Victor Frankel, a psychiatrist, and holocaust survivor, once wrote, “Those who have a ‘why’ to live, can bear with almost any ‘how’”. He believed that meaning was central to a fulfilling life and that consequently, the search for meaning was a fundamental component of the treatment of psychopathology like depression.
Most providers understand this intuitively—that patients with purpose and avenues for joy tend to be less likely to develop major depression. And while this is not a perfect correlation, in almost all cases it is a worthwhile treatment goal. But though the role of meaning is often implicitly acknowledged in patient/provider interactions, it actually rarely rises to the level of active intervention. What if we could bring this to the forefront? What if we could prescribe “meaning” as a therapeutic intervention?
Maybe we can.
A growing body of literature is showing that volunteering may be an effective intervention to help address depression. And while the exact mechanism of this effect is not known, incubating a sense of meaning and purpose through service seems to be a strong contender. A number of qualitative and cohort studies have looked at this relationship and found that across a number of populations, volunteerism has been associated with lower feelings of depression, higher life satisfaction, and in some studies, better health overall. Additionally, the aggregate of these studies sketches the beginnings of a defined dose-response relationship, with a greater number of volunteer hours equating to better outcomes, up to a certain point. The vast majority of this research centers around elderly adults where the relationship has been fairly well characterized, but studies of younger patients also show a significant, if slightly less robust impact.
The few randomized controlled trials that have been conducted on this phenomenon have shown mixed results, with several likely not achieving a high enough “dose” of volunteerism. However, the direction of effect across the aggregate of the literature highlights this concept as one worthy of further study.
As a longtime volunteer, this has long been a passion project of mine. What if clinics could have the infrastructure in place (in a post-pandemic world) to prescribe a volunteer opportunity as easily as one might prescribe physical therapy or medication? Provided the data backs up the effectiveness of such an intervention, this could have a force-multiplying effect on the health of a community. Not only would the patient/volunteers reap the benefits of greater mental and physical health, but they would go out into the world and continue to help others. I think this is a very worthwhile goal.