Meaning

Why Meaning Belongs in a Medical Practice at All

Most medical practices never talk about meaning.

Not because it isn’t important, but because they don’t know what to do with it.

Medicine is trained to identify disease, suppress symptoms, normalize labs, and reduce risk. When those tasks are complete, the system quietly backs away. If you can work, eat, sleep, and perform basic activities of daily life, you are considered “healthy enough.” Anything beyond that, from dissatisfaction to restlessness, to loss of engagement, to a vague sense that something is off, is treated as someone else’s problem, or no problem at all.

At RiverRock, we don’t think that division makes sense.

Because once disease is no longer the primary limiting factor, meaning becomes one of the dominant determinants of health, not just in a poetic or spiritual sense, but in a practical, operational one. Meaning determines what you are willing to work for, what discomfort you will tolerate, what trade-offs you will accept, and what version of yourself you are trying to become.

That is why meaning, and what we call MeaningSpan, sits at the center of how we practice.

Health Creates Freedom. Meaning Creates Direction.

On our What Is Health page, we define health as autonomy: the capacity to choose which dreams you want to make real.

That definition is deliberate.

Health is not a feeling. It is not comfort. It is not happiness. Health is the freedom to act, the ability to turn possibility into choice.

But freedom alone is not enough.

... if no direction is taken, if one goes nowhere, no change will occur. One’s freedom to choose and to change will be unused, exactly as if one were in jail, a jail of one’s own building, a maze in which no one way is better than any other.

— Ursula K. LeGuin, The Dispossessed

And so, if health gives you the ability to choose, meaning answers a deeper question: what is worth choosing?

Without meaning, freedom collapses into comfort-seeking. Choice collapses into distraction. The enormous power created by modern medicine and modern wealth ends up being spent on avoiding friction, numbing boredom, or chasing markers of success that never quite satisfy.

This is why so many people are “healthy” by medical standards and still feel unwell. Their bodies work. Their labs look fine. Their scans are clean. And yet their lives feel thin, brittle, or oddly effortful.

Meaning is what gives health a vector.

Loss of Meaning Rarely Feels Like “Loss of Meaning”

One of the most important things to understand is this: loss of meaning almost never announces itself as loss of meaning.

People rarely come into a medical practice saying, “My life feels directionless” or “I’ve lost touch with what matters.” Not because those experiences aren’t real, but because our culture has trained us to treat them as illegitimate, vague, or unscientific.

Instead, loss of meaning is often experienced somatically.

It shows up as fatigue that doesn’t resolve. As brain fog. As low resilience and reduced tolerance for friction. As diffuse aches or discomfort. As a sense that something is wrong, even when nothing clearly is.

These experiences are real. They are not moral failures, and they are not signs of stupidity.

What’s happening instead is worldview-constrained sensemaking.

In a culture that treats only the objective as real, subjective distress must be translated into acceptable categories to be taken seriously, even by oneself. And the culturally sanctioned explanatory frameworks are almost always biological: hormonal, inflammatory, immune, toxic, infectious, metabolic.

Sometimes those explanations are correct. Sometimes they are contributory. And sometimes they are not relevant. Our culture makes it deeply difficult for a patient who is struggling with these symptoms to even consider a non-biological option, because the only alternative explanation is weak-mindedness.

Because we’ve excluded any inquiry into meaning or character or the struggles of being human, we are left to try to pigeonhole any symptom into a biological explanation.

At RiverRock, we do not replace medical evaluation with “meaning talk”. We do both. We’re expert in both. But we also do not pretend that meaning becomes irrelevant once labs are normal. Excluding meaning as a category prematurely closes off an entire domain of understanding, and with it, a set of possible interventions.

What We Mean by Meaning (And Why It Is Not Happiness)

When we talk about meaning, we are not talking about happiness.

Happiness is a feeling. Meaning is a lens.

Happiness comes and goes. Meaning persists, even when things are difficult, and often because they are difficult. The pursuits that people consistently report as most meaningful are rarely the most comfortable. Parenting, building something real, creating art, caring for others, telling the truth, growing into responsibility … these are often stressful, exhausting, and emotionally complex.

And yet people willingly choose them.

That willingness is the key.

Not because suffering is inherently good, but because it is frequently necessary. A life that is organized entirely around comfort ultimately corrodes motivation, identity, and wellbeing.

Modern culture relentlessly confuses meaning with pleasure. We are surrounded by systems designed to minimize friction, maximize convenience, and offer constant stimulation. These systems are very good at reducing immediate discomfort. They are terrible at creating long-term fulfillment.

When pleasure becomes the primary goal, health quietly turns into a tool for staying comfortable rather than becoming capable.

Meaning, Motivation, and the Limits of Optimization

One of the recurring frustrations people have with health optimization is that motivation fades.

They start an exercise program, a diet, a sleep protocol, or a supplement stack with enthusiasm … and then gradually stop. This is usually framed as a willpower problem.

It rarely is.

More often, it’s a meaning problem.

Health behaviors require sustained effort. They require saying no to easier alternatives. They require tolerating boredom, discomfort, and slow progress. Without a meaningful reason to do that, the system collapses back toward comfort every time.

This is why purely technical approaches to health so often fail. You can know exactly what to do and still not do it, what Plato called akrasia, because nothing important is guiding you.

Meaning is what makes effort sustainable.

MeaningSpan: Depth and Duration

Most conversations about health focus on duration: how long you will live, how many years you can add, how much risk you can reduce.

That focus made sense when infectious disease and acute illness dominated mortality. It makes much less sense now, when most people will live long enough to face diminishing returns from further medical intervention.

We use the term MeaningSpan to describe a different optimization target: the combination of the length of your life and the depth of your experience.

At some point, further pursuit of longevity yields trivial gains (or even losses) at real cost. More testing. More restrictions. More protocols. All a frantic expression of anxiety in not knowing what’s important, attempting to squeeze more juice from a lemon that’s been squeezed dry.

MeaningSpan forces those trade-offs into the open.

In many real human lives, meaningful depth comes with costs to duration. Parents accept sleep deprivation, stress, and long-term health consequences for their children. Athletes sacrifice joints and longevity for excellence. Builders, caregivers, and leaders take on responsibility that shortens their lives but deepens their impact.

None of this is irrational. It is honest.

RiverRock exists to help you make these trade-offs consciously rather than accidentally.

Meaning Is Personal, But Not Arbitrary

Meaning is deeply individual, but it is not random.

Over time, we have found that people’s sources of meaning cluster into recognizable patterns. Different individuals emphasize different domains, but the domains themselves recur across cultures and eras.

• Intimacy - the experience of integration that comes from inhabiting your full self, not just the nice parts, not just the socially acceptable parts, but even the parts of us that live in the Shadow (lust, rage, aggression, try-hard, power, shame, guilt, weakness, evil, silliness, sadism, helplessness, authoritarianism, manipulativeness, etc.), and having that full self witnessed and enjoyed.
• Family - the experience of safety, comfort, and stability that comes from participating in a group that is deeply invested in your existence and wellbeing. Taking care of, and being taken care of. The nobility of self-sacrifice for the future of your tribe (whether by blood or by choice).
• Community - the experience of promoting the values and interests of a group to which you belong. Sharing common goals and purposes, and connecting on the basis of promoting those goals. From churches to sports teams, nationalism to crossfit.
• Personal Growth - aiming to embody your ideal vision of yourself. To maximally fulfill all of your potential as a person. To improve yourself with knowledge, skill, strength, morality, courage, maturity, wisdom, and grace. To embody the highest expression of your own value hierarchy.
• Exploration - pursuing the ecstatic experience of discovery, the process of tinkering until something “clicks”, an idea becomes clear, an invention starts suddenly working, or a new vista becomes visible. Venturing into the unknown, the never-before-seen. To go where no man has gone before.
• Self-expression - the authentic outpouring of your soul into an artistic expression of the depth of your being, your uniqueness, your inimitable self-hood. To sit down at a typewriter and bleed. To play the strings of an instrument as if they are the strings of your very heart. To share the deepest essence of your innermost self.
• Impact - to make your mark on the world. To leave a legacy. To have your name spoken and remembered by generations to come. For your immortal memory to live in the hearts of those not yet born. To affect the course and direction of the world, even if only in your corner of it.
• Experiences - to collect beautiful memories. To see, taste, and experience all that life has to offer. To “suck all the marrow out of life”.
• Victory - to win. To achieve the highest status. To gain more points, and be recognized as the best. To be GOATed in your domain.
• Transcendence - to experience oneness and interconnectedness with something larger than yourself. To see the world in a grain of sand, and to know that you are the world, and the grain. To blur the boundary between your Self and others, and God, and the universe, and your highest ideals, and thus to escape the illusion of isolation within your ego.

At RiverRock, we use these Categories of Meaning as a practical framework, to make implicit commitments explicit.

Many people believe they are pursuing one thing while their lives are organized around another. That mismatch creates friction, anxiety, and a persistent sense that something is off, even when nothing is medically wrong.

Clarifying meaning is often less about discovering something new and more about admitting what has been true all along.

Meaning, Self-Trust, and Internal Consistency

Meaning is identity-forming. It is about who you are, and who you want to be.

Human beings require internal consistency over time. When actions repeatedly violate what someone claims matters, motivation collapses, because some deeper part of them no longer believes them.

One way to understand this is trust.

You trust yourself when your actions reliably reflect your values. When that trust erodes, identity begins to fracture. Energy leaks. Effort feels pointless. Friction becomes intolerable.

This has nothing to do with moral purity or virtue. It is a functional issue. Incoherence is metabolically expensive. It consumes attention, emotional bandwidth, and psychological energy.

Meaning provides the spine around which identity can reorganize, especially during times of profound change.

Meaning During Transition and Collapse

Most people only become aware of the need for meaning when something collapses.

Illness. Aging. Divorce. Career endings. Loss of belief systems. Children leaving home. Success that fails to satisfy.

These moments feel destabilizing because the structures that once supported identity no longer hold. Roles disappear. Assumptions fail. What once felt stable suddenly isn’t.

At RiverRock, we view these moments as identity transitions. These transitions are the reason that death and rebirth are such common metaphors in spiritual traditions.

Meaning is what allows continuity through those transitions. It provides a thread that survives when specific roles, capabilities, or narratives fall apart. Without that thread, people grasp at substitutes: comfort, certainty, ideology, or endless optimization.

With it, rebuilding becomes possible.

Why Religion Used to Do This (And Why That Matters)

For most of human history, religion provided a durable meaning framework. It offered a value hierarchy, a narrative structure, and a community that persisted through personal upheaval. Even when specific roles changed, the highest organizing principle remained intact.

As religious authority weakened under scientific and cultural pressures, many of those functions disappeared as well. Science explains mechanisms, but it does not tell you what to live for. Medicine can extend life, but it cannot tell you what makes that extension worthwhile.

The result is a widespread, largely unacknowledged crisis of meaning. This crisis often expresses itself as anxiety, nihilism, obsession with optimization, or somatic distress without clear explanation.

RiverRock takes seriously the psychological functions that meaning frameworks historically served, and attempts to address them honestly, without myth or false certainty.

What RiverRock Actually Does With Meaning

RiverRock is trying to re-integrate meaning into medical decision-making.

That means starting with questions most medicine never asks: What kind of life are you trying to live? What demands does that life place on your body, mind, relationships, and character? Which trade-offs are you willing to accept, and which are unacceptable to you?

From there, we work backward.

Some constraints can be removed. Some can be improved. Some must be accepted. The difference matters.

This is why RiverRock is dream-driven and data-assisted. Data helps us avoid self-deception. Meaning tells us where to aim.

What to Expect If You Work With RiverRock

If you work with RiverRock, you should expect direct conversations about what matters to you and why. You should expect honesty about limits, uncertainty, and diminishing returns. You should expect medical recommendations that serve your life rather than abstract optimization goals.

You should not expect guaranteed happiness, comfort at all costs, or someone else to define meaning for you.

This is medicine practiced as applied philosophy - disciplined enough to respect biology, and serious enough to take your life as a whole.

Go Deeper

This page discussed RiverRock's view of the concept of health. For those who want to explore further:

• Watch the lecture series – Dr. Z has recorded extensive discussions on longevity skepticism, Bayesian medicine, and MeaningSpan philosophy. Topics include:

  • Why homocysteine optimization is a biomarker bamboozle
  • Why testosterone supplementation doesn't improve longevity
  • Why full-body MRI screening generates more harm than benefit
  • Why massive lab panels on healthy people are "quantified quackery"

  Explore Lectures
• Read related essays – For more on the philosophy behind RiverRock:

  • What is Health?
  • The RiverRock Methodology
  • Dream-Driven, Data-Assisted Medicine