On Purpose

Research shows that if you can connect to a higher purpose, you will be more likely to reach your health goals.

For example, the most effective treatment for hepatitis C is interferon, a drug that requires self-injection and has some very nasty side effects, like fatigue, anxiety, nausea, and skin rashes. It is very difficult to get people to take it on a regular basis, even those who understand that their lives depend on it. The short-term pain blinds them to the long-term gain.

Dave Sifry told me about a study that tried something new. Instead of appealing to people’s sense of self-preservation, researchers told a group of hepatitis C patients that if they could reach a collective goal of 90% adherence to interferon over the course of the study, a donation of $10,000 would be made in their name to a local burn center for children. The group visited the burn center, toured the wards, and met the doctors and nurses who worked every day at saving children’s lives. The group also kept in touch with each other, cheering each other on, more like teammates in a contest than study participants. And in the end, they did it. The study was successful and the donation was made in the name of these brave people who were more willing to go through hell on behalf of someone else than to save their own lives. (Note: neither Dave nor I have been able to locate the study again so if anyone reading this has the access and skills to search for it, please post a comment about what you find.)

What goal can you set for yourself? What higher purpose will motivate you to keep putting one foot in front of the other?

If this sounds daunting, I am happy to report that there is a shortcut. Vic Strecher, PhD, MPH, a professor at the University of Michigan School of Public Health, has boiled down all the wisdom of the great philosophers – and captured it in a comic book narrated by a dung beetle. Seriously.

A stylized dung beetle from On PurposeI use the book’s companion app, On Purpose, to rate the following five aspects of my life on a daily basis:

  • Sleep
  • Presence
  • Activity
  • Creativity
  • Eating

You might notice that the acronym spells S.P.A.C.E. and the app developers created a cute visual – each aspect appears as a planets in the night sky. For example, for today you might place Sleep up near the top (“really super great”) and then place Presence or Eating down low, closer to “out of whack!” The next day, you might strive to do better with those aspects you placed low in the sky.

Another exercise gives you a grid of 15 values: achievement, community, creativity, enjoyment, expertise, independence, kindness, relationships, reputation, responsibility, security, self-control, spirituality, tradition, and vitality.

Take out a piece of paper right now and choose up to 5 of those values. Now write a short description of what each one means to you and how deeply rooted that value is in your life. The app does this by allowing you to pull animated tree roots down into the soil, from level 1 to level 5. Now try your hand at writing an overall purpose statement for your life, which gets easier to do after you have spent some time thinking about the different values you hold. (My first attempt was so bland it could have been anyone’s, but I’m getting better at it.)

The final exercise is a showstopper. Picture a gravestone carved with your name, birth year, and death year (which is filled in to be the current one). Now write your own epitaph, how you would like to be remembered. The lesson is that death brings meaning to life; it clarifies your values in an instant. (I have to admit that tears sprang to my eyes the first time I tried to write mine.)

You might find it useful to explore these themes further by writing in a journal or keeping a blog. Research shows that the act of writing helps people process their feelings and put difficult, even traumatic, experiences in perspective.

Be mindful of your choices about publishing under your real name or revealing personal details that you wouldn’t want splashed on the front page of your local newspaper. But don’t miss out on what has been shown to be a powerful therapeutic tool in managing your health.

Lisa Gualtieri and Pam Ressler’s research shows that people who blog about their health conditions say that it puts their situation in perspective and, by sharing their own story, helps people who share the same issues find each other. Blogging or otherwise sharing online can create a sense of community and you may find that this leads to a higher purpose – a camaraderie that motivates you to better understand your condition or adhere to treatments.

24 thoughts on “On Purpose

  1. Thanks so much – again – for a great post. As primarily an existential psychologist and someone who practices values clarifications often within motivational interviewing, there is nothing more important than these exercises and Vic’s work is an amazing method to achieve these goals. I also highly recommend that people read the classic “Man’s Search for Meaning” which I have found is a wonderful introduction to building purpose in ones life. Thanks again for bringing up this important – but underutilized – strategy to light.

  2. I just recently bought Vic’s book but — since it’s behind a couple of others — I just put it on a table in my living room. The next day, I came downstairs and saw my 10-year-old engrossed in it. He’s already read much of it — I can’t wait to read it too and compare notes with him.

    • Yes! That is the kind of book it is — beautiful, funny, engaging, and deeply meaningful.

      Do you know Robie Harris‘s work? She’s a children’s book author who teaches about reproduction and sexual health through humor and cartoons, backed up by science. On Purpose reminded me of, for example, It’s So Amazing which is narrated by a bird and a bee.

      • Vic,

        have a look at “The Sexual Healer: The Couples Therapy Expert Esther Perel Takes On Sex and Sexuality.”

        Here is a quote: “when the older of their two sons, Adam Saul, walked in the door of their home that afternoon, she [Esther] invited him (in French, in which she usually converses with him) to comment on his mother’s work if he was so inclined. Adam, a sophomore at Wesleyan, said that for years he begged his mother to cover up her books about sex when his friends came over.

        “But she said she wouldn’t cover up books about weapons of mass destruction, ‘And so I wouldn’t cover these up, either,’ ” said Adam, putting on his mother’s European accent as she looked on with pride. For all the embarrassment he might have endured, he had some nice things to say about having a sex therapist for a mother, too. “High school sexual education programs don’t teach you how to communicate with your partner,” he said. “They’ll show you a picture, I can tell you if it’s gonorrhea or chlamydia, but not how to have normal, healthy intimacy.”

  3. Thank you for connecting Vic’s phenomenal contribution, and concepts of aligning personally meaningful and early work on ‘pro-social behavior’…it cuts across so many parts of peoples’ lives and relationships.

    I couldn’t find the study you mentioned [what ARE the search terms? :-) ], I did come across a trial among people with a liver condition to were randomized to donations to the World Food Programme…which had an effect on the outcome. Abstract only is at:

    The ‘donations for decreased ALT (D4D)’ prosocial behavior incentive scheme for NAFLD patients

    • Thanks, Sue! I’ll look at that study. And I wish I did have better search terms to offer. It’s like a game of health intervention telephone we’re playing :)

  4. Interesting – on many levels – and very well aligned with an essay Adam Grant posted this morning, highlighting the connection of meaningfulness and being of service to others … and, aligned with Fred Muench’s previous comment, referencing Frankl’s book, “The Meaning of Life” The #1 Feature of a Meaningless Job.

    FWIW, I am usually pretty good at tracking down studies, but searching around for various combinations of terms in the interferon study referenced above, I could not find anything. And nothing relevant appears to be included in a recent review:

    Ann Hepatol. 2013 May-Jun;12(3):380-91.
    Patient adherence to antiviral treatment for chronic hepatitis B and C: a systematic review
    Lieveld FI, van Vlerken LG, Siersema PD, van Erpecum KJ.

  5. Today was a good day. A bunch of people fanned out across the network to try to help me locate a citation for the interferon study, tweeting updates and links whenever they found something useful (including hitting dead-ends — better to know that avenue has been tried!)

    @pfanderson wrote, for example: Not finding it in Pubmed or Google. Tried http://ClinicalTrials.gov in case not pub yet, no luck.

    She later followed up with ideas about how to sleuth it out:
    - Maybe related to this project? Virtual Coaching for Hepatitis C Patients or Hepatitis Neighborhood
    - These folk might know of it, wherever it is going on Hepatitis C treatment access and uptake for people who inject drugs: a review mapping the role of social factors and Self-Efficacy and Adherence to Antiviral Treatment for Chronic Hepatitis C
    - It’s really hard finding these types of answers. Often just finding the person who might know is all you can do.
    - I’ve also collected a lot of links about adherence for a storify from last weeks HCSM on adherence vs compliance
    - Need to take the question and turn it upside down, backwards, look at it fr diff direction.
    - The bit about financial incentives is another post I’m working on – the risks, and drawbacks.

    Mark Vrabel, aka ONSmark, wrote: I’ve seen studies on “nudges” like this (charitable donations) but not for hepatitis C patients & interferon adherence, sorry.

    Later, he shared:
    - Patient adherence to antiviral treatment
    for chronic hepatitis B and C: a systematic review
    (PDF) has studies on interferon adherence for HCV but “nudges” (donations etc.) not among them.
    - Analysis of the factors motivating HCV-infected patients to accept interferon therapy has many interferon adherence for HCV factors but “nudges” (donations etc.) not among them.
    - “Are charity donations the key to medication adherence?” links 2 some general info not HCV/interferon
    - And finally (whew) Longwoods.com has articles on “nudges”/”user financial incentives” for medication adherence etc.

    (At which point I dropped the fork I was holding — I was eating lunch at the time. Wow! I had no idea I’d get this kind of response and am deeply grateful.)

  6. Susannah,
    Thanks for a thought-provoking post. Unfortunately, I don’t have any leads on the Hep C/IFN reference – though it sounds like you’ve got others digging deep!
    I’ve downloaded the On Purpose app and ordered the book, but haven’t yet had the emotional reserve to try the gravestone exercise.
    With regard to health, the On Purpose approach seems to be part higher purpose and part habit loop. The exercise of writing down specific targets (be they core beliefs or specific tactics) definitely drives habit formation and helps anticipate negative inflection points – which helps us navigate around them.
    This reminded me of the Scottish orthopedic rehab study referenced in Duhigg’s “The Power of Habit” (Chapter 5, Section III). It would be intriguing to evaluate whether determining values and purpose is additive to the mere act of writing down one’s plans and strategies. Perhaps Vic has some thoughts on that.
    Will also add a +1 for Frankl’s “Man’s Search for Meaning.”

    Greg

    • I got a copy of The Power of Habit at a conference but haven’t read it yet — I’ll skip ahead to Ch. 5 to read up on the study you mention. Thanks!

    • Very thoughtful questions/points brought up. And thanks for prompting me to get out my “Power of Habit” book again! Couple of thoughts:

      When you mention the “exercise of writing down specific targets (be they core beliefs or specific tactics)” I started wondering whether “core beliefs” are very close conceptually to “specific tactics.” Albert Bandura, Gary Latham, and others have discussed how goal setting elicits greater concentration and planning (article on goal setting: http://1.usa.gov/1i3uYPt). I honestly don’t know whether a “meta-goal” such as a life purpose would also elicit this type of planning. In designing the app I considered incorporating tactical goals but in the end wanted to make the daily monitoring as simple as possible, at least for Version 1, placing more weight on intrinsic motivation than tactics. It could be, however, that a meta-goal such as a life purpose actually stimulates tactical thinking.

      Example: One of my life purposes is to “teach my students as if they were my own daughter.” Thus, when a student asks for a meeting that I don’t have time for, I first say to myself (really!) “this is my purpose in life), then focus on a tactical plan to make time for the student. As my friend Ken Resnicow says about Motivational Interviewing, “with sufficient motivation, the barriers tend to take care of themselves.”

      In the section of “Habit” you’re referring to, Charles Duhigg talks about specific goals leading to greater self-control (“willpower”). The simple Sleep, Presence, Activity, Creativity, and Eating well (S.P.A.C.E.) activities have all been found in prospective research studies to be related to greater vitality. This was their primary function in the app — to provide greater vitality toward your life purpose(s). However, four of the activities (Sleep, Presence, Activity, and Eating well) have also been shown to influence willpower (creativity may influence willpower though I could find no study of this).

      I’m not sure if any of this helps respond to your message. I think you bring up an important area worth studying further! Thanks again, Vic

  7. hi susannah. as always, your work and your writing jolt us into reflection, questions, and application.

    the hep C study reminds me of companies that try to galvanize employees into better habits, whether sustainability or health habits. for example, walmart has a personal sustainability project (put in place in 2008). campbell soup starting requiring a sustainability goal for each individual performance plan more recently, maybe last year. charity miles lets us turn our walking, biking, etc. into donations. and employers and employees in various ways tie their 5ks and other events into local and national support.

    i have to admit that the tracking the on purpose app offers overwhelms me. you’ll appreciate that i’m a mental tracker in this department. however, as i mentioned on your FB page, the idea of evaluating my purpose, while not new to me is more deeply resonant right now due to my mom’s recently diagnosed terminal illness. i’ve always had a good bead on my life priorities, but her illness (and maybe creeping up on 50…) has spurred me to start pondering whether the way i’m creating my work purpose is the most effective. i’ll think on that epitaph and buy the book, and wait to see if i have the wherewithal to track on the app.

    • Thanks, Fran!! I hear you on the “am I ready for this?” score. I confess that it took me a few weeks to download the app after reading the book. I’d say I tiptoed in to this personal work, I didn’t jump.

      One note about the app — you don’t revisit your epitaph every day. You write it once and can revise it. What you do evaluate every day (for me, every morning) is how you’re doing with the SPACE elements of your life and how, in general, your day aligned with your purpose.

      Personally I am seeing lots of variation on the SPACE chart and generally giving myself a “nearly aligned” rating on the overall goals. As I rated yesterday (this morning) I wondered if I would ever give myself a perfect score on the overall assessment (I haven’t yet, despite having some really great days recently). What would that day look like? It was a nice question to start this day (and motivated me out the door to get a run in before work!!)

      And on the workplace goals — thanks for the tip about Wal-mart’s and Campbell’s programs. I’ll look into those.

      • before i forget, i wracked the cobwebs of my brain for the company who “rewarded” employees for completing a risk assessment by contributing money to a worthy cause. unsurprisingly, it is KP. for every employee who completed a health risk assessment, they donated $50 to wholesome wave, a nonprofit increasing access to healthy, nutritious food. http://bit.ly/1a7ZwQD

        i’m less intimidated by writing my epitaph than by tracking my SPACE daily. i’m tiptoeing in by downloading the iBook!

  8. Hi Susannah- First, thanks so much for the post! Really interesting stuff. I’m responding to your entreaty (via Twitter) that we share some thoughts around our team’s approach to developing the On Purpose app (and website), particularly from the design perspective. Happy to do so!

    Foremost in our minds was the absolute necessity (and pleasure) to draw our inspiration in terms of look and feel and user experience from Vic’s graphic novel. One thing Vic said that really struck a chord with the team was, “Make it delightful.” What a wonderful gauntlet toss to receive from a client — would love to hear that more often! Needless to say, the team was inspired by this.

    When it comes to designing any interactive experience we have to determine where on the continuum between innovation and utility we want to put down stakes. These two attributes aren’t mutually exclusive, but navigating between the two can present some challenges from time to time and this project was no exception. We ultimately opted to create an interface with features and functionality that would be entirely resonant with the spirit of the graphic novel. So, no standard iOS touchstones whatsoever. Taking this approach definitely meant a lot of conceptual work up front to ensure the UX was intuitive as well more than the usual user testing to validate our efforts.

    We also wanted the iPad and iPhone versions of the app to be responsive, tactile, and viscerally satisfying — this seemed important to us given that we want users to enter tracking data daily using their devices. We wanted it to be fun and quick; simple but interesting.

    We hope people discover and enjoy using the On Purpose app. It was a labor of love from start to finish, so thanks again for sharing your thoughts about it.

    Best,

    David Rossiter

    • Thanks, David! As a daily user I can tell you: it is delightful. I don’t miss any of the “standard” navigation buttons and find it quite easy to understand, even the first time.

      My 9-year-old was intrigued enough by the look of the app to watch the video with me, prompting a great chat about how he’d rate his own SPACE and underlining discussions we have had recently had with two rabbis (on separate occasions) about the Jewish understanding of death (!!)

      Thank you for dropping a beautiful pebble into our pond — many ripples.

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