¶ … middle-aged man. The stakes are rather high for this man because he is very depressed and on the verge of suicide. He has lived life in a very altruistic way over the course of his years and his recent struggles have led him to become very despondent. The author of this report is asked to help the man via a course of treatment. The man in question is facing very real questions about his life and his death. However, he is clearly not looking at the entire picture and he would likely find very high amounts of meaning in his life is he did so. While this man is in very bad shape, logotherapy, which is based on finding meaning in one's life, would probably help this man a great deal. Patient Summary

The man in question for this treatment question is a married man with two children. As noted in the introduction, he is a man that has always foregone his own happiness so that he can instead help others. As a boy, he saved his younger brother from drowning. Later in his life, he saved a pharmacist from going to jail. The pharmacist was intoxicated and would have accidentally poisoned a child had the man not been there and noticed what he was doing wrong. As a younger adult, he really wanted to go to college but he instead chose to run the family business. He felt the need to step in because his father suffered from a stroke and there was apparently no one else to fill the void. Further, he helped his brother go to school and his brother went on to become a war hero and an established professional.

However, the needs of others that he has met, at least to the patient, seemed to have run dry. He states that life is now "meaningless" and that nothing "seems to work for him." He feels that he just makes things worse for the people around him. He is apparently more and more despondent as the years pass and things have recently come to a head when he applied for and was denied a loan on Christmas Eve. As noted in the introduction, he is very depressed and on the verge of suicide. Something that is very clear from this patient is that he has been very self-sacrificing and has always put the needs of other before his own. It started when he was young and saved his brother and there have been very prolific examples of this throughout his life with the major examples being taking over the family business and helping his brother through school. One could argue it is still going on as he is a family man with two kids and a wife that he presumably loves.

Treatment Approach

To get through to this man, there are two major things that the author would focus on from a therapeutic standpoint. The first is that while many of the prior people that relied on him and that were the benefactors of his assistance are in his past, there are people in his present that need him to be a strong and confident man right now. While his father is apparently out of the picture and while his brother is now self-sufficient, his wife and kids need him to be strong and be the father/husband that they need him to be. While this is a continuation of a theme that he may not like all that much, it is indeed a way that he can find meaning. If he were to commit suicide, it would absolutely shatter his wife and it could absolutely traumatize the children. There would be big questions as to how they would fare without him present. They may very well be fine in the long run but they would be in a very bad place in the short-term at the very least.

To address the fact that the patient has been altruistic throughout his life, perhaps to a fault, the author of this report would seize on what dreams and desires the patient has. As noted in the details of this patient, he wanted to go to college. Presumably, he wanted to gain a skill of the knowledge sector variety and probably become a professional like his brother is now. It is not clear whether or not the family business is still in operation. Regardless, the man should absolutely pursue other endeavors of the family business is "not for him" and/or not what he really wants. The man has sacrificed so much...

Obviously, he should not do something that endangers his children or otherwise puts them in a bad spot. However, he has a right to pursue his own happiness.
That is perhaps why he was pursuing a loan from the bank. The author of this report would be very curious about what that loan was for. It could be for a number of things including a house, a car or perhaps even school. If indeed he wants to go back to school, there are obviously loans he could get with little to no credit. Also, his life is certainly not "over" as the notes indicate he is a middle-aged man and people change careers mid-life and mid-career all of the time. What he needs is a true self-definition of what he wants and how he is going to get there. If he becomes too disheartened and despondent, he is going to get in a cycle of self-fulfilling prophecies and things turning out the (bad) way he expected in the first place. If he finds what his "meaning" in life is, focuses on the needs of his family and also focuses on himself, he can find a path forward and out of his depression. He is obviously not being fair with himself. The statement in the vignette that states "he believes that things he does makes worse for people around him" is patently false and the vignette is riddled and teeming with examples of proof to the contrary.

Obviously, the man will have to deal with his mortality at some point in his life. Given that he is middle-aged, that point will start to come sooner rather than later. However, he is still in the prime of his life and he still has people that rely on him and that are counting on him. Even if he insists on continuing to self-sacrifice and put others before himself, he needs to remember that much. This should not be posed in a way that imposes a guilt trip or anything like that. Rather, it is about love and what his suicide-caused death would do to the lives of his children and his wife, at a bare minimum. There are surely reasons he was denied the loan and those issues can surely be addressed if the loan is something that is important to him. Also, any therapist that sees him would need to "dig deep" and find out what would truly make him happy. He obviously had big dreams earlier in his life and there is no reason why he should continue to forsake those dreams. People work and go to school all of the time and he could greatly improve the outcomes and fortunes of him and his family if he got educated in the field he desires to be in. It would seem he might have concerns about being a good enough provider for his family but there are ways to address that.

Research Support

The treatment approach mentioned above, that which pertains to finding "meaning" in one's life, was prior referred to when the term "logotherapy" was mentioned. The man that this form of therapy can mostly be attributed to would be Victor Frankl. As explained by the Victor Frankl Institute of Logotherapy, there are three basic principles of logotherapy. The first is that life has meaning under all circumstances, even when one is at their most miserable. Second, the main motivation of people when it comes to living is to find meaning in life. Finally, the third tenet is that people have the freedom to find meaning in what they do, what they experience or at least in stand that they take when face with a situation of "unchangeable suffering." (VFIL, 2015). Frankl has been quoted as saying that meaning can be discovered and found in life through a number of different ways including creating a work/doing a deed, by experiencing something or encountering someone and by the attitude we take toward unavoidable suffering. The assumptions that any therapist engaging in logotherapy should go by include that the human being is an entity that is made up of body, mind and spirit, that life has meaning under all circumstances, people have a "will to meaning," that people have freedom under all circumstances to activate the aforementioned "will to meaning," life has a demand quality to which people will have…