“Dr. F, would you be willing to see one last patient? He’s at the neuropsychiatry facility across the street. All he needs is something for gastroesophageal reflux.”

“OK, sounds easy enough. What is his name, so I can start looking at his medical record while I wait for him to get here?”

The nurse gave me the patient’s name, date of birth, and medical record number. I pulled up his chart and read some of the available notes:

Mr. Schafer is a 65-year-old, English-speaking, white Jewish male, currently living at a shelter. Patient was born in New York City and arrived in Houston, Texas, when he was 6 years old. His parents moved to Texas because both he and his brother had rheumatism and Texas appeared to be a better place for them to grow up.

Mr. Schafer denies homicidal ideations but answers in a seemingly careful way, as though he is concerned about being misunderstood or concerned that his answers will be misconstrued. He states, “No one who comes into my life alive will leave dead.”

Patient asked several times to “justify psychiatry” and explain why he needed medications. The visit was terminated after about 10 minutes when Mr. Schafer became agitated and threatening. After checking out of the clinic, he walked back in and stated that he was upset because he realized that he couldn’t “help save me from the forces that are destroying me.”

Interesting… I hope he won’t get belligerent with me and hope this visit won’t take too long.

“Good evening, Doctor,” Mr. Schafer said, entering the room, “Thank you for seeing me on such a short notice. I know they told you I need something for my gastroesophageal reflux, but I’m not planning to take any medications. I know what’s causing it, and I want to explain to you my theory, which I believe to be right…”

Oh, my goodness, what did I get myself into?

“…but, before I get into that, I’d like to tell you more about myself.”

Oh no! My eyes opened wide. I couldn’t hide my concern over the direction the visit was taking.

Mr. Schafer, correctly interpreting my feelings, quickly added, “Don’t worry, Doctor, just bear with me. It won’t take but a few minutes.”

I knew all too well that would not be the case, but I decided not to cut him off. I decided to sit back and listen. He was my last patient, so I had no compelling reason to rush through the visit, other than the fact that the office staff were anxiously waiting to go home. I took a deep breath and asked Mr. Schafer to go ahead.

“Doctor, you need to know that I’ve been diagnosed with schizoaffective disorder and paranoid personality disorder. I also suffer from major depression. You are not different from me. I know you are depressed too, because everybody is depressed, but you’ve found ways to function in life, where I haven’t been able to.”

Wow! What a way to start! How does he know I’m depressed? I guess he has a point—we are all somewhat depressed.

“I can’t hold a job and I live in a shelter. I have no family. They are trying to change me with medications, and that’s a terrible thing to do, changing people with the use of drugs. Seroquel makes me feel drunk. I need a rational explanation of why I need to be on drugs. I know I’m irritable with people, but I’m controlling myself. I’ve been suicidal for the past 40 years, but I make a conscious decision every day not to commit suicide. I wouldn’t kill anybody because that’s not the right thing to do. Do people have the right to kill themselves though? Or is life too sacred to consider that acceptable? I’m not talking about end-of-life issues, like the terminally ill patient on life support with an irreversible condition who chooses to have the plug pulled, or who has that chosen for them. I’m talking about when the movie we live in gets bad and we don’t want to sit and act in it until the bitter end. Do we have the right to kill ourselves? I’ve made a choice not to kill myself and to stay alive. I came to realize that the way we imagine the future affects our longevity. The most critical factor keeping us alive is hope; once we lose that hope, we’re doomed.”

Isn’t that true? When we lose hope, it’s over.

“I teach myself right and wrong every day and I choose to do right. I teach myself how to be humane. Human beings need to be taught how to be humane, because it’s clear that it doesn’t come naturally to behave in ways that are respectful and loving. I have the gift of discernment and I can use this gift for good. I can help people see the truth in a way that they may leave the conversation wishing to improve themselves. But I’m fully aware that I could use this gift for bad, leaving the other person feeling insecure, sad, and defeated. We all have this gift, but many people are not aware of it. Nevertheless, people too often use their words to detract from you and make you feel bad about yourself.”

This man is very intelligent and very wise. It is too bad that he can’t function well in life, as he has found a lot of truth in his illness.

“I read a lot, Doctor,” he continued. “When I leave the shelter, I go to the public library. I love this particular author, Scott Peck. Doctor, you need to read his book The Road Less Traveled. Read the paragraphs about white lies, page 59 and 63, how they are accepted in society, yet are hurtful. There is a façade between parents and children; if children test honesty and authority, parents have the excuse for verbal and/or physical abuse. If people speak their minds and speak the truth, they are considered insubordinate and untrustworthy, promoting the idea of ‘obey me or else I will hurt you.’ This leads to accepting the organization’s identity and losing personal identity and integrity. You need to be careful, Doctor, because I know you speak your mind.”

How does he know that? I haven’t said a word yet.

“Truth is dead,” he continued, “replaced by ‘truth by consensus.’ Lies become the truth when people agree to them and don’t speak up. If you refuse to agree to a lie, you get fired. Do not agree to a lie, Doctor. It’s better to be fired than agree to a lie.”

I was quite taken by the insightfulness of Mr. Schafer. I decided to let him talk, as I found myself wanting to hear more about what he had to say.

“I don’t like staying at the shelter,” he continued. “I don’t sleep well there, but I find comfort in having clear rules. I must return by 6 pm and shower. If you don’t shower, you can’t stay at the shelter. I appreciate this black-and-white rule. It doesn’t leave any room for interpretation and confusion. Dr. Peck believes that discipline is essential for emotional and spiritual health and evolution. What makes discipline important is the ability to delay gratification, accepting responsibility for oneself and one’s actions and a dedication to truth.”

Go on, Mr. Schafer, go on.

“You are the only one who’s been willing to listen to me and I want you to know that I appreciate that. I also appreciate you not wearing revealing clothes. Boundaries are very important. If I continue to come and see you, we’ll have to set clear boundaries.”

“Of course, Mr. Schafer, boundaries are critical. This is very true,” I answered, adjusting my white coat as to close it even further.

“I know I speak the truth.”

“So, Mr. Schafer, what is the meaning of life? What is the truth about that?” The question came out of my mouth before I could even think about asking it. I realized that it was a loaded question and that I was going out on a limb, but I really wanted to hear his answer. I felt like Mr. Schafer was already putting many of my personal beliefs into words. Why not venture into the meaning of life, something I had wondered about so many times? Maybe he had the answer to it.

“I’ve already told you that I like reading books,” Mr. Schafer said. “Man's Search for Meaning by Viktor Frankl concludes that the meaning of life is found in every moment of living. I have the book with me.” Mr. Schafer pulled the book out from a plastic bag where he kept a bottle of water and a small box of saltine crackers.

“Here it is.” He opened it up and pointed to a paragraph he had highlighted. I noticed that many paragraphs throughout the book were highlighted.

“Read this,” he said. “Our actions have to be informed by love.”

I read the following:

A thought transfixed me: for the first time in my life I saw the truth as it is set into song by so many poets, proclaimed as the final wisdom by so many thinkers. The truth—that love is the ultimate and the highest goal to which man can aspire. Then I grasped the meaning of the greatest secret that human poetry and human thought and belief have to impart: The salvation of man is through love and in love. ([1], p. 37)

I found out later that the book’s original title in German is...trotzdem Ja zum Leben sagen: Ein Psychologe erlebt das Konzentrationslager, that is, ...To Nevertheless Say Yes to Life: A Psychologist Experiences the Concentration Camps. It is an amazing account of Frankl’s experiences and personal reflections while imprisoned in the harsh conditions of the infamous Auschwitz concentration camp. It is considered one of the most influential books in the United States and the world, and I hadn’t read it, but Mr. Schafer had, clearly more than once.

Mr. Schafer continued, quoting from the book, “You see, Doctor, life never ceases to have meaning, even in suffering and death. Even in severe suffering, we have freedom of choice and we can choose to do good. Read here:

What was really needed was a fundamental change in our attitude toward life. We had to learn ourselves and, furthermore, we had to teach the despairing men, that it did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead think of ourselves as those who were being questioned by life—daily and hourly. Our answer must consist, not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual. ([1], pp. 76, 77)

So, Doctor, your question should not be ‘what’s the meaning of life’ but rather ‘how do we find meaning in life.’ And we find it by being good and doing good. There are only two races of men on this earth, decent men and indecent men. No society is free of either of them. If you choose to be a decent human being, then it’ll be easier to find meaning in life.”

I was stunned. Why hadn’t I thought of that? That the real question is not “What is the meaning of life?” but “How to find meaning in life?" A seemingly insignificant change in preposition, from of to in, can entirely change the approach to life.

By that time, the nurse had come to knock on the door. “Dr. F, sorry for interrupting, but you have a phone call from the hospital.” I knew that was a code phrase that really meant “It is time for you to conclude this office visit.”

“OK,” I said, “I’ll be out in a moment. Mr. Schafer, I have to go now. What about that gastroesophageal reflux? I can print a list of foods and drinks you should avoid to help with your problem.”

“Thank you, Doctor. I appreciate that. I’ll take the list. Will you be here tomorrow?”

“Not tomorrow, Mr. Schafer, but I’d be glad to see you again.”

As Mr. Schafer left the room, so many thoughts were swirling in my head that I almost felt dizzy. I wondered who had helped whom during the office visit. I knew that the simple act of listening was much appreciated by Mr. Schafer, but I felt that, most likely, I had gotten much more out of the conversation than he had. It was as if his ranting had come at the perfect time for me, both personally and professionally. I left the office thinking that we often look for complicated answers to life’s questions, when in fact it should all be about love and doing the right thing.