Paul Valent

Paul Valent

Consultant liaison psychiatrist, psychotherapist, traumatologist,
Co-founder and past president Australasian Society for Traumatic Stress Studies,

The meaning of meaning

February 7, 2019


Meaning is more important than life itself, as people may sacrifice their lives if they find that meaningful. Trauma tears through established meanings. To make life worth living post-trauma, meaning of life must be restored. It is important to understand the nature of meaning if we are to help to restore it. This chapter examines the sources of meaning, provides a classification of meanings, and examines how meanings are disrupted and how they may be restored.

Meaning is central to human motivation. People sacrifice their lives for causes that they find meaningful and they may kill themselves if they feel that their lives have become meaningless. Trauma, such as occurs in disasters, has long been known to disrupt core human meanings (Wolfenstein, 1977; Raphael, 1986; Valent, 1983; 1998; 2004). Recovery requires re-establishment of life’s meaning. To re-establish life’s meanings we need to understand the meaning of meanings.


Meaning of life has been a nebulous philosophical concept, often confused with spirituality and religion. Disasters rip through previously held assumptions of the meanings of life. To counter their senselessness, supernatural meanings have been ascribed to disasters. The most common one has been that the disaster was God’s punishment for sin. Realignment with God’s will could then retrieve hope and meaning for the afflicted. Another meaning-making myth has been a Job-like testing of human faith in God. Utter senselessness may be countered by simply insisting that one cannot know God’s purpose.

Wrapping temporal meaninglessness within a supposed divine universal meaning can provide comfort and spiritual satisfaction. However, it can supplant scientific endeavour to explain the meaning of meaning and help restore it in survivors who feel that they have lost the meaning and purpose of life.

In what follows, I will first examine the semantics of meaning. Next, I will postulate survival and fulfilment levels of meanings. Then I will suggest that the wide variety of positive and negative meanings make sense and can be classified as results of successful and unsuccessful survival strategies that were used at the time of the disaster. Lastly, I will discuss implications of this classification of meanings.

The Semantics of Meaning

Meaning of a word refers to its essence and its ramifications. The meaning we refer to here is the psychological perception of the essence of life and its ramifications. On one level, life force, the unstoppable desire to survive, is the essence of life. But humans need reasons to keep surviving. They need fulfilling meanings to do so.

Otherwise death may be more meaningful than life.

The see-saw between the meaningfulness of life or death involves many areas. They include personal goals, relationships, love, usefulness, dignity, nobility, the sacred, ideals, and the universal. Spirituality increases as we proceed along this trajectory. It includes religion which is often thought to be the only source of spirituality. The point is that each of these areas, from temporal to spiritual, can include life or death as meaningful. For instance, from fire fighters to suicide bombers, risking or forsaking life can be more meaningful than preserving safety.

What is lacking is a definition of the purpose of life, a definition that includes meaningfulness of life, and sometimes of death.

Purpose of life in evolutionary terms is the survival of the maximum number of genes in a genetic or breeding population. In human terms, I define the purpose of life as survival in order to fulfil the maximum of one’s potentials according to the life cycle, and to help others to survive and to fulfil their potentials similarly.

Life has meaning if it fulfils such purpose, or if there is hope to fulfil at least part of such purpose. If life cannot do so but death can, death may be chosen as a meaningful alternative. Death may also be chosen if there is no hope of purpose, because life is then meaningless.

Meaning then has two platforms: survival and fulfilment. Yet it is a circular journey, for human purpose requires survival in order to be fulfilled, and fulfilment to create or nurture more life which needs to survive. Values, ideals, and spirituality are stations along the cyclical journey between survival and fulfilment, and helping new or other life surviving and fulfilling itself. Meaning derives from riding on that cycle.

Survival and Fulfilment Meanings

Survival meanings form almost immediately after the disaster and are compounds of traumatic experiences, responses to them and judgements of those responses.

A rescuer who has just saved a person may feel relief and joy and a sense of worth. The two may be compounded into the meaning “I am a good rescuer.” If rescue failed, an alternative meaning may evolve: “I have caused a death.”

Fulfilment (existential) meanings may evolve only after a latent period.

A survivor said, “I feel that I have been saved in order to tell the world how to avoid such catastrophes.” Another said, “The Holocaust convinced me that men are evil and that there is no God.”

Meanings According to Survival Strategies

Survival strategies are evolutionary templates that we share with animals which help us to survive as a species in traumatic circumstances. I have detailed eight survival strategies that make up an octave of potential means of survival (Valent, 1998; 1999; 2004, 2008). Survival strategies send reverberations from the most basic to the most evolved parts of the brain, following the pathways toward fulfilment. Those pathways include survival and fulfilment meanings.

Survival and fulfilment meanings are negative or positive according to whether survival strategies have been successful or not. Successful survival strategies can radiate the greatest joys of fulfilment and meaning. Responses that belong to survival strategies that failed to prevent trauma can radiate into the greatest human sorrows and meaninglessness.

The eight survival strategies that can fuel positive and negative meanings are: rescue/caretaking, attachment, goal achievement, goal surrender/adaptation, fight, flight, competition, and cooperation.


Rescue and caretaking comprise instinctive responses by which one capable individual saves the life of another who is threatened and vulnerable.

Survival meaning.

Positive. Altruism, kindness, pity, patience and charity are admirable virtues. Their use in the saving of another’s life means that the rescuer is a good, selfless, worthwhile person.

Negative. Lack of desire to help the needy can mean that the person is selfish. However, such meaning, survivor guilt, and belief that one caused the death, can occur even when circumstances prevented effective rescue.

Fulfilment meaning.

Positive. Preserving life, and offering dignity to the weak feels existentially meaningful and serves the purpose of life by the above definition. Survivors especially, or those whose own lives’ fulfilment has been curtailed, may yet find purpose in saving and nurturing others. Such nurture may become a lifelong mission.

Rescue of humanity is a common ideological and religious theme. Both provide a sense of universality and sacredness to one giving the gift of life.

Negative. Failure to save life leads to the meaning that one has betrayed the primal purpose of life, of preserving life. Survivor guilt may rack one eternally. Failure to save one’s child is a special torture. One does not deserve to be in this world when the other has died.

Understanding. We need to acknowledge the narrow and often fortuitous balance between capacity and inability to save, between altruism and self-preservation, between generosity and being burdened. Humans can only do so much for others.


Attachment is an instinctive mammalian bond whereby a vulnerable individual attaches to a protective and caring rescuer/caretaker. Attachment is the reciprocal drive to rescuing/caretaking.

Survival meaning.

Positive. Being held securely by a powerful rescuer and extraordinary carer means not only that one is safe, but also that one is important, worthwhile, lovable, and worth risking for.

Negative. Feeling abandoned and alone means insecurity and that one is not worth saving and caring for; that one is an outcast.

Fulfilment meaning.

Positive. The sense of worth matures into positive self-esteem and positive attachment into a belief that help will come when it is needed. Having been saved intensifies the bond to the rescuer. It may be seen as a sacred gift of life from another, a flame carried from another’s heart to one’s own.

When saviours are absent they may be remembered, imagined, or manufactured. On an individual scale, amulets, prayers and magic may be used to avert catastrophe. For a disaster afflicted community, sin may explain the disaster, leaving a benevolent saviour still possible. Virtuous deeds, rituals and sacrifices redeem hope and meaning through the belief that they will realign the offended rescuer to one’s needs. Otherwise the very fact of survival may be interpreted to mean that God intervened for one’s sake.

Negative. Belief that one was abandoned because one was worthless and unlovable radiates into low self-esteem and mistrust that the world will help. Loneliness and alienation are interpreted to mean that the world means to cast one out without reprieve. There is no justice, and no God who will help. Without love or care life has no meaning or purpose.

Understanding. We need to understand the difference between fulfilled attachment with its visions of paradise, and traumatic disruption of bonds with its visions of purposeless insignificance.

Goal achievement

In this survival strategy one has to achieve oneself what in attachment was achieved by others on one’s behalf.

Survival meaning

Positive. Capacity for independent survival means control, potency and success in the face of the challenges of the world. Self-confidence and morale are high. “If I want to, I can do it.” “I am strong, and I succeed.” “Survival is in my hands.”

Negative. Inability to meet challenges leads to feelings of impotence, powerlessness, and lack of control. They mean that one is incapable and inadequate. Self-confidence and morale are low. “I am a failure.” “I cannot rely on myself to survive.”

Fulfilment meaning.

Positive. In attachment one received the necessities of life. In goal achievement one achieves these necessities. The first necessity is food. To eat one kills life. Tribal societies recognized themselves as part of a sacred chain of life. Eating can feel sacred to this day as manifested by the abundance of social and idiosyncratic rituals around food.

Hunting and gathering has been replaced by money and wealth. Money can buy food, shelter, and territory. Money has replaced meanings of being a good hunter. Wealth means success.

Survival skills such as being an expert shooter, sailor, fire fighter, and so on, radiate into various fields of excellence and fulfilment of potentials including sport and art.

Skills of attracting the other sex, sexual prowess and achievement of progeny fulfil important survival goals too.

In all, achievement and command of wealth, shelter, territory, sexuality, progeny, and actualization of one’s capacities, mean success as a human being.

Magic, rituals, myths and religion are ubiquitously utilised to ensure good hunts and harvests, to overcome adversities, and to make up for deficiencies in abilities to achieve goals. They are also used as means of reconciling the taking of life.

Negative. Impotence, lack of control and failure negate ideals of achievement and self-sufficiency. A sense of failure overshadows all effort. Instead of affluence there is poverty, both physical and emotional. Creativity is stifled. Fulfilment is lacking. This means that life is a sham, a stagnant conveyor belt to failure as a human being.

Religion and ideology may offer promise of a different future where essentials are provided and success is assured.

Understanding includes realisation that skills of survival and actualization of potentials carries satisfaction, meaning and joy, and that the energy to achieve them comes from other life. One day we all contribute our own beings to the chain of life. In the meantime, if we do not actualise our potentials, our lives are unsatisfied and demoralised.

Goal surrender and Adaptation

One may have to give up basic goals in order to be able to find new ones. It is like chopping off a limb so that the rest of the body survives. The limb may be another person. The process of adaptation starts in shock and being overwhelmed, and ends after grief and mourning when new life goals emerge.

Survival meaning

Positive. In the face of death and destruction the only meaning of life may be a desperate drive to survive, or to maintain some hope – perhaps reunion with a loved person that gives meaning to survival.

Indeed, grief and mourning may highlight love that provides meaning: “The cost of love is loss.” This loss may be negated when dead person appears in visions, dreams, as a ghost, in séances, or through various signs. Loss may be mitigated by absorbing the lost person psychologically. Anything that keeps the dead person alive in some way may be experienced as meaningful.

Magic, myths and religion also offer comfort through the belief that the dead person is still alive and happy in a better place, a place in which reunion will happen.

Negative. The extent and senselessness of death and destruction negates the purpose of life and leaves one in a meaningless world. The result may be depression and despair. Death may offer the only relief as well as hope of reunion.

Fulfilment meaning

Positive. Lost love mourned and now absorbed may form a platform for new loves. Relationships may be sweeter and deeper, appreciated more as a result of past trauma.

Disasters may evolve meaning if they are used as lessons to save other lives. Examples of movements to achieve this outcome are MADD (mother against drunk driving), and Mothers Against War.

Religion can continue to provide comfort by insinuating God’s unknowable designs, and providing heaven as a perpetual antidote to death and trauma. Religion can provide a semblance of justice. “God gives, and God takes.” “Life is but a loan that has to be repaid.” Cycle of life as a universal principle may provide both religious and secular meaning. Religion provides mourning rituals that can help the process of grief.

Negative. Traumatic losses may destroy any semblance of purpose and meaning.

They may be seen as evidence of the absence of a just, compassionate and concerned

God. “God is dead.”

Understanding acknowledges that death is part of life. With death as a backdrop, we must appreciate whatever life is granted to us. We should apply lessons from catastrophes to prevent future ones. In the meantime we should not interfere with the comforts people draw from their cultures and imaginations.


Fight is an instinct whose function is to remove danger. Threats, hatred, revenge, and killing are escalating manifestations of this survival strategy.

Survival meaning

Positive. Defence of life, property, territory, and values, and ridding those who threaten them is intensely meaningful for the defenders. “I am a brave warrior who defends the lives of my people.”

Enemies are like predators and monsters that have to be killed. “Kill or be killed.” Magic, rituals, myths, are harnessed for support. “Only a bullet with my name on it can harm me.” “If it is meant to happen, it will.” God will protect me, but if one should

die, meaning is found in martyrdom and in heavenly rewards.

Natural disasters may be symbolised as wild animals and monsters. Killing the fire dragon was a spontaneous community ceremony that marked survival in a bushfire. Killing humans is expiated in ceremonies such as sweat lodges.

Negative. Killing for purposes other than survival is murder. Killing innocent people who have been scapegoated, demonised and dehumanised constitutes atrocities and crimes against humanity. Realization that one has killed other than in self-defence shatters the meaning of one’s life. Such killing goes totally against he purpose of life. Soldiers may try to blot out such realization through drugs, rage, or expiate their guilt by getting themselves killed.

Fulfilment meaning

Positive. Preservation of one’s people and their ability to fulfil their lives continues to be highly meaningful.

One’s status may be fulfilling. Warriors enjoy awe and sacred status through their authority to take life while staking their own.

On a wider scale, one may have fulfilled God’s mission, especially in holy wars. Or one may have fought for an ideology such as patriotism or class equality, or democracy. Fascist and Hegelian ideology saw war as an ancestrally connected nation (master race) expanding and fulfilling itself.

Negative. Killing is meaningless when fed by blind paranoia and hatred, leaders’ ambition and vanity, or when killing becomes a numbers game (body count) or a banal job (as in concentration camps).

Realisation of the evil one perpetrates may fended off by assuming God-likeness through one’s power over life and death. Then killing cannot stop and becomes an addiction.

Needless killing means that one is a monster, a wild animal, an outcast from humanity.

Sometimes veterans retrieve meaning by exposing the horrors of war and by becoming peace activists.

Understanding weighs up the necessities of true defence as against the tendency to exaggerated fear. With the extinction of predators and sufficient resources in the world, fight is always an ultimately unnecessary survival strategy.

Difficulty in empathy for enemies and perpetrators hides facts that attackers fear us like we fear them, that perpetrators were themselves victims of violence, and that atrocity-making situations can make us all violent.


Flight is the reciprocal survival strategy to fight. Rather than ridding enemies, in flight one removes oneself from them. Fear, anxiety, panic and freezing are emotional associations of this survival strategy.

Survival meaning

Positive. Flight can preserve life in certain circumstances as effectively as fight does in others. It can take much courage, resourcefulness, astuteness and cunning to escape annihilation. To have manoeuvred one’s family to safety is intensely meaningful.

Amulets, witchcraft and prayers may be enlisted for effective escape or hiding. Negative. Inability to escape means that one is trapped, a helpless victim. One may be pounced on, raped, tortured, and annihilated at any moment.

Fulfilment meaning

Positive. Reaching sanctuary means that one and one’s family or group are safe.

One can continue one’s life or start a new one.

Sanctuaries may be geographical, social, political, or ideological, such as joining a group or party for safety. Religion offered temporal safety when churches were sanctuaries in wars. Religion offers spiritual haven in heaven – the ultimate sanctuary.

Negative. Meanings of a dangerous world may persist beyond objective danger. “Be prepared.” “Keep your head down. Have your suitcase packed. Don’t be conspicuous. Hide. Get out.”

One may live in continual fear, which is paranoid and phobic if unjustified. Nightmares relating to past traumas persist. Triggers reminiscent of past dangers trigger panic attacks. These responses are the hallmarks of PTSD (post-traumatic stress disorder). Withdrawal and drugs may avoid or dampen these triggers, but survival in a dangerous world remains the dominant preoccupation. Progression to spirituality and meaning are disrupted. There is no God, only monsters.

Understanding acknowledges human vulnerability. Prudent heedfulness without paranoia may prepare one for changed circumstances, and facilitate flight should it become necessary. PTSD may be treated by separating past and present realities and re-establishing a life narrative that has hope and new meanings.


In situations of scarce resources hierarchies form and resources are distributed down a pecking order. Hierarchical competition is for dominant status. When hierarchies break down people scramble and struggle for resources without order.

Survival meaning

Positive. The meaning of hierarchies is that everyone has his or her place in the pecking order. Sure, those on top receive first and most, but they have an obligation to distribute enough down the line for all to survive. The meaning of hierarchies is that if you honour and obey your superiors they will look after you. If you in turn look after those below you, the community survives. In disasters police and rescuers have special leadership roles. After disasters new hierarchies form.

Each rung on the hierarchical ladder, like figures on a chess board, carries different meanings of status, privileges and survival.

Governmental hierarchies also help in disasters. Priestly and heavenly hierarchies offer non-material comfort.

Negative. Those in power appropriate excessively for themselves, robbing those below them of their necessities. This injustice means submission or revolution. When hierarchies break down, struggle and scramble ensue. Meaning of such situations is that “The world is a jungle where dog eats dog.”

Fulfilment meaning

Positive. Dominance in hierarchies carries meanings of superiority, privilege and power, as well as responsibility to pass resources down the line. Each level in the pecking order can be fulfilling in its own way, with admixtures of respect for superiors, dignity in one’s own status, and respect from those below. Existentially, “Everyone has a place in the order of things.”

Religion and ideologies may offer succour to those on the lower rungs by the promise of classlessness or all being equal in the eyes of God. In practice ideologies and religions have their own hierarchies. Religion has a hierarchy in its priesthood, and even heaven has its hierarchy.

Negative. Inferior status can mean a precarious subsistence level and even elimination. This is especially so when dominants rob, exploit and oppress. Inferior status carries meanings of defeat, powerlessness, subservience, and negative self-regard.

Leaders may abuse their power an succumb to corruption, greed, venality and vanity. Political and religious leaders may claim to be parts of a divine hierarchy, and use religious power to exact obedience. The meaning of such situations is that “For whoever has, to him more shall be given, and he will have an abundance; but whoever does not have, even what he has shall be taken away from him.” (Matthew 13:12)

However, excesses may lead to revolutions and social chaos. “The social order is unjust.” That means that “a new world order must be established.”

Understanding acknowledges the value of hierarchies. However, excessive use of power and dominance corrupts and leads to struggle. High status is fortune to be enjoyed but also to be shared, otherwise it turns against oneself.


Opposite to competition, in this survival strategy hierarchies dissolve and people are reciprocally helpful and generous. They create mutual security and new resources.

Survival meaning

Positive. Hierarchical levelling, mutual help, altruism, generosity, reciprocity, and love, evoke a meaning that people are basically good hearted. Later there is nostalgia for the sense of community togetherness as occurs in the “post-disaster euphoria” phase of disasters, or as occurred during the London blitz.

Negative. When trust and goodwill is not reciprocated, but is abused and exploited, one feels cheated and betrayed. That can mean that one’s love is unworthy, or that it is foolish to open one’s heart and to be generous.

Fulfilment meaning

Positive. Belief holds that trust and goodwill can radiate to the community and even the world. Generosity will be rewarded. “Give, and it will be given to you.” (Luke 6:35-38). The world can be changed through love. “Make love, not war.”

Love and being loved can have divine dimensions. “Beloved, let us love one another, for love is of God, and he who loves is born of God, and knows God…God is love…he that dwelleth in love dwelleth in God, and God in him.” (John 4: 7-8)

Existential meaning of the world holds that union, giving, and love creates a beautiful universe, like it creates a beautiful baby in a loving couple.

Negative. Betrayal, exploitation and abuse of generosity and love lead to hurt and cynicism. In extreme cases one’s heart is broken, soul desecrated and universe fragmented. Trust and love must be resisted because they destroy.

Understanding acknowledge many types of love, each with its generative and creative aspects. However, the cost of love, as well as potential grief, is also potential exploitation. The flame of love requires constant guarding and refuelling.


Humans are the only meaning making animals. They make meaning out of their survival and out of their existence. Both help to organise nodes of information about their states of being and help them to achieve their purpose. Meanings can mean more to humans than their very lives, because they inform whether the purpose of life is being served or not.

Some readers may be offended by the idea that what they experience as spiritual and sacred derives from survival needs which radiate from the primitive brain to the prefrontal cortex, the part of the brain uniquely developed in humans.

The alternative is to define spirituality as coming from a supernatural force outside oneself. Using that format, helping survivors who see their lives as meaningless requires a priest-like exhortation to faith and to utilisation of specific rituals in which the helper believes.

Recognition of loss of meaning in terms of survival strategies that could not cope with traumatic situations and interfered with the trajectory of a purposeful life, gives us a chance to diagnose the source of the loss of meaning. This can be done by tracing specific losses of meaning back to the situations where corresponding specific survival strategies failed. It is from the points of failure that negative survival and existential meanings derive.

These points of failure can be explored and reframed in terms of specific human limitations at specific traumatic times rather than universal failures of the survivor or of the world. Release from fixed trauma derived meanings can lead to a reassessment of current potentials for meaning and purpose.

In this chapter I did not consider a variety of defences that help people cope with meaninglessness. People may distort information about their meaninglessness through denial, dissociation, repression, displacement and other psychological defences.

They may sublimate their distress into art, sport, or hobbies, using survival strategies in which they can claim success. For instance, survivors may immerse themselves in work or power plays rather than deal with their despair at meaningless loss or their sense of helplessness at being cast out. In other words, humans do not see meaning and meaninglessness in black and white terms. They may cushion and delay full consciousness of what they perceive as their meaningless lives. This gives windows of opportunity for intervention.

Nevertheless, within the dynamics of defences which may distort the flow of streams of meaning, the basic streams that emanate from traumatic situations and survival strategies used in them can still be discerned.


Survival strategies can contribute to recognition, classification, and diagnosis of positive and negative survival and existential meanings. Negative survival and existential meanings can be traced to their origins, made sense of, be reframed according to realistic current circumstances, and be replaced with positive meanings.


Raphael, B. (1986). When Disaster Strikes. London: Hutchinson.

Valent, P. (1984). The Ash Wednesday bushfires in Victoria. Medical Journal of Australia, 141, 291-300.

Valent, P. (1998). From Survival to Fulfilment; A Framework for the Life-Trauma Dialectic. Washington, DC: Taylor and Francis.

Valent, P. (2004).

Wolfenstein, M. (1977). Disaster: A Psychological Essay. New York: Arno Press.

Consultation-Liaison Psychiatry: A Personal View

Prepared for Advanced Trainees Dinner 12th October 2011
Thank you for asking me to share my view on CL tonight. I will briefly describe my history in CL in the hope that an old person’s completed journey may resonate with those who set out on similar roads. I know that a personal journey leaves out other personal stories. I apologise for that.

History in Div A

My CL story started in 1975, 36 years ago, when I was 38, and a psychiatrist for 9 years. Dr Orchard at Prince Henry’s Hospital introduced me to Dr Ian Jones, head of general medicine Division A. I had no idea what my role was to be. I thought I would monitor antidepressants to secondarily depressed patients.

I was given a couple of weeks’ grace, in which I was grateful that I did not have to deal with life and death issues like my medical colleagues. Then I was thrust into life and death issues, and did not leave them till the end of my working life, if even then.

I was asked to help the group on how much morphine dying patients in pain should receive. I could have given a glib answer, but I had the idea to talk to dying patients in pain. Again I had no idea how to approach them. I couldn’t ask “How is your dying going?” Necessity made me devise a question that I found to be useful subsequently for all patients. The question was, “Of all the things that worry you, what worries you the most?”

Emergency departments

The emergency department wanted a liaison psychiatrist but nobody wanted to fill that post. Psychiatrists were reluctant to work in a chaotic unfriendly environment, to just rid the department of unwanted overdoses so doctors could get on with real medicine. I agreed to give it a 3-month trial. I stayed for a quarter of a century.

I soon realised that overdoses were the tip of an iceberg of fear that pervaded the department: fear of the unknown that signified death. The unknown was mental- why did people find life so meaningless that they wanted to end it? And another fear: why were people aggressive and violent, threatening the security of staff? If I could get rid of the depressed and the violent, they could just get on with rationally saving people’s lives.

I had previous experience of locked up patients becoming violent due to terror and indignity resulting from their treatment. This translated to the emergency department. We taught staff that aggressive patients were four times as frightened as the staff themselves, and if asked, aggressive patients would communicate their fears. Civilised treatment pacified patients.
In fact we had built a homely yet professional talking room in the emergency department where agitated patients calmed down. The room was lockable but it was never locked.
The journey to understand despair and “The mental” was longer but of course neither understanding violence against self, nor against others, solved life and death issues for emergency department staff. But understanding did help patients.

Let me just interpose that at our peak, we had developed a nice little team in the emergency department: we had a psych registrar, 2 psychologists, a social worker, and emergency department residents and registrars. We had regular clinical meetings and students could observe interviews in the talking room through a one-way mirror.
I want to mention briefly two life and death areas of experience that greatly influenced my journey. The first area was stress and trauma.

Stress and Trauma

When I started my emergency department CL work, Dr Allen Yuen, head of the department and a friend of mine to this day, was developing Victoria’s medical Disaster Plan. He organised a major disaster exercise in which for the first time mental health staff took a significant part.

Not long after this the 1983 Ash Wednesday bushfires erupted in Victoria. Through the auspices of the new Disaster Plan, Prince Henry’s psych department sent a mental health team to the Mt Macedon area.

Observations of raw trauma threw up many interesting observations. I want to mention just one. In the initial days people were very clear that their various aches and pains and palpitations were part and parcel of their fire experiences. However, within 2 weeks these very same manifestations became disconnected from traumatic experiences and became symptoms that caused people to flood their doctors. These symptoms resembled many similar symptoms that we saw in the emergency department, and on enquiry they were also results of disconnected personal disasters.

Whether in the bushfire or in the emergency department, these psychophysiological symptoms were not random. They belonged to one or other survival strategy that we realised were used ubiquitously in disasters: – fight, flight, rescue, attachment, goal achievement, goal surrender, competition and cooperation. Symptom relief was achieved by tracing symptoms back to the original traumatic situation, contrasting that situation with current security, and resolving moral dilemmas and meanings embedded in the traumatic situations.

I came to realise that my psychotherapy patients had suffered similar traumatic situations and had developed similar symptoms. The difference was that their symptoms were more entrenched and their traumatic situations had often occurred in childhood.

The other area that greatly influenced my thinking were the biopsychosocial expressions of stress and trauma.

Biopsychosocial Medicine

The bushfires made it crystal clear that survivors’ survival strategies led to concurrent biological, psychological, and social symptoms. It also became clear that survivors communicated symptoms according to helpers’ cultures. Physical symptoms were culturally most acceptable, and were the ones survivors communicated to doctors. However, psychological symptoms were communicated to psychiatrists and psychologists, and social symptoms to social workers.

The harm done by restricting communication to a particular mode was clinched for me when I observed a registrar making physical observations on a raped woman. His purely physical approach contrasted with the patient’s face- it expressed horror. She was being re-raped, re-traumatised.

It was as if medicine was a three-sided pyramid of biological, psychological, and social surfaces that were invisible to each other, each striving for a simple diagnosis at the top. Our CL team tipped the pyramid upside down. The question “Of all the things that worry you, what worries you the most?” allowed the heaviest contents of the pyramid to emerge first, in a conglomerate of biopsychosocial problems. For instance, instead of climbing up the pyramid gathering symptoms of depression and finishing with depressive or bipolar disorder, grief would pour out from the inverted pyramid and depression would dissolve in the shed tears.

We took “The mental” to all emergency department patients. We picked patients randomly from a white board. To our surprise we found that even typical physical illnesses had significant psychosocial contributions.

Eventually we postulated 6 overlapping categories of illnesses: classically physical; classically psychiatric; psychophysiological stress responses, like after the bushfires; reliving of traumas; symptoms cherished for purposes such as keeping a spouse from leaving; and lastly, symptoms that replicated those of deceased love persons; such as a widow who suffered chest symptoms that she imagined her husband had suffered prior to his death.

Finally, I want to say a few words about why CL has been treated as the Cinderella of medicine.

Rejection of CL Psychiatry

Medicine has become ever more technical, fragmented, reductionist, and infiltrated by managers who use statistics for their own and their masters’ purposes. The movement was abetted by Big Pharma who benefited from ever more DSM diagnoses that its drugs supposedly cured.

CL psychiatry, on the other hand, is less technical, more mental, human, and integrative. Its psychodynamic revelations are not naturally amenable to statistics, and they often render drugs to be superfluous. So we swim against a cultural tide.

Yet I believe that there is more to CL psychiatry being a poor cousin than the rise of technology, specialisation, and computer-like thinking. It goes deep into the way we are made up; divided into logical, rational, verbal, thinking, time-aware, self-aware selves, and emotional, non-verbal, unthinking, time insensitive, integrative, creative, self-unaware selves.
You realise that I am referring to the split between the right and left hemispheres of our brains. Historically one or other hemisphere has dominated cultures at different times. Currently the left hemisphere is dominant and it has taken over medicine and psychiatry, which hangs on to medicine’s coat-tails for survival.

Left-brain dominance allows only a mechanistic view of life and death issues. Traumatic ripples of survival and moral predicaments, existential dilemmas, even regulation of psychophysiological responses, all of which are right-brain functions, are outside left-brain consciousness. Those threatened by the secrets of the unconscious deride any attempts to expose this can of worms. And yet, at the least, we did introduce compulsory departmental debriefs whenever a death occurred in the department, and the doctors were grateful to be able to resolve their hidden guilts, angers, and existential meanings. After all, life and death issues, beyond suicide and violence, were ever-present in the emergency department.

In conclusion, I want to say that we are the only ferrymen who can navigate the right- and left-brain biopsychosocial streams; who recognise mind and body and their evolutions into science and spirituality. I mean it is we who appreciate the value of this special jewel in the crown of medicine, one which is constantly re-buried in dust rather than is polished and allowed to glitter.

You are the special jewellers in whose care we entrust this treasure in the hope that it will survive and impart its light.

Body, Mind, and Soul

February 6, 2019

Body, Mind, and Soul
Monday 7th November 2011   12.30pm –  1.30pm
Staff  Education  Centre,  Jewish  Care  619  St Kilda Road, Melbourne

Thank you very much for inviting me to speak to you today on this wide ranging and extremely important philosophical topic.

If we talk of body, mind, and soul, we might think that at least the first of these is problem free. I mean the body is visible, tangible, measurable, and has clear boundaries.

But there is one part of it that is invisible and even though it controls us it does not know of its own existence: I mean the brain. And there is a further conundrum: even when neurologists discovered the functions of the brain, half of it, I mean the right hemisphere of the brain, seemed to be useless. It looked complicated, even weighed more than the left hemisphere, but its functions, apart from serving emotions, seemed to have no other functions. It was ignored from studies till quite recently. Now its subtle, but very important functions are being at last discovered. I’ll come back to the right hemisphere of the brain later, because it is a very important aspect of how body, mind, and soul are interconnected.


There is little problem in semantics when talking of bodies. Problems arise with terms like mind, consciousness, self, spirit, and soul, which imply some kind of invisible human essence. That essence fans out into mysteries of life and death, and meaning and purpose.

The Hebrew words nephesh, n’shamah, and ruach connote blowing and breath. Genesis says that God breathed life and soul into man. This contrasts with the dust of which the rest of him is made.

The ancient Greeks had similar notions. Soma was the body, while the word psyche had roots in both the concept of breath as a vital, non-corporeal animating principle, as well as in life, spirit, and consciousness.

Plato divided psyche, which he also called soul, into instinct, emotion and reason. He considered that after death the soul entered another body. On the other hand, Aristotle considered the soul to be the essence of human capacities that ceased on death. The ideas of Plato and Aristotle were templates for later religion versus science arguments.

Religious beliefs of ghosts, spirits and souls that survived death have existed since hunter and gatherer times, where tribal ancestors hovered around like ghosts. All civilisations espoused religious beliefs of supernatural existence. The ancient Egyptians, Hindus, and Buddhists, all believed in different ways in a continuous life-soul that transcended death. In the Jewish religion it is unclear what happens to the soul, but it is implied that it reunites with God. Christianity is perhaps clearest on the attributes of the soul. It is quite separate from the body, and according to its morality during life lives eternally after death in heaven or hell.

Since the 17th century science and technology have expanded exponentially. Science relied on the physical that could be touched, measured, and manipulated. It had no way of dealing with the conundrum of how non-physical emotion and thought could motivate physical action. Descartes said that thought and action, that is, mind and body that were totally split, acted in unison through divine coincidence. The way it played out philosophically, was that the body was granted to science, while mind, emotions, and soul, anything that could not be seen and be measured, was in the domain of philosophers and religion. We still live with the inheritance of this Cartesian split.

Even today, when psychology and psychiatry try to appropriate the mind for science, they are careful to leave most emotions, morality, meaning, purpose, soul and spirituality in the territories of religion and philosophy.

What religion and many philosophers have in common is an up-down approach. By this I mean an assumption of a kind of blueprint of omnipresent values, morality, and justice, and of meaning and purpose; all of which are components of the unique human spirit. By exploring the universal in ourselves and through teachings of the elders, we will find the truth of each of these components.

Today, there are still two basic approaches to the spiritual. The up-down approach has two manifestations. One is still religious beliefs that have prevailed throughout history. The other approach is a modern belief in holism, a universal interconnectedness, love of the environment, dietary proscriptions, and utilisation of disciplines such as yoga, breathing exercises, and meditation.

The down-up approach is a modern version of western science, found especially in a combination of neurology and psychology. This approach states that what we call the mind is a result of billions of brain cells interacting through trillions of potential connections at ever-higher levels of organisation. Complex parts of these interactions are experienced as self, being, thinking, self-consciousness, etc.

What I propose today is a special view from below: a secular evolution of spirituality and soul, a view that brings body, mind, and soul into an understandable coherence.

A wholist view

I use the term wholist to indicate both whole and holistic- something more than the two put together.

I believe that to survive we use a number of survival strategies. When a survival strategy achieves its goal, people feel a specific sense of fulfilment.

Once a platform of fulfilment is attained, a higher evolutionary platform of fulfilment is desired. At a certain level the platforms are felt to be spiritual.

Let us take one survival strategy as an example and see how it works. I propose to start with the survival strategy attachment. You know what attachment is: it is the bond a weak or vulnerable person craves with a powerful person. In that bond one feels united with a mother, father, or other carer. It is a bond in which one is held, cared for, protected, and nurtured.

At the most basic level, fulfilment of attachment contains intense physical, psychological and social satisfactions. They include a sense of security, support, care, nurturance, understanding, benevolence, and contentment.

Unbounded care does not usually come without strings attached. Cared for persons such as children or nursing home residents need to be good, meaning obedient and following the rules. They also need to be appraised as lovable and deserving. When these criteria are not met, judgements by carers evoke guilt, shame, and having done wrong. These in turn rectify unwanted behaviour and are rewarded by positive judgements. Then in addition to feeling secure, content, etc., those cared for also feel virtuous, worthy, and justly deserving.

We are now on the platform of Morality. In this case outside judgements and inner conscience regulate conditions in such a way that attachment is effective.

Survival strategies and their judgements weave the next platform which is initial meanings of oneself and the world. For instance, “If I obey everything is granted.” “I am lovable and people like to help me.” “I am worth caring for.” Negative judgements are opposites, such as “I am bad, unlovable, not worth caring for.”

The next platform contains ideals and principles of care, such as providing dignity and ensuring the rights of those cared for.

The next platform starts to enter the spiritual dimension. Stemming from the experience of care as a child, parental attributes are transferred to ever more encompassing rulers and deities. Obedience to king and patriotism can assume spiritual qualities. Correct behaviour will make fate benevolent. Obedience of religious rules will please God and make him protective, benevolent and nurturing.

God can provide the ultimate attachment figure. He protects from danger and death. He provides home in heaven where every attachment need is eternally fulfilled.

However, even without God and religion, nature that provides and cares, the eternal and universal, the sacred awe of belonging in the universe, can still provide spiritual fulfilment.

Other survival strategies

Just as attachment ranges from instinctual survival needs to the widest spiritual dimension, the same applies to other survival strategies. I don’t have time to include all platforms of all survival strategies, so I’ll mention only instinctual and final spiritual fulfilments of each.

The reciprocal survival strategy to attachment is care for the weak. Giving birth, caring and nurturing infants is among the most fulfilling human experiences. So is rescuing someone from danger, or prolonging another’s life in comfort and dignity.

Spiritually, to be the source of another’s life is one of the most fulfilling human satisfactions. One becomes part of an awesome sacred stream of creation and maintaining others’ lives and their fulfilments.

We all know survival strategies fight and flight. Soldiers who fight to defend the lives of their families and countrymen receive gratitude and adulation for their courage. Sacrifice of one’s life is awesome and sacred.

Each side in a fight believes that God is on their side; that they are fulfilling God’s mission. In holy wars martyrs kill enemies of God. If they themselves die, they are immediately rewarded by heaven.

Flight is the opposite survival strategy to fight. Here foresight, deftness, and cunning in avoiding superior enemies is admired. Morality requires giving sanctuary to refugees. Israel is seen as a more or less holy refuge for Jews. Heaven is the ultimate sanctuary.

In the survival strategy assertiveness one is not given; one provides for oneself. Here God helps those who help themselves. Though one may be successful in hunt, growing food, building one’s house and hearth, spiritually one may feel that God gives the animals to kill, the plants to grow, the potency and strength to kill and till. Flesh and plants are imbued with sacred rituals, myths, and sacrifice to the gods.

In life success is not assured. The survival strategy for disasters, loss and death is surrender to the inevitable, grief, and adaptation to new circumstances. Grief releases despair and sorrow can be one of the most poignant affirmations of love. Mourning allows loving anew.

Spiritual explanations and mitigations of the meaninglessness of catastrophes and death abound. Religion explains disasters in terms of one’s sins, akin to punishment by a parent for disobedience and disrespect. There is then hope that repentance will stop further punishment. Spiritualists and religion help to deny death as the end of life. The spirit, or soul, the supposed real essence of oneself, is eternally alive.

But even without religion one can sense awe and sacredness in the cycle of life, death and regeneration, and being part of it.

The second last survival strategy is competition. Struggle for scarce resources in civilised societies is replaced by contest for status. Winners gain power, preferential rewards, deference, and respect.

Aristocracies and clergy have a hierarchy of power at the top of which may be claims of divine relationships. Even in heaven there is a hierarchy of saints and angels. God is at the pinnacle of the pyramid of earthly and heavenly power. Deference, obsequiousness and self-punishment may gain the favour of the lord.

Lastly, the opposite survival strategy to competition is cooperation. Love, mutuality, generosity, reciprocity, sexuality, generativity and creativity, are all part of this means of survival and fulfilment. Love already has a spiritual sense. So does empathy, exemplified in the injunction, “Do unto others as you would have them do unto you.” Combination of love, sex, giving and taking, trust, faith, creation, and procreation enhances the existential miracle. Many feel reciprocity between man and nature or man and animals as spiritual. Love bonds between humans are similarly felt as spiritual.

Love and fertility have always been surrounded by magic, myths, and the spiritual. Religion often emphasises love, a sacred compact between God and his people. Circumcision is an example. Some consider the reciprocal love between God and humans as the greatest spiritual achievement.


We all have a dominant view of spirit and soul. What I hope I have demonstrated is that spirituality arises from needs of survival and fulfilment. And just like needs of survival and fulfilment differ and even contradict each other, so do different types of spirituality. One spirituality may feature giving, another receiving; one achieving, another surrendering; one preserving life, another killing.

One explanation of this variegated spirituality is in the up-down philosophy: that God has many faces and reveals himself in different guises which we need to understand and follow.

The other explanation is a down-up philosophy: that spirituality evolved from a variety of survival and fulfilment needs. I have presented evidence for the latter possibility. This possibility can explain the connection between body, mind and soul. It can provide an existential purpose to life- to survive in order to fulfil one’s potentials, and to help others do the same.

Lastly, I want to supplement the up-down and down-up ways of approach with a horizontal view. You remember that I said that our brains are the most hidden parts of ourselves, and that half our brains, the right hemisphere, has till recently been considered to be silent. We now know that the right hemisphere has been silent because it has no words, no sense of time, no ability to think, or to be self-aware. Thus it is unable to let us know of its existence. This contrasts with the left hemisphere, which is verbal, thoughtful, rational, time-aware, and allows a sense of self-awareness.

Yet it is the right brain that contains passions, which experiences, and which has nervous connections to our bodily organs. It is the right hemisphere that discerns and organises patterns in new and creative ways. It is the right brain that is the source of instincts and survival strategies, while the left brain merely determines tactics. It is the right brain that has evolved platforms of ever higher organisation to which the left brain gives words. The right brain knows justice, the left brain knows law. The right brain knows awe and universal patterns, the left brain invents bibles and ideologies.

What about manifestations of modern desire for spirituality as evidenced by turning to eastern religions, holistic, organic, and meditative activities? All of them facilitate right hemisphere activity. All of them, such as relaxation and breathing (remember the soul being compared to breathing) take us away from the left brain rat race and provide us with opportunities to travel our right brain trajectories.

Today our right brains have pressured us to give voice to our needs to understand ourselves. I have provided survival strategies as a verbal code to help our understanding.

In conclusion

I have provided an outline of a secular view of body, mind, and soul. I want to emphasise that a secular view does not detract in any way from its spiritual value. The more science reveals the universe, the more aweinspiring is the truth about it.


© 2013-2019 Paul Valent: Trauma, Stress ~ Log in FacebookTwitterLinkedin