William Breitbart, the chairman of the Department of Psychiatry and Behavioral Sciences at New York's Memorial Sloan Kettering Cancer Center, specializes in end-of-life care for terminally ill cancer patients. For much of his career Breitbart has been surrounded by suffering people who just want to die. Breitbart said, "When I walked in the room, my patients would say, 'I only have three months to live. If that's all I have, I see no value or purpose to living.'" One of his patients, a former IBM executive who had been diagnosed with colon cancer, said, "Everybody said how important it is to have a positive attitude, but...I want to jump in the grave."

If death means nonexistence, Breitbart's patients reasoned, then what meaning could life possibly have? And if life has no meaning, there's no point of suffering through cancer. By the nineties, physician-assisted suicide was a hot topic in Breitbart's circles and beyond. As Breitbart heard more and more stories of assisted suicide, he began to wonder what specifically was driving the terminally ill to give up on life. The assumption had been that the ill chose to end their lives because they were in terrible pain. But when Breitbart asked patients why they wanted a prescription for assisted suicide, many said it was because they had lost meaning in life.

Breitbart knew he could treat depression with drugs or therapy, but he was stumped when it came to treating meaninglessness. "What I suddenly discovered," Breitbart explained, "was the importance of meaning—the search for meaning, the need to create meaning, the ability to experience meaning—was a basic motivating force of human behavior. We were not taught this stuff at medical school!"