ORIGINAL ARTICLE
Existential positive psychology and integrative meaning therapy
Paul T. P. Wong
Department of Psychology, Trent University, Peterborough, Canada
ABSTRACT
The unprecedented changes in our society because of COVID-19 and the fourth industrial revolution
(4IR) shows that our healthcare system and the medical approach to psychotherapy can
no longer meet the mental health needs of society. This paper first described the negative
impact of COVID-19 and 4IR on our mental health. Then, following a brief critique of the medical
model, this paper proposes that the future of psychotherapy needs to be based on the
more inclusive and integrative framework of existential positive psychology (PP 2.0), which
emphasizes flourishing through suffering. Finally, the paper emphasizes Viktor Frankl’s cure and
Wong’s integrative meaning therapy. It concludes that integrative meaning therapy represents
the future of psychotherapy, because it is situated in the area of interactions of at least three
traditions: Clinical psychology, existential psychology, and positive psychology. This integrative
model is holistic, recognising humans as bio-psycho-social-spiritual beings and considers several
theoretical perspectives in both diagnosis and treatment.
ARTICLE HISTORY
Received 1 July 2020
Accepted 19 August 2020
KEYWORDS
Existential positive
psychology (PP2.0);
meaning therapy;
psychiatry; Viktor Frankl;
logotherapy; existential
psychology; positive
psychology
Our world is like a runaway bullet-train on a collision
course, with no one able to stop it. This metaphor
captures the general anxiety over losing control of
one’s own destiny. It also captures the fear of an
uncertain future with all the rapid changes in technology,
and social changes decided by the big international
corporations and governments. For example,
Friedman (2016) pointed out that during the twentyfirst
century, the three largest forces-Moore’s law
(technology), the market (globalization), and mother
nature (climate change and biodiversity loss)-are all
accelerating at a pace beyond the comprehension and
control of the average citizen. These accelerations are
reshaping all the main domains of life: the workplace,
politics, geopolitics, ethics, and community. These
changes threaten our sense of control and security.
Therefore, we need to slow down, learn from nature,
and reimagine life.
According to the Ederman-Trust Survey (Purtill,
2020), there is increasing anxiety about job losses and
an economic recession due to automation. Nearly two
in three people felt that the technological changes are
too fast, and they had no control over the robotic
processing automaton technology (RPA; Galer, 2020).
The International Data Corporation (IDC; Jyoti &
Schubmehl, 2019) also predicted that by 2022, 75 percent
of the world place will incorporate some AI and
automation. There is mounting concern about
job losses.
With the promises of the 5 G network and the
fourth industrial revolution (4IR), we may have created
a society which is too fast and too complicated
for our brain to cope. Therefore, we need to pause
and ask ourselves: What kind of society de we really
that will optimize positive mental health? Are the big
businesses really creating a society that meets our
deepest human needs? Indeed, it is high time to reimagine
a better society and a more effective approach
to mental health.
The Negative Impact of the 4IR on
Mental Health
According to Klaus Schwab (2018), the 4IR unleashed
a series of social, political, cultural, and economic
upheavals over the 21st century, and it is ‘driven
largely by the convergence of digital, biological, and
physical innovations.’ When we recognize all the great
challenges ahead, ‘we can take the steps to align common
human values with our technological progress
CONTACT Paul T. P. Wong drpaulwong@gmail.com Department of Psychology, Trent University, 13 Ballyconnor Ct. Toronto, Peterborough ON
M2M 4C5, Canada
The paper was partially based on Paul T. P. Wong’s July 16, 2019 presentation of The current mental health crisis and meaning therapy at Ottawa’s
Royal Mental Health Centre, Canada. Retrieved from http://www.drpaulwong.com/the-current-mental-health-crisis-and-meaning-therapy/.
ß 2020 Institute of Psychiatry and Johns Hopkins University
INTERNATIONAL REVIEW OF PSYCHIATRY
2020, VOL. 32, NOS. 7–8, 565–578
https://doi.org/10.1080/09540261.2020.1814703
and ensure that the Fourth Industrial Revolution benefits
human beings first and foremost.’
Therefore, Schwab called for a vision of a
‘sustainable foundation for social and economic development,
built around shared values of the common
good, human dignity, and intergenerational stewardship.’
In accordance with Schwab’s call for action, this
paper proposes the development of a sustainable
foundation for wellbeing and positive mental health,
built around shared values, existential concerns,
human dignity, and the intrinsic value and meaning
of life.
There is serious concern about the negative impact
regarding the increasing dependence on technology.
Johnson (2020) reported research that discovered
overdependence on technologies, such as social media,
can negatively affect people, making them feel more
isolated, depressed, and anxious.
According to Anderson and Rainie (2018), PEW
research showed that many experts were concerned
about the harmful effects of too much digital life on
children and adults. For example, David Ellis, Ph.D.,
course director of the department of communication
studies at York University in Toronto concluded:
‘There’s growing evidence these digital addictions are
promoting depression, loneliness, video-gaming abuse
and even suicidal behavior, especially among teens
and young adults.’
According to psychiatrist Samoon Ahmad (2020),
work is a necessary part of life. Meaningful work is a
necessary part of one’s wellbeing and happiness.
Work can endow one with a sense of dignity, significance,
and fulfilment. As work becomes more scare
and competitive, many will become unemployed.
Thus, people are worried about overwork in order to
keep their job, or difficulty of finding steady work
after losing their jobs. Those who are unemployed
‘will likely feel deeply humiliated, lonely, and resentful,
and will likely experience many of the well-documented
physical and mental health problems
currently associated with ‘worklessness’ (hypertension,
diabetes, stroke, heart attack, anxiety, and depression).’
He also urged mental health professionals to’
become more attuned to these global phenomena to
better understand our patients and their struggles.’
In a highly advanced society, the geek will inherit
the earth because individuals without higher education
and computer skills will have little chance of getting
all the new jobs created by new innovations.
People will have difficulty making a living by working
with their hands doing factory work, practicing traditional
trades such as carpentry, or creating artistic
work such as pottery. The 4IR may increase productivity
and physical wellbeing at the expense of human
dignity. By conceptualising people as consumers of
material good, human beings are nothing but animals
or supplicated machines. This will result in
dehumanisation.
The 4IR has created new kinds of psychological
problems, such as Hikikomori (Takano & Wong,
in press). This is a new a phenomenon whereby
Japanese youth physically withdraw from society and
isolate themselves for extended periods of time, staying
in touch with others virtually. A similar phenomenon
can also be found in many Chinese people who
spent most of their time surfing the internet, playing
electronic games, or indulging in pornography. Many
of them developed symptoms of depression and anxiety.
They suffer from a sense of shame and guilt
because they cannot fulfil their parents’ expectations
and feel useless in depending on parental support.
This phenomenon happens because parental wealth
and the ubiquitous access to the internet makes it
possible for young people to live comfortably without
having to work and establish relationships, two of the
three main ingredients of the golden triangle, which I
will discuss later.
Online connectiveness can never replace face-toface
wholistic and authentic relationships. Therefore,
no amount of online communication can completely
fill the need for real intimacy and genuine trusting
relationships. The by-product of social isolation are
feelings of emptiness and boredom. Humans are
wired for relationships, which are essential for meaning
and wellbeing (Baumeister & Leary, 1995;
McDonald et al., 2012).
From the perspective of existential positive psychology
(Allport, 1981; Frankl, 1985; Peck, 1978/2012;
Peterson, 2018; Wong, 2019) human beings are hardwired
as religious/spiritual beings in order to survive
in a world full of dangers and uncertainty. Meaning
and faith primarily come from taking responsibility
for making the necessary sacrifices for the common
good and worshipping a higher power for protection
in coping with all kinds of evils, from pandemics and
natural disasters.
All the machine models and animal models fail to
recognize the deep-seated human quest for existential
meaning. Carrying the logic of the computer model
to its extreme would be Yuval Noah Harari’s controversial
book Homo Deus: A Brief History of Tomorrow
(2018); it gives us a chilling future when dataism
becomes our new god and our faith will be placed in
the power of data processing and algorithms.
566 P. T. P. WONG
Without a higher view of human beings, with its
unique spiritual dimension of responsibility and selftranscendence,
we will either become apes with dark
destructive instincts and a computer-assisted god-like
intelligence, or citizens of a totalitarian state that controls
every aspect of our thoughts and behaviours
with artificial intelligence and robots. In both scenarios,
people will feel a loss of human dignity and
meaning in life (Wong, 2020a).
A related challenge we face is how to protect our
individual freedom and dignity, when we are constantly
monitored by ubiquitous face-recognition
technology and big-data that collect every aspect of
our activities. This is already happening in China,
where people are constantly evaluated by the central
government and given social credit (Vinayak, 2019),
which may determine whether they are free to travel
of qualified to apply for certain job.
With the government’s need to control the spread
of COVID-19, such monitoring becomes ever more
sophisticated and all-encompassing. The central government
has so much information on their citizens
that some individuals may run the risk of being
arrested for making statements or doing things that
are considered as subversive. Therefore, we need to
consider the ethical implications of violating universal
human rights if there is nothing to counteract the
abuse of technology (Swart, 2020).
The Challenges of COVID-19
The pandemic has created a mental health crisis
through fear of the deadly virus, the lockdown, and
social distancing policy. For example, Yong (2020)
observed that,
‘At a moment of profound dread and uncertainty,
people are being cut off from soothing human
contact. Hugs, handshakes, and other social rituals
are now tinged with danger. People with anxiety or
obsessive-compulsive disorder are struggling. Elderly
people, who are already excluded from much of
public life, are being asked to distance themselves
even further, deepening their loneliness.’
According to the latest update on 17 August 2020
(European Centre for Disease Prevention & Control,
2020), more than 20 million cases of COVID-19 (in
accordance with the applied case definitions and testing
strategies in the affected countries) have been
reported, including 770 273 deaths. Most heath
experts are not optimistic that the pandemic will go
away anytime soon, and they are concerned about the
second wave of COVID-19 in the fall.
In spite of all their progress in science, technology,
and wealth, so many mighty countries have been
brought to their knees by the pandemic. COVID-19
has demonstrated in a convincing manner that
human beings are defenceless against a steadily evolving,
airborne micro pathogen that is capable of killing
millions of people. One good thing that comes from
this global catastrophe is that COVID-19 reminds us
that we are foible and fragile beings.
Prior to COVID-19, we already had a mental
health crisis. Suicide rates in the U.S. have increased
nearly 30 percent in less than 20 years, according to
the Centres for Disease Control and prevention.
Suicide among people aged 10–24 was the second
leading cause of death (Center for Disease Control &
Prevention, 2016).
The medical model of having more psychiatrists,
more diagnoses, and more medication has not
stopped the rising rates in suicide, drug overdoses,
and depression. Therefore, we need to search more
broadly for the underlying cultural and social factors
that contribute to suicide, overdoses, and depression.
The National Academic Press in Reducing Suicide:
A National Imperative (Institute of Medicine et al.,
2002) had this to say:
Society and culture play an enormous role in
dictating how people respond to and view mental
health and suicide … Cultural variables have a farranging
impact on suicide. They shape risk and
protective factors as well as the availability and types
of treatment that might intervene to lessen suicide.
Given the importance of culture, we need to ask
ourselves: Why is addiction primarily a problem with
Western affluent societies? My hypothesis is that the
pursuit of personal happiness and success may have
contributed to our existential crisis of inner emptiness,
loneliness, and anxiety–the common factors
underlying the current epidemic of addiction, depression,
and suicide.
Our cultural obsession with happiness has unwittingly
resulted in the ‘unhappiness epidemic’ because
of spending too much time on social media and
smartphones, according to research by Twenge
(2017). In a national study, she found that ‘teens who
spent more than five hours a day online were twice as
likely to be unhappy as those who spent less than an
hour a day.’
In her book iGen (2017), Twenge shows that those
born in the mid-1990s up to the mid-2000s spend
their entire adolescence on smartphone and social
media, contributing to their unprecedented levels of
anxiety, depression, and loneliness.
INTERNATIONAL REVIEW OF PSYCHIATRY 567
In a similar vein, Brock Bastian (2018) book, The
Other Side of Happiness: Embracing a More Fearless
Approach to Living provides considerable evidence
that conforming to the social pressure of pursuing
happiness and avoiding pain has created a coddled
generation, vulnerable to hardships and mental illness.
This generation has experienced the loss of protective
factors, such as religion, faith community, or a stable
home; increased use of smart-phones and social
media, resulting in a decrease in genuine face-to-face
relationships; and the lack of psychological preparedness
and coping skills for life’s inevitable problems.
They also have unrealistic expectations of happiness,
beauty, and success. The resulting alienation (loneliness),
helplessness, anxiety, hopelessness, and meaninglessness
contribute to the epidemic of depression,
addiction, and suicide, as predicted by Viktor
Frankl (1985).
Therefore, at both the societal and individual levels,
to avoid the happiness trap, we need to develop a
more realistic life orientation and focus on what really
matters in life, such as developing loving relationships,
making personal sacrifices for something bigger
than oneself, and having faith in a higher power or
transcendental values: all protective factors against
depression and suicide.
The mental health crisis has gone from bad to
worse during COVID-19 because of the lockdown
and the daily bad news of rising death toll and the
dangers of the pandemic (O’Donnell, 2020, Roy, 2020;
Wan, 2020).
Critique of the biomedical model of
mental health
The current mental health system is overwhelmed by
the mental health fallout of COVID-19, and its inadequacy
of overdependence on psychiatrists and medication
has been fully exposed. It is unfortunate that
most of the advice from mental health experts is
focussed on negative emotions, such as depression
and anxiety, and they have only mentioned medication
and cognitive behaviour therapy (CBT) as treatment
options.
A little reflection would tell us that the existential
suffering inflicted by the absurdity of life cannot be
explained away by rational thinking. This is especially
true during this pandemic. Groundhog Day, filled
with bad news about the rising death toll and harsh
economic condition, would not go away simply
because we can think clearly.
There is nothing new in critiquing the medical
model in mental health (Huda, 2019). Szasz (1961)
was the first major figure to point out that humans
difficulties should be conceptualized as ‘problems in
living’ rather than mental illnesses or diseases; therefore,
family members, friends, clergymen, and other
mental health professionals could all be solicited by
or on behalf of those experiencing difficulties adapting
to the demands of life (Benning, 2016).
According to Deacon (2013), the biomedical model
posits that mental disorders are brain diseases and
emphasizes pharmacological treatment. But this
approach has not resulted in good mental health outcomes
and neglected the biopsychosocial model. In a
similar vein, Huda (2019) defended psychiatry as a
medical practice, but he also recognized that other
perspectives are needed. He preferred a humanistic
psychiatric framework for the conceptualization and
treatment of mental illness/disease.
The need for existential positive psychology
(PP 2.0)
I have been working on PP 2.0 since 2010 (Wong,
2010, 2011, 2016a, 2017, 2019). More than ever
before, I believe that PP 2.0 provides the most promising
path to fulfil the full potentials of both positive
psychology and existential psychology for the benefits
of individuals and society.
For example, wellbeing is no longer conceptualized
as the outcome of positive affect, positive traits, and
positive circumstances. Rather, wellbeing is reconceptualized
as both the process and the outcome of managing
an adaptive balance between pursuing positive
goals and overcoming or transforming all the negative
forces.
According to PP 2.0, the only kind of sustainable
wellbeing is one that has survived trials and tribulations.
Therefore, one major task for the new science
is to identify the different sources of suffering and
their transformation. For instance, Salman Akhtar
(2014) considers fear, greed, guilt, deception, betrayal,
and revenge as the six major sources of suffering,
which cannot be eliminated by the medical or cognitive
models. That is why PP 2.0 advocates a new kind
of science of flourishing though the gates of suffering
(Wong, 2019).
Another character of PP 2.0 is that it demands
wellbeing researchers to take into account both the
macro factors (such the pandemic, global economic,
and systemic discrimination) and micro factors (such
as one’s personal demons and limitations).
568 P. T. P. WONG
In other words, individual flourishing is not just a
matter of doing all the right thing, but dependent on
coping with negative external forces and the collective
efforts to improve complicated large systems such as
social justice, political freedom, and the human ecology.
Properly understood, PP 2.0 links the wellbeing
of individuals to the world condition. Consequently,
living a better life requires efforts to improve both
one’s own life and the world we all live in.
The need for Viktor Frankl’s cure and PP 2.0
Viktor Frankl’s name was frequently mentioned during
various interviews of mental health experts, typically
psychiatrists. A recent biography of Frankl
(Pytell, 2020) also attests to the fact the Frankl lives
on even in the 21st century. He redefined psychiatry
by restoring the spiritual dimension to personhood.
Therefore, we have a new bio-psycho-social-spiritual
model of mental health and psychotherapy.
His current popularity demands a new interpretation
of Frankl’s revolutionary ideals. He redefined
psychiatry as a spiritual therapy psychotherapy, which
restores human dignity and quest for meaning to the
forefront. He advocates that the best way to cope with
the suffering and the existential crisis is to embrace
the contradictions and paradoxes of life in a hostile
world.
The power of Frankl’s ideas comes from the tension
between suffering and happiness, freedom, and
responsibility, self-transcendence and self-actualisation.
This is a shift from the simplistic binary view of
the world to a dualistic view that everything exists in
polarity, and successful adaptation depends on achieving
the dynamic balance between two interdependent,
opposite dimensions.
Frankl is the most optimistic existentialist. He
would react very differently to the coronavirus compared
to Albert Camus, who believed that the plague
means life–meaningless and absurd. In his story The
Plague (1947/2020) Camus’ answer to the arbitrariness
of death and the absurdity of life was personal revolt:
‘Rieux becomes the incarnation of the man in revolt.
He continues to fight for his fellow human beings no
matter how dire the circumstances or elusive the
chance of success.’ (Gloag, 2020, p. 60). Dr. Rieux’s
dedication to his patients was simply motivated by his
moral instinct to save lives against an evil monster in
a meaningless and hostile world.
In contrast, Frankl believed that life has intrinsic
meaning and our faith in meaning and love can triumph
over all evils, including the pandemic. Rarely
was a psychiatrist claimed by both the existentialists
and positive psychologists as Frankl.
Indeed, COVID-19 has made it impossible to
ignore the fact that death and suffering is a big part
of life. The world has become a laboratory to test out
this new science of resilience and wellbeing through
the gates of suffering. My research partners from
more than 20 different countries and I are currently
conducting a multinational study of how meaning,
responsibility, and existential coping can function as a
buffer against the adverse effects of COVID-19.
Therefore, for therapy to be effective, we need to
help clients give up their victim mentality to become
an everyday hero, who has the courage and optimism
to accept the absurdity of life as the foundation to
create a better future:
Only to the extent that someone is living out this self
transcendence of human existence, is he truly human
or does he become his true self. He becomes so, not
by concerning himself with his self-s actualization,
but by forgetting himself and giving himself,
overlooking himself and focusing outward. (Frankl,
1977/2011, p. 35)
This quantum shift in mindset also means that
they no longer regard suffering caused by COVID-19
as a dreadful enemy, but as a warning that their life is
out of balance and a signal for them to overcome all
their setbacks and find a new path of meaning
and purpose.
All kinds of unexpected good things can come
from this shift in mindset. According to Frankl
(1985), we all have the primary need for transcendental
meaning; this is the deepest yearning in our soul,
which cannot be satisfied with material things or egotistic
goals. We need to discover some value or life
goal that is worth dying for.
The importance of self-transcendence
That is why he defined our search for meaning as the
search for self-transcendence, for something much
greater than ourselves, greater than our own life.
Once we are awakened to transcendental values, we
become truly alive and fearless. This is when we have
discovered our passion for living.
Frankl made the greatest discovery in psychology
and psychotherapy–to transform all our suffering into
resilience and happiness, it takes willing and joyful
suffering for something we love more than ourselves.
For example, I am grateful for all my suffering,
which have made me a better person and good psychologist
who know how to help others. My suffering
INTERNATIONAL REVIEW OF PSYCHIATRY 569
also enables me to find my calling which is to bring
meaning and happiness to suffering people.
That is why I always find ways to help my clients.
Recently, I had a young client (17 years old) who suffered
from high levels of anxiety because of COVID-
19. Right from the start, I told him, ‘welcome to the
club, because everyone is nervous about the coronavirus,
which is capable of infecting anyone who does
not practice public hygiene.’ Then, I surprised him by
saying, ‘consider it a privilege that you are able to
learn how to cope with hardships and suffering. It
will prepare you well for the future. Life is hard and a
constant struggle. If you learn how to be a tough guy
and how to overcome your anxieties and difficulties
at a young life, you are more likely to succeed in life
than those young people who are coddled and overprotected.’
I could instantly see a transformation of
his facial expression and energy level. The rest of the
session was very positive and productive, focussing on
how to benefit from the lockdown.
For the first time in my life I saw the truth as it is
set into song by so many poets, proclaimed as the
final wisdom by so many thinkers. The truth – that
Love is the ultimate and highest goal to which man
can aspire. Then I grasped the meaning of the
greatest secret that human poetry and human
thought and belief have to impart: The salvation of
man is through love and in love. (Frankl, 1985, p. 57)
At the heart of self-transcendence is love for
others. This above quote from Frankl is quite powerful.
Frankl was able to discover the secret code to
resilience and happiness because of his suffering in
Nazi death camps.
Yes, love is the only way to our salvation. This is
no poetic hyperbole, no romantic sentimentalism, and
definitely no overused cliche.
It sounds so simple, but it is so profound that it
will take time to understand and practice . It will take
the new science of self-transcendence decades of
research will reveal the full extent of the power and
mechanisms of sacrificial love, which also happens to
be the greatest commandments from Jesus (see the
bible, Matthew 22:36–40).
We have only scratched the surface with the recent
publication of Transcend: The New Science of Selfactualisation
by Scott Barry Kaufman (2020) and my
own research of self-transcendence (Wong, 2016b,
2016c). We still know very little of why and how selftranscendence
is the key to resilience and happiness.
I can only speculate that we were wired for selftranscendence,
that is why have the primary motivation
and deepest yearning for self-transcendent love.
But sufficient to say that all the research so far has
demonstrated that belief in self-transcendence can get
your through all the challenging life situations, from
aging and cancer, to palliative care (For more details,
please read Wong, 2016d).
Love is always reorienting our attention from selfinterest
to caring for the beloved. For anyone who has
been fallen in love would understand that they would
be willing to make any sacrifice in order to bring happiness
to the beloved. They would be willing to suffer and
endure anything for the beloved’s sake – love gives
them courage and resilience. They will suffer joyfully if
their sacrifice brings the beloved happiness – love gives
them deep satisfaction in spite of suffering. They would
be willing to help all those who are related to the
beloved – love makes them a caring person.
By the same token, to discover one’s passion for a
calling or a career means one is willing to make any
sacrifice in order to realize their dream. One would
be willing to suffer and endure anything for one’s
mission. This passion would give one courage and
resilience to self-actualize.
The above are just simple examples. Self-transcendence
can permeate and transform every aspect of our
life. In short, self-transcendence will transform our
inner landscape and empower us to use our body as
an instrument for a higher purpose beyond ourselves.
According to PP 2.0, suffering has always constituted
an important part of human existence. The average person
is primarily concerned about bread and butter
issues, but in times like this pandemic, we are thrown
into unchartered territory, where we are confronted
daily with existential issues, such as suffering and death.
In a paradoxical way, I have shown that how we
resolve our existential crisis can have a direct impact
on our wellbeing and happiness.
According to a Buddhist Proverb, ‘Pain is inevitable.
Suffering is optional.’ But what is psychic pain? How
can differentiate it from suffering? What are the differences
between inevitable and optional suffering? What
are the neuro-mechanisms for happiness in suffering for
what or who one loves passionately? That is why I have
set up the Research Institute on Flourishing and
Suffering (RIFS), the research arm of the International
Network on Personal Meaning (See INPM, 2020).
I have also written the book Made for Resilience
and Happiness (Wong, 2020b) which provides a road
map on how to become stronger and happiness by
going thorough the turbulent journey of fighting
against the pandemic. At times, the waves may seem
too gigantic to overcome, but we have the innate
human capacity to achieve something positive in the
worst of circumstances though self-transcendence.
570 P. T. P. WONG
For example, for clients who are reluctant to work
because of all the risks, difficulties, and the hopelessness
at the workplace (such as palliative care or longterm
care homes), I would suggest that they challenge
themselves with the following tough questions:
1. Confront yourself by asking such simple questions
as: Are you a coward who is too afraid of
risks? Are you being selfish for not willing to
help others? Do you realize how important and
valuable your work is? Do you realize that the
value or meaning of work does not depend on
your position, but on your attitude? Why can’t
you bring a positive attitude and give it your best
when you go to work?
2. Stop complaining about your work and start
thinking what a wonderful experience it is. Yes, it
is tough and nerve-wrecking. It is exhausting and
frustrating. But also think about what a privilege
it is to help others. Do you not realize how many
people depend on your work? Do you not feel a
sense of significance and dignity to be able to
contribute in such a difficult time? Do you feel a
sense of pride when so many people are grateful
for your heroic work and want to show their
appreciation? How many people have the opportunity
to be under the spotlight as a hero?
3. Do you realize that love is the most powerful
force on earth? Do you know that love can give
you the strength to endure anything, the courage
to face any danger, and the joy to sacrifice for
others? Remind yourself that you work because
of your passion for your work, and your passion
to help others. More importantly, your work provides
the financial support for your loved ones.
4. Say to yourself that you are no longer afraid of
suffering and death because love make it worthwhile.
The idea of being motivated by sacrificial
love will fill your heart with joy and ignite the
fire in your belly to play an important role in
combatting the deadly monster. Say to yourself
that the worse will be over and your life will be
stronger and better because you dare to face the
crisis, face your own shadow, and found your
way back through self-transcendence, the source
of positive energy and divine joy deep in
your soul.
The importance of Frankl’s 3-second rule
Based on all my reading of Frankl’s writings, the following
popular quote typically attributed to Frankl
can be best understood as a 3-second pause that can
save us from acting impulsively based on our
instincts, old habits, biases or emotional reaction
without going through our forebrain:
Between stimulus and response there is a space. In
that space is our power to choose our response. In
our response lies our growth and our freedom.
(Quote attributed to Viktor E. Frankl.)
These 3 seconds will create enough space for us to
make the right decision, which may mean a different
outcome, a different destiny:
The 1st second. What is happening in this situation
(Mindfulness)? We need to observe what is unfolding
with mindfulness or self-detachment in Frankl’s
terminology. This brief intentional pause can make
all the difference because it enables us to suspend
our impulse, bias, or emotional reaction in a split
second to allow for more accurate stress appraisal
(Peacock & Wong, 1990). Don’t panic even when
you feel overwhelmed by all the dark forces attacking
you. One moment of stillness can save your life
and turn the tide in your favour. One moment of
pause will give you the necessary time to seek guidance
from your soul and/or from higher power for
the right response.
The 2nd second. What are my options or what kind
of freedom do I have in this situation (Reflection on
freedom)? Whatever the circumstances, we always
have some degree of freedom or control; even in the
worst-case scenario of having a gun pointed at our
head to obey an evil order, we still have the freedom
of attitude to take a stance. It is always possible to
maintain the freedom to protect our inherent
human dignity and core value by boldly declaring:
‘You can destroy my body, but you cannot kill my
soul.’ We have the freedom to choose to die happily
as a martyr, whereby we instantly transform the
human tragedy into a heroic triumph.
The 3rd second. What is the right thing to do? How
can I decide which is congruent with my life purpose
and core value (Frankl, 1988)? We are constantly
confronted with the existential dilemma of
choosing between expediency and meaning.
Choosing to gain some practical advantage, we may
have to sacrifice our integrity or sell our soul, but
choosing to do the right thing, we may have to face
persecution and suffering.
This third question represents Frankl’s greatest discovery:
The question of the meaning of life is not
about me or what I can get from life, but about the
INTERNATIONAL REVIEW OF PSYCHIATRY 571
human family or what life demands of me in terms of
moral obligation. This question is actually a wake-up
call, which may result in an ‘aha!’ moment of awakening
and a quantum shift from ‘What is in this for
me?’ to ‘What can I offer to others?’
Sadly, most people are content with living in a
two-dimensional space; to them, life is all about eating,
drinking, and personally being happy. They will
only work if they have to make a living. However,
some serious reflection on the third question may
open our eyes to the vertical spiritual dimension of
life, enabling us to live at a deeper level.
The first and second questions of the 3-second rule
require the important mechanism of self-detachment,
whereas the third question requires self-transcendence
(Wong, 2016c).
The 3-second rule serves the same purpose as the
Chinese idiom of ‘Think thrice before you act’ (三思
而行), except that it is more explicit in providing a
clear guide about how to think thrice. The end result
is that it reduces the likelihood of making the
wrong decision.
Together, these two spiritual mechanisms–mindfulness
(self-detachment) and meaning (self-transcendence)–function
like a pair of strong wings that can
lift you above your stress and personal problems into
a new realm of hope and possibilities. Most mental
health professionals who mentioned Frankl did not
realize that these two mechanisms are the doublehelixes
for our meaningful life just as the double-helix
DNA is essential for our biological life.
Together, these two spiritual mechanisms represent
a fundamental re-orientation from everyday self-interested
obsessions, towards a broader concern for
others (e.g. Adler, 1938/2011) or something greater
than oneself (e.g. Frankl (1985) idea of ultimate
meaning). Therefore, meaning may be unique in each
individual and in each situation, but the fundamental
structure of meaning is the same, always shifting
from self-preoccupation to a larger story, even a
meta-narrative. Our heart needs to be large enough to
embrace others, nature, and the Creator in order to
achieve self-transcendence and self-actualisation.
These 3 seconds may even buy you enough time to
laugh at the absurdity of life and make yourself
happy: ‘Humour … can afford an aloofness and an
ability to rise above any situation, even if only for a
few seconds.’ (Frankl, 1985, p. 63)
In sum, meaning lies in going beyond the bondage
of carnal desires or egotism (e.g. No Self according to
Buddhism, or self-crucifixion according to
Christianity) so that you may be free to connect with
others, with nature, or with transcendental reality and
higher values in an authentic and generous way.
Once you have made the quantum shift to the vertical
dimension of human existence–the spiritual
dimension–you are in a position to decide how to
realize meaning and value in your life regardless of
circumstances. To further help you to make the right
decision, Frankl has also identified three fundamental
values, as discussed below.
Frankl’s three avenues of value
Then I grasped the meaning of the greatest secret
that human poetry and human thought and belief
have to impart: The salvation of man is through love
and in love. (Frankl, 1985, p. 57)
Meaning is related to value. Not every goal has
objective value. Subjective meaning needs to be
related to some normative value. It is amazing how
Frankl was able to summarize the complex issues
regarding the relationship between meaning and values
in a simple and comprehensive way. One’s subjective
meaning needs to be congruent with the
following enduring values in order to be truly beneficial
and worthwhile:
Creative value
What you can give to the world through your unique
creative work. Whenever you have the freedom and
opportunity to do something worthwhile and creative
with your time or your life, you would want to do it
whole-heartedly, so that it bears your unique imprint
of personality, character strengths, experience, and
imagination. You can create something valuable and
leave a footprint that helps others. It does not make
any difference whether it is a paid job, volunteer
work, or a hobby; it is not the nature of work but the
nature of your attitude towards you work that makes
it meaningful or significant. Whether your work has
enduring value all depends on whether you care for it
enough to create some real value. When your work
matters to you, it will in turn makes your life matter
or significant because of your unique contribution.
Experiential value
How you can receive it from the world through your
appreciation. You can savour the moment through
your five senses. You can also discover some hidden
beauty and goodness in people, nature, or negative
events with mindfulness and a meaning mindset
(Wong, 2011). The secret to meaning and happiness
572 P. T. P. WONG
is that you can always discover something beautiful in
life, no matter how brutal life is. You can discover it
with an attitude of humility, appreciation, imagination,
and faith in the transcendental reality–all
involving the activation of your right brain. Suffering
can be painful but appreciate the precious life lessons
from going through it. The most important part of
this value is the appreciation of a love relationship,
which is a like a stream in a desert or a ray of sunshine
after a dark night. True love always involves the
pain of yearning during separation and grieving during
death, but it is always a major source of meaning
capable of transforming people’s lives for those who
accept the sacrifice demanded by love.
Attitudinal value
How you can experience it through the ‘defiant power
of the human spirit’. It can be an attitude of courage
or an affirmation of faith to protect your human dignity
and core values, even when you were stripped of
everything. It is an attitude that enables you to face
imminent death with your head held high and your
eyes turned towards Heaven. It will give you the mental
and emotional toughness to survive COVID-19.
Wong’s definition of meaning
Meaning therapy is actually depth therapy; it is about
sinking down deep roots so that we can survive the
violent storms of life. To use a war metaphor, when
we are bombarded by enemy fire and surrounded by
toxic gas or pathogens with nowhere to go, we can
always go deeper and deeper until we reach the innermost
recess of our soul, the spiritual and healthy core
which cannot be corrupted, according to Frankl’s
logotherapy.
Another way to clarify whether one’s desired value
is really worthwhile or meaningful is Wong’s (2010)
PURE test. Not all goals are equal–some are trivial
pursuits, and some are misguided self-destructive
ambitions. To avoid self-deception, one can always
apply the following four criteria:
1. A meaningful life is purposeful. We all have the
desire to be great or significant, we all want our
life to matter, to be somebody rather than a
nobody. We all want to make a difference in the
world. A sense of mattering or significance
imbues our lives with meaning. The intrinsic
motivation of striving to improve ourselves to
achieve a worth goal is a source of meaning. That
is why purpose is the cornerstone for a meaningful
life. Even if you want to live an ordinary life,
you may still want to do the best you can so that
you will be known as a good neighbour, a decent
human being. But not all purposes are alike. If
our life purpose is centred around getting rich
and famous by any means, even if it involves
stepping on others, then such a life goal is neither
responsible nor rationally justifiable.
2. A meaningful life is understandable or coherent.
We need to know the reasons for our existence,
or the reason or objective of our actions and
plans (Antonovsky, 1987). Having a cognitive
understanding or a sense of coherence is equally
important for meaning.
3. A meaningful life is a responsible one. We must
assume full responsibility for our life or for
choosing our life goal. Self-determination is based
on the responsible use of our freedom. This
involves the volition aspect of personality. The
next criteria will explain why responsibility
equals meaning.
4. A meaningful life is enjoyable and fulfilling. It is
the deep satisfaction that comes from having
made some difference in the world. This is a natural
by-product of living a life of significance and
the self-evaluation that ‘my life matters’.
Together, these four criteria constitute the PURE
definition of meaning in life. Most meaning researchers
support a tripartite definition of meaning in life:
comprehension, purpose, and mattering (George &
Park, 2016; Martela & Steger, 2016), but these elements
are predicated on the assumption that individuals
assume the responsibility to choose the narrow
path of meaning rather than the broad way of
hedonic happiness. In the existential literature, freedom
and responsibility are essential values for an
authentic and meaningful life (In addition to Frankl,
you can also read Rollo May, Irvin D. Yalom, Emmy
van Deuzen, etc).
For instance, my life is meaningful because I chose
the life goal of reducing suffering, as well as bringing
meaning and hope to suffering people. This was not
an easy choice, but it was the only choice if I wanted
to be true to my nature and my calling. I had to be
what I was meant to be.
Faith is the key to understand Frankl’s cure
The prisoner who had lost faith in the future – his
future – was doomed. With his loss of belief in the
future he also lost his spiritual hold; he let himself
INTERNATIONAL REVIEW OF PSYCHIATRY 573
decline and become subject to mental and physical
decay. (Frankl, 1985, p. 95)
According to Frankl, logotherapy is spiritual therapy.
Just as cognitive psychology restored the mind to
psychology after behaviourism, Frankl restored the
soul and spirituality to mainstream psychology, which
was dominated by reductionist and determinist
materialism. The soul represents the most sacred spot
in everyone’s life; it is where we discover our best
angels. It is where we encounter what is sacred and
transcendental. Most importantly, it is where we find
our passion for life.
The key to understanding the power of Frankl’s
meaning therapy is to discover the power of faith,
such as faith in a better future, in the self, in others,
and in God. Faith in God is very involved in the exercise
of attitudinal value. All hope is based on faith,
especially hope in hopeless situations.
What kept Frankl alive through multiple Nazi
death camps was precisely his faith in a future
reunion with his wife (not knowing that she was
already dead), faith in the enthusiastic acceptance of
logotherapy in the world, and faith in the inherent
value and sanctity of life. He never gave up the belief
and hope that allied forces would arrive, and he
would still be alive to fulfil his dreams.
Faith, nothing but faith, can counteract the horrors
of life and death. All our pursuits of meaningful work
and meaningful relationships are initiated by faith
and sustained by faith even when we are living in a
hellhole. We need faith to sustain our hope in an
uncertain future which is beyond our control.
It does not matter whether you have faith in God,
Jesus, Buddha, or the spirit of our ancestors. If you
have faith in someone or something greater than
yourself, you would have a better chance of overcoming
seemingly insurmountable problems and defeating
more powerful enemies.
In sum, wellbeing can be conceptualized in terms
of a golden triangle as illustrated in Figure 1. Each of
the three components of this triad is possible because
of the of double helix of self-detachment (mindfulness)
and self-transcendence (meaning) that liberate
us from self-absorption.
Just as social distancing saves lives from the coronavirus,
self-distancing and self-transcendence can
provide the necessary life space that saves us from the
heart of darkness, characterized by greed, pride,
ignorance, and egotistic pursuits. Faith, meaning, and
love are like air, food, and water which are essential
to our physical health.
In Frankl’s view, life is priceless. One cannot put a
price tag on anyone’s life because we were all created
equal in the image of God and endowed with greater
value than any material things. That’s why he encourages
people to say Yes to life, no matter what. Value
has intrinsic value because of its singularity and capacity
to grow and to make a unique contribution. What
makes a fragile life resilient is the primary motivation to
discover and serve something worth dying for; the capacity
of self-transcendence makes suffering not only
bearable, but as a source of deep joy.
A related argument in favour of life is that a living
individual is always able to create some value or
wealth, whereas a dead individual will be a terrible
emotional loss to their loved ones and entails economic
loss. Therefore, whether from the perspective
of cost/benefit analysis or from the framework of
humanistic values, saving lives should be given a
higher priority over saving the economy. In short, life
always trumps money.
We can ask our clients to reflect and ask themselves
the following self-reflection questions:
1. What do I want to do with my one and only life?
2. What is worth all my effort and sacrifices?
3. What is life, if there is no dream, no suffering,
no overcoming, and no hope?
Reflecting on these three questions may set one
free from one’s shallow meaningless existence and get
one started on a risky but exciting adventure.
Figure 1. The Golden Triangle. This figure was posted on the
author’s social media network.
574 P. T. P. WONG
We should also encourage our clients to meditate
on the following three self-affirmations:
1. I believe that life has meaning till I breathe
my last.
2. I am grateful that the reality of suffering and
death shows me what I was meant to be.
3. I am confident that I can find my way to a happy
and meaningful life even in a hostile
environment.
As Frankl (1946/2020) once said regarding the
inherent, unconditional value and meaning of individual
life:
What remained was the individual person, the
human being — and nothing else. Everything had
fallen away from him during those years: money,
power, fame; nothing was certain for him anymore:
not life, not health, not happiness; all had been called
into question for him: vanity, ambition, relationships.
Everything was reduced to bare existence. Burnt
through with pain, everything that was not essential
was melted down—the human being reduced to what
he was in the last analysis: either a member of the
masses, therefore no one real, so really no one—the
anonymous one, a nameless thing (!), that ‘he’ had
now become, just a prisoner number; or else he
melted right down to his essential self.
PP 2.0 and meaning-focussed therapy
While Martin Seligman’s positive psychology is about
happiness and flourishing, Wong’s PP 2.0 (Wong,
2019) is about suffering as the gateway to flourishing.
Wong’s two approaches represent the Yin and Yang
halves of the wellbeing circle.
COVID-19 has shown that the basic tenets of PP
2.0 are undeniable aspects of the human condition:
(1) we all live in a dangerous world full of evil and
suffering; (2) all human being have inherent limitations
and vulnerability; and (3) flourishing is impossible
without overcoming the frailty and the dark side
of life (Fowers et al., 2017; Wong, 2020c).
In contrast to the dominant message of American
positive psychology that emphasizes what is good and
right in life, the message of PP 2.0 (Wong, 2011,
2016b) and meaning therapy is that life is full of suffering
and injustice. We need to give up our unrealistic
expectations of only good things and confront life
with a sense of tragic optimism and struggle for a better
future with courage. Paradoxically, more recent
research has shown that such a realistic life orientation
actually increases our capacity for resilience
and happiness.
Contrary to the popular belief that we should avoid
painful emotions, all our efforts to protect ourselves
against suffering actually make us more vulnerable to
life’s problems and mental illness. Running away
from what we fear only make it scarier. Paradoxically,
according to Frankl’s strategy of paradoxical intervention,
to confront and exaggerate our worst fear to the
point of being laughable actually reduces our fear.
That is why I advocate the radical acceptance of personal
responsibility to face suffering with courage.
Consequently, the most important tenet of PP 2.0
is that sustainable flourishing can only be achieved
only on the foundation of overcoming suffering – a
bold claim that has already received considerable
empirical support. I have devoted two decades integrating
Frankl’s ideas with positive psychology
research (e.g. Wong, 2007, 2016c).
The main thrust of my recent book Made for
Resilience and Happiness: Effective Coping with COVID-
19 is that we are wired in such a way that our genes
and brain have the necessary capacities to survive and
thrive in any adverse situations, provided that we are
awakened to our spiritual nature and cultivate our psychological
resources, such as faith, love, and meaningful
work. In the (2015) book The Upside of Stress: Why
Stress Is Good for You, and How to Get Good at It,
McGonigal highlights new research indicating that stress
can, in fact, make us stronger, smarter, and happier, if
we learn how to cultivate the power of beliefs and
embrace stress as source of energy.
We have a serious mental health crisis because we
are like the fish out of water, living in a materialistic
consumer society and a digital world without paying
much attention to our spiritual needs. Technological
progress contributes to our physical wellbeing, but it
also destroys the soul if we do not make an intentional
effort to care for our soul.
Meaning Therapy helps people get back into
water—to meet people’s basic psychological needs for
loving relationships, meaningful work, faith in God,
and some transcendental values. In times of life crisis,
collective madness, and an uncertain future, we need
to get back to the basics of:
1. Faith in God or spiritual core values.
2. Love for people and develop relationships.
3. Meaning in one’s work and pursuits.
This positive triad, as depicted by the golden triangle,
has enabled humanity to survive since the beginning of
time; it is still essential in overcoming depression, addiction,
and suffering, and creating a better future.
INTERNATIONAL REVIEW OF PSYCHIATRY 575
Paradoxically, meaning therapy teaches the basics
of positive mental health—radical acceptance of suffering
with courage; a return to the core values of
faith, love, and meaning; and the life intelligence of
coping with the adversities and vicissitude of life.
My integrative meaning therapy is innovative in
many ways. The most important departure from traditional
practices of psychology is that meaning therapy
advocates a pluralistic and integrative approach. It is
opposed to the prevailing tribal or silo mentality; it
believes that the more we collaborate and work together,
the faster we can resolve the mental health crisis.
Figure 2 represents the current situation. There is
only limited cooperation and overlaps in the three
disciplines. One may substitute existential psychology
with religion, or replace clinical psychology with
psychiatry, but the situation remains the same – they
all operate as separate disciplines.
I propose the best spot for effective psychotherapy
is the small common core, where the therapist is able
to address a client’s existential crisis, psychological
disorders, and basic need for happiness and meaning
in the same clinical session.
In contrast to the current practice, I have
attempted to increase the common core as shown in
Figure 3. There are at least three reasons for this
movement towards integration:
1. Clinical psychology or psychiatry and positive
psychology are inadequate in and by themselves;
they really need each other to be complete. It is
like the synthesis that emerges from both the thesis
and antithesis, as I have argued for PP 2.0.
2. Existential psychology has to do with the condition
of human existence, relevant to all people.
Therefore, it is impossible for any psychotherapist
to totally ignore the client’s existential concerns. I
have argued that all psychotherapists need to
have existential competency.
3. The existential givens include both the basic
primitive emotions of shame, guilt, and fear, and
the basic emotional needs for faith in something
stronger than oneself, relational support, and
meaning (both symbolic meaning and objective
values for the human community to survive).
During this unprecedented time, in the presence of
a contagious pandemic, a high level of anxiety is a
natural emotional reaction. Therefore, generally, the
problems come from a case of living through a difficult
time. However, in some serious cases of mental
disorder, psychiatric morbidity and physical illness
needs to be ruled out prior to meaning therapy.
Frankl (1985) considered logotherapy as a medical
ministry or an adjunct therapy to deal with existential
suffering. Likewise, my proposed integrative meaning
therapy can so be regarded in the same way.
One of my visions is to harness the power of AI
and technology to help people to meet their deepest
needs for meaningful relationship, meaningful work,
and meaningful spiritual experience. I believe that
when people are satisfied in these three life domains,
Figure 2. The current status of three psychology disciplines.
This figure was posted on the author’s social media network. Figure 3. Future integration of three psychological disciplines.
This figure was posted on the author’s social media network.
576 P. T. P. WONG
they will enjoy good mental health and wellbeing. For
example, regarding relationships, we can make use of
brain-computer interactions and develop all kinds of
computer-assisted devices and apps that allow people
to assess another person’s character trait, relational
skills, and capacity for compassion or empathy. In the
area of work, we can also develop AI-powered
coaches to teach people to discover their skills, interests,
and aptitude, and to explore the different areas
of work or to create their own career path. Therefore,
the 4IR can also help promote the new approach in
mental health and help people find meaningful relationships
and work.
Disclosure statement
No potential conflict of interest was reported by
the author(s).
ORCID
Paul T. P. Wong http://orcid.org/0000-0003-4982-8127
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