Viktor Frankl’s Holocaust memoir, Man’s Search for Meaning, is an extraordinary essay on resilience and spirituality, a reminder that human life, under any circumstances, never ceases to have meaning. At the risk of mentioning Bob Dylan in the same sentence as Viktor Frankl, it was Dylan who said: “When you ain’t got nothing, you got nothing to lose.” I suppose Bob Dylan read the book too, ranked by the Library of Congress as “one of the ten most influential books in America.

Man’s Search for Meaning is as much about hope as it is about loss. “Whoever was still alive had reason for hope,” Frankl told his comrades. They could hope for health, family, happiness, fortune, and a return to their occupation and position in society. “After all, we still had our bones intact,” Frankl reasoned. Clearly, he set the bar low.

Anyone searching for a meaning to their life will be disappointed if they think they will have it after reading Frankl’s book. Frankl specifically writes that the meaning of life cannot be defined in a general way, because it “differ[s] from man to man, and from moment to moment.” Nor can the meaning of life be answered by “sweeping statements.” A person’s unique opportunity – the reason for their existence – lies in the way in which they bear their burden. Indeed, the words over the entrance gate to Auschwitz concentration camp – Arbeit Macht Frei – meant: “Work Sets You Free.” Even under the most difficult circumstances such as forced labor, Frankl would have seen a deeper meaning to it.

In contrast to Emil Sinclair’s epiphany in Hesse’s Demian, i.e., the realization that: “Each man had only one genuine vocation – to find the way to himself” – Frankl was of the persuasion that “it did not matter what we expected from life, but rather what life expected of us.” Individuals content with the life they lead and forgiving of their own flaws may not be able to learn much from Man’s Search for Meaning, for Frankl would have us believe that it is important to overcome adversity and hardship to derive meaning in life. Frankl speaks not only of hard labor and the day-to-day unknowing of whether one would be executed or gassed, but also the ability to withstand the brutal pain of disease and famine. Common among the prisoners were malnutrition, severe vitamin deficiencies, lice infestations, frostbite and typhus outbreaks.

Epidemic typhus is caused by a bacterium (Rickettsia prowazekii) spread to people through contact with infected body lice. Though epidemic typhus was responsible for millions of deaths in previous centuries, it is now considered a rare disease. Occasionally, cases continue to occur, in areas where extreme overcrowding is common and body lice can travel from one person to another.

The concentration camps were a different story; they were fertile ground for the spread of typhus. The exact number of prisoners who contracted typhus cannot be determined, but the number has been estimated at well over 100,000. Frankl became infected with typhus and almost died. The first symptoms, visible several days after infection, were high fever and a rash. Next came damage to the central nervous and circulatory systems, including delirium and myocarditis.

Effective treatment with antibiotics was not available during World War II, and a lack of nutrition made it harder for a prisoner’s immune system to fight off disease. Mass selection of infected prisoners for the gas chambers was a common method of “prevention.” Recovery without treatment occurred after about four weeks for the lucky few, although to be sure, many did not consider themselves lucky to survive the ordeal, believing they would be better off dead.

One has to wonder how those who were not killed straight on arrival at the camps and were instead condemned to unimaginable torment – both physical and psychological – as well as to a sense of constant insecurity about their future, starvation, labor beyond their capacity, and to life in utterly unsanitary conditions that fostered the spread of numerous infectious diseases (not only typhus), managed to survive. On this point, Frankl quotes Nietzsche – “He who has a why to live for can bear with any how” – and concludes that “only the men who allowed their hold on their moral and spiritual selves to subside eventually fell victim to the camp’s degenerating influences.” However, not many were capable of reaching great spiritual heights, which Frankl conceded was man’s meaning in life even if spirituality was experienced differently by each person.

There is a parallel between Frankl’s world and the medical arena, where patients have survived grave medical illnesses associated with grim prognoses. Research has shown that spirituality often provides a coping mechanism for individuals facing severe illnesses. Conversely, a decline in spirituality seems to be associated with potentially negative health effects.

For example, a spiritual life can offer comfort, improve resilience, and provide a sense of purpose, which may enhance the overall quality of life and even positively influence survival rates. Spirituality can influence health behaviors like adherence to medication, diet, and exercise regimens, which can significantly affect the outcomes of patients with grave illnesses.

Patients who engage in spiritual practices may experience less anxiety, depression, and stress, which can positively affect their overall health status and potentially their prognosis. Some studies suggest a potential link between spirituality and the immune system. Patients with strong spiritual beliefs may experience less inflammation and improved immune response, which could potentially impact their ability to combat serious illnesses.

As a physician and psychiatrist, Frankl was keenly aware of the impact of the prisoners’ physical and mental states on their survival: they were highly correlated. In other words, prisoners who were better able to withstand the mental and physical torture were more likely to survive partly due to a healthier immune system and fewer depressive and suicidal thoughts. In this context, it is worth noting that spirituality can also play a crucial role in end-of-life care, influencing decisions about treatments and interventions. It can lead to better patient satisfaction and potentially improved survival rates.

It is also important to note that while these correlations exist, the relationship between spirituality and health is complex and influenced by a variety of factors. More research is needed to fully understand the mechanisms behind these associations.

Meanwhile, why not make Man’s Search for Meaning required reading for all health care practitioners?

Arthur Lazarus is a former Doximity Fellow, a member of the editorial board of the American Association for Physician Leadership, and an adjunct professor of psychiatry at the Lewis Katz School of Medicine at Temple University in Philadelphia, PA. His forthcoming book is titled Every Story Counts: Exploring Contemporary Practice Through Narrative Medicine.