Adam Kaplin, MD, PhD, is the principle neuropsychiatric consultant to the Multiple Sclerosis Center of Excellence at the Johns Hopkins School of Medicine. In his research investigating links between depression and autoimmune diseases such as multiple sclerosis, he has become interested in the role that having a purpose in life may have on health. Dr. Kaplin talked with us about the latest findings—and why he thinks encouraging people to find a meaningful purpose in life is as important as encouraging them to exercise or eat a healthy diet.
First, what does the term “purpose in life” mean?
The concept of having a purpose in life goes back to the Greeks and probably even before. But the contemporary notion of purpose in life derives from the writings of Viktor Frankl, a Jewish physician trained in psychiatry and neurology who survived three years in Nazi concentration camps, including Auschwitz, and wrote about his experience in Man’s Search for Meaning. Frankl believed that having a purpose in life helped him survive, and that all of us need some purpose in our lives. We need our lives to have meaning. It’s a basic human need, as important to health as the need for exercise and a nutritious diet. Human beings need to have something that they are committed to and passionate about and that is directed toward helping others or the world.
Is there a scientific way to measure purpose in life?
In the 1940s, Frankl created a set of 13 questions as a way to measure purpose in life. In the 1960s, researchers Crumbaugh and Maholick extended his work and came up with a 20-item questionnaire that’s widely used and that has been shown to do a good job of measuring purpose in life. The questions cover three basic areas. The first is whether you believe the universe is simply random or that there is some greater sense of meaning in the universe. The second is whether you believe that your own actions can in some way influence the world. The third is whether your own personal life has meaning or purpose.
What’s the evidence that purpose in life affects health and wellness?
There’s good evidence in the form of correlations, or associations. There’s evidence that purpose in life helps people recover from addiction. It helps people with mental help issues such as depression and anxiety. More recent findings show that having a purpose in life may protect against Alzheimer’s disease. As part of the Rush Memory and Aging Project, researchers followed a group of 246 older volunteers. People with a low purpose in life had a two-fold greater risk of developing Alzheimer's than those who scored high. That’s really dramatic. The greater their sense of purpose, the lower their risk. The interesting thing is that when the researchers looked at the brains of people in the study, the amount of abnormal plaques and other gummy-like substances in their brains that we associate with Alzheimer’s didn’t predict whether they had dementia. Instead, people with a greater sense of purpose in life were less likely to have symptoms of dementia, even though their brains looked the same as people who had Alzheimer's and a low purpose in life.
Other studies have shown that purpose in life is associated with other protective effects—a 50 percent reduction in stroke, heart attack, and all-cause mortality, for example. It’s important to point out that these studies show an association. They don’t prove that having a high purpose in life is the cause.
To discover that, we’re currently doing a study of patients with multiple sclerosis. We’ve randomly selected some people to become mentors for other people with the disease, via a virtual support group called MyCounterPane. Our findings have already shown that becoming a mentor significantly improves scores on the 20-item questionnaire I mentioned. So we’ve shown that it is possible to improve people’s purpose in life. Now, the question is, does improved purpose in life have an impact on health and, in this case, the course of MS? We hope to find out.
Why do you think having a purpose in life might influence health?
As it turns out, there is a link between the mind and the immune system. Chronic stress and depression, for example, both cause elevated cortisol levels. Cortisol, often called the stress hormone, is the emergency brake of the immune system. Over time, when people experience chronic stress, immune cells stop listening to cortisol because the level is up all the time. One effect is that if there’s a viral infection or an injury in the body, immune cells don’t respond normally. Instead, the immune cells often get overactivated. It’s like the emergency brake to the immune system no longer works.
Another effect is that the immune system overreacts inappropriately to things that aren’t a threat. We know, for example, that people who are diagnosed with depression go on to be over two times more likely to develop MS and rheumatoid arthritis, which are linked to abnormal immune responses. Now comes the speculation on my part. I believe that having the belief that your life has purpose gives you a kind of resiliency, a buffer against stress. When something stressful comes along, you’re able to handle it better. You have things in your life that you can turn to, and that give it meaning and purpose. Your cortisol levels may go up, but they return to normal. The system operates in balance.
Many of our readers are likely to ask: Can I consciously bolster my own sense of purpose in life?
Absolutely. Some people already have a strong sense of purpose, of course. But I think those who don’t can develop it by finding something to do that helps others in a meaningful way, or that makes the world a better place. Not only do I think that’s a good idea in itself, but I’m convinced that it’s likely to make you a healthier, happier person.
Should doctors talk to their patients about purpose in life?
I do think doctors should be taking the time to ask people, “What’s going on in your life? What matters to you? What gives your life meaning?” We have good reason to think that a sense of purpose is important to health—as important as exercise and a healthy diet. Unfortunately, doctors have, what, about eight minutes to spend with each patient. So while they may be able to ask about purpose in life, they probably won’t have time to offer much help. Ultimately, I think, doctors will refer patients to counselors trained in helping people find purpose in life, just the way they now refer people to nutrition counselors or physical therapists.
This opinion does not necessarily reflect the views of the UC Berkeley School of Public Health or of the Editorial Board at BerkeleyWellness.com.
Also see The Science of Happiness.