CBT tools we could use—Empathy, Paradoxical Agenda Setting, and Methods. For example, we could do a Cost-Benefit Analysis (CBA) and balance the Advantages against the Disadvantages of viewing an enjoyable job as a “need.” Then we could balance the advantages against the disadvantages on a hundred point scale. For example, is it 50-50? 60-40? 35-65?

Then we could do a second CBA, balancing the advantages against the disadvantages of thinking of an enjoyable job as a “want,” and balance the advantages against the disadvantages on a hundred point scale.

The way you use language is a personal decision. It is not so much the idea that one approach is inherently more “correct.”

Similarly, when you goof up at something, the way your think and use language will impact your feelings. For example, you can beat up on your “self,” telling yourself “I am a bad teacher,” or a “failure as a father,” or some such thing. These kinds of thoughts contain multiple cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Labeling, Self-Blame, Emotional Reasoning, Mental Filtering, and Discounting the Positive, and they are hidden Should Statements as well. These distortions will probably trigger feelings of depression, shame, anxiety, inadequacy, loneliness, and hopelessness, because the negative thoughts sound so absolute and permanent.

Or instead, you can focus on the specific error you made as a teacher, or as a father, or whatever, and make a plan to correct it. These two approaches are a matter of personal choice, but they can have massive implications in terms of how we feel.

The idea that our thoughts create our feelings is also a spiritual notion, embedded in Buddhism and nearly all religious traditions. Buddha emphasized the importance of focusing on specifics, rather than thinking about our errors and shortcomings in global terms. He was one of the first to teach that our thoughts, and not our external circumstance or the events in our lives, cause all of our feelings, positive and negative. We are creating our own emotional reality at every moment of every day. This notion is some basic, obvious, and fundamental, that many people simply cannot “see” it, or grasp it. Understanding this notion is one form of enlightenment.

Many people with enjoyable work, good friends, wonderful hobbies, and great romantic relationships are depressed and suicidal—I have treated many of them in my career—and many people who lack these things are very happy. But again, it is a matter of choice how you want to think about your life. If you ruminate about things you don’t have, and you tell yourself that these are “needs,” how will you feel?

I go on Sunday hikes with members of my training groups at Stanford. The hikes are not a basic human “need.” I spent most of my life not going on Sunday hikes. So if the hikes are not a “need,” why do I go on them? That is the type of question you are asking. I go on the Sunday hikes because they are a lot of fun. It gives me the chance to do personal work with students and colleagues, and to get to know people on a deeper level. In addition, it is a nice way to get some exercise.

To me, wants and needs are very different. Why do we do anything? For me, I do things because I am alive, and grateful that life offers so many opportunities and experiences. We have a new kitten—sadly, my beloved Obie disappeared two months ago. He was my best friend and likely killed by a predator in the middle of the night, in the woods behind our house. I will grieve his loss for a long time. I still shout out his name when I am out jogging, thinking he might hear me and suddenly appear, even though I know he is gone. A neighbor kindly gifted my wife and me an adorable kitten they found abandoned by the side of Moody Road, near a trail I hike on. She was three weeks old and it was a rain storm. They took her home and gave her a loving home for several months. But they traveled a lot, and did not like to leave her alone, so they gave us this beloved kitten, Miss Misty, who is now 4 ½ months old. And what a joy she is! So cute and full of life, and love. But I do not think of Miss Misty as a “need,” but rather as a gift, or as a little miracle of sorts.

Dr. Beck once told an interesting story in our weekly training group when I was first learning cognitive therapy. He said he and his wife went to a night club to hear some jazz performance, and the man sitting alone at the table next to them seemed like he was having an extraordinarily good time, even though he was alone, Dr. Beck asked the man why he was so happy. The fellow said he was incredibly happy because he’d just gotten an extremely important promotion at work. Dr. Beck asked him what work he did, and what promotion he’d received. The man said he’d been working in a local bakery for 25 years, and he had the job of making the donuts in the kitchen in the back area of the bakery. But he said that earlier in the day, the manager said that he could actually arrange the donuts in the display area, and gave him a 10% raise, and thanked him for the excellent work he’d been doing for so many years. The man was beside himself with happiness! Dr. Beck talked to him a bit more and learned that the man was living alone and could not read or write, and had not graduated from fifth grade.

I guess the point Dr. Beck was making is that our thoughts, and not the facts of our lives, create our feelings. You can be miserable in the midst of abundance—like many of the depressed individuals I treated—or joyous in the midst of very little. It all depends on how you think about things.

Still, none of this is meant as persuasion, just examples to illustrate my own very different way of thinking about wants vs, needs. In my opinion, we “need” oxygen, food, and water to survive. The new reality TV show, “Alone,” illustrates this very well! But I do not believe that we “need” enjoyable work, love, hobbies, or friends, although all of these can be sources of pleasure and joy.

But that’s just my way of looking at things. Ultimately, we are all free to think about things in whatever way we want. And lots of therapists do like to emphasize the “needs” we have as human beings. And I would say this line of thinking is “politically correct,” too. Your point of view, Richard, is quite popular, and if it is working for you, then there is no real need to change!


Hi Dr. Burns,

Yes you can use my first name if you publish our emails. We could go on forever so i will respond briefly.

As far as four things people need for happiness, maybe we could add a fifth which would be good health (depression being bad health).

Also, there are people who are happy who have bad jobs but are they really a 10 on the happiness scale or more like an 8?

Thanks for your thorough response.


Hi Richard,

You are most welcome! And thanks for the good dialogue which will likely interest a few people. However, this blog may make some people mad (at me, not you), since my thinking is somewhat politically incorrect.

But once again, my answer is no. Good health is wonderful, but not a requirement for happiness, and certainly not a guarantee for happiness, either.

In addition, my hunch is that there is no “cap” on happiness one way or the other. I have had many patients test this theory with the Pleasure Predicting Sheet that I described earlier in the blog. An experiment can be a nice way to check these beliefs out, sometimes.

I’ve treated or known many people with severe illnesses who were tremendously happy and content with their lives. And I’ve treated many, of course, who were in great health, but miserably unhappy.

I had a pretty severe problem with my right hand years ago (reflex sympathetic dystrophy), and had to do hand exercises 18 hours a day for 6 months to get my hand back to normal, or close to normal. I also had to go for hand therapy several times a week in a gym designed for people with serious hand injuries.

I was always amazed at the cheerfulness and friendliness of many patients in that gym who had the most grotesque and horrible hand injuries you can imagine. One was a woman with extremely advanced arthritis in both hands, and her profession was restoring rare paintings. She could barely move her fingers! And I can remember a professional skier whose hand had been crushed by a truck, and it was as flat as a pancake, making it nearly impossible to hold onto those things that skiers hold while skiing. But they weren’t complaining, and had the most positive outlook on life.

And I can remember an African America high school student who was doing some kind of exercise on one of the hand machines next to me, so I struck up a conversation and asked him what he planned to do with his life when he finished his schooling. He said he was hoping to become a professional basketball player. Then I asked him about his hand injury—what had happened?

He explained that he was injured when using a saw in his shop class at his high school, and that both of his hands had been cut off. He explained that they tossed his hands into a bucket of ice water and rushed him to the University of Pennsylvania Hospital Emergency room, and that Dr. Osterman (who was also my doctor) had sewn his hands back on. And he told me he wasn’t giving up on his dream!

But there were usually one or two patients in the hand gym who were miserable complainers, nasty, demanding, and hard to be around—and usually their hand injuries were mild. So once again, it is our thoughts, and not the external circumstances, that create our emotions, positive and negative. But that’s just my mind-set, and others will have different ideas for sure!

I remember diagnosing terminal lung cancer in a woman I treated in our hospital in Philadelphia before I moved back to California years ago. I had been making rounds with the residents to prepare for my medical board examination when we moved to California, since I had let me medical license in that state run out and was pretty rusty on my memory of medicine.

The woman was very cheerful, and the residents who I made rounds with kept telling me that she “should” be more upset, as if her reaction to her diagnosis was somehow wrong, or involved denial, or some such thinking. But she told me that she was a deeply religious woman, and that she was extremely grateful that she’d had a good life, with two daughters who she loved and who loved her a great deal. She told me that she had nothing to worry about, and nothing to be upset about, because if it was God’s time to take her home to heaven, then she was ready to make the trip!