Too many people live in a state of chronic lack, experiencing prominent dissatisfaction, emptiness, disenchantment, estrangement, directionlessness, pointlessness, or lack of commitment. Likely, a person with any of the above, doesn’t feel special to the world and the world doesn’t feel special back to them. They may manifest a shallowness of emotional expression, easy distractedness, flitting from one activity to the next, perhaps gaining momentary focus and twinges of feeling, only for those minor coherences to dissolve back into the blankness of the interminable day.

Covid, with its disruption of routine “grounding” activities, such as the expectation of getting groomed and dressed for work and being in the physical presence of others throughout the day, has exacerbated this groundlessness for many. It is not surprising that with a less grounded day, free-floating anxiety and unfocused malaise has increased. There is an additional factor that leads to such dysphoria: it’s the cycle of bad news-good news-bad news that we’ve been living through. Parts of the world are now experiencing a third- or fourth- wave of covid surges and lock-downs and, this, after a period of growing optimism earlier in 2021. These cycles undermine hope since these cycles lead to hope rising only to – once again – having it dashed.

There are ways to overcome or avoid falling into such malaise. At the start I conceptualized the problem as one of chronic lack, presumably of a state of a naturally coherent, precontemplative being in the world. The one word that for me captures this naturally occurring groundedness is engagement, engagement with people, with activities that are part of a greater whole, and with encompassing life projects. But when gone, meaningful and life-sustaining engagement is hard to capture or recapture.

As clinicians we can help direct patients onto unexamined and perhaps dormant aspects of their lives, ones that can be reawakened to provide them with sustenance and direction. There are questions we can ask of our patients that can lead to new trains of thought and feeling. I call these focusing questions. Here are some examples. Not all are appropriate for all patients, of course.

  • What’s most alive for you right now? It can be good or bad but focus on what is vivid and most grabs your attention and emotions.
  • What’s happening between us right now? Are there times you feel a strong connection and other times a disruption to our connectedness? What do you make of this?
  • Is there a pattern to what you first think and feel as you wake up in the morning?
  • No one feels equally good or bad throughout the day. What are the situations or thoughts that lead to comfortable or happy feelings? What seems to affect your state of mind most strongly?
  • What are the memories that give you the most comfort or that you savor the most? What do you see? Hear? Smell? What can you do now that will form such memories for you in the future?
  • If you could travel into the past, what advice would you give your younger self? And if you could travel into the future and give advice to your current self, what would your ‘future self’ say?
  • Have you ever noticed it’s easier to give advice to someone else then to notice and fix problems in your own life? So, imagine sitting across from yourself giving yourself some advice. What’s most important for your ‘wise self’ to tell yourself right now?

These focusing questions cue consideration of different aspects of one’s life. They can lead to new insights, to free associating with whatever comes up, to meeting new people, to conversing deeply, to starting a journal, to artistic expression and to many other such things that can focus and give meaning to life.

As an aside: the question about the clinician-patient relationship can be uncomfortable for some patients and even some clinicians and is not right with every patient. It can be useful for some within a psychotherapeutic context. Many forms of psychotherapy entail an intimate and professional relationship. Thus, rules of engagement between clinician and patient need to be laid out beforehand.

I’ll end with examples of the types of challenges (of imperatives that must be faced) that arise from such explorations.

  • How does one live without knowing. We don’t know what the future holds. How does a person, especially one prone to anxiety and worry ruminations, deal with unavoidable uncertainty, or even to embrace it?
  • How does one live with knowing. The one thing about life we know is that it will end. How can awareness of this inevitability lead to a life of deeper engagement and one pursued with more urgency?
  • How does one build a meaning-enhancing structure, one that, rather than constraining, affords focus and commitment?
  • How does one establish autonomy and, at the same time, deep connection with and commitment to others?
  • How does one turn one’s inchoate yet powerful desires and sense of true self into a life plan and, once the plan is made, deploy it in daily praxis?

Thanks and take care.

Dr. Jack

Language Brief

“Pay attention. It’s all about paying attention. Attention is vitality. It connects you with others. It makes you eager. Stay eager.” – Susan Sontag

“To see and hear what is here, instead of what should be, was, or will be. To say what I feel and think instead of what I should. To feel what I feel instead of what I ought. To ask for what I want instead of always waiting for permission. To take risks on my behalf, instead of choosing to be safe and not rock the boat.” – Virginia Satir

“Whatever is rejected from the self, appears in the world as an event.” – Carl Gustav Jung

“…the more unlived your life, the greater your death anxiety. The more you fail to experience your life fully, the more you will fear death.” – Irvin D. Yalom