Hi, I’m organizer at EA group at Middlebury College, and I’m working with EA Harvard and EA Princeton on a project that started as some scribbles about ambition and fulfillment, and has grown into a book-and-Substack project: How to Want Better Things.
The problem is obvious to anyone who has spent five minutes on a U.S. campus. Students insist, often quite passionately, that they do not care about money or prestige. They say things like, “I just want to do something meaningful.” Then, with near comic timing, recruiting season arrives and almost half of graduates march directly into consulting, finance, or law. It is hard not to admire the consistency of the inconsistency.
What is going on here? It is not that students lack ambition. If anything, they have an almost heroic surplus of it. Ambition is abundant, but without a framework for distinguishing between pursuits that generate prestige and those that generate meaning, it tends to default toward the most legible and socially rewarded paths. EA technically has one, but much of the literature reads as though it was designed for peer review rather than for people deciding between Deloitte and Goldman. Students nod, respect the rigor (sometimes), and then go back to their consulting case prep. We have not lost faith, though. We do not need to reach everyone. If only a small number of students reorient their ambitions toward problems that matter (even just on our own campuses!), the project will have justified itself.
That’s where this project comes in. We want to make these ideas more accessible for the average U.S. student, the kind who wouldn’t read The Precipice cover to cover, but would pick up something that feels like Atomic Habits with more moral weight. I’m deliberately using the structure of self-help classics (narrative hooks, memorable mental models, simple action steps) as a Trojan horse for EA ideas. The packaging is familiar, the substance is and will always be, EA
At the heart of the project is a shift from an inside-out model of fulfillment to an outside-in one.
- Inside-out says: start by reflecting on your passions, then try to map those passions onto an existing career field. Do you like debating? Maybe law. Do you like math? Maybe finance. Do you like arguing with people online? Maybe law again. This model is the one most students are handed, and it sounds empowering, but it often traps people in a cycle of chasing recognition and wondering why the promised meaning never quite arrives.
- Outside-in flips the process. Start with a problem that speaks to you. Ask what challenges in the world feel urgent and real. Then reflect on your own skills and interests and figure out how they can be applied to that problem. Instead of beginning with “What do I want?” the question becomes, “What is worth wanting, and how can I help?” This model not only produces more impact, it tends to produce more durable meaning.
That shift is the backbone of the book. The first part makes the case that altruism is not self-sacrifice at all, but in many ways the most selfish thing you can do in terms of job satisfaction, general sense of purpose, genuine connection to your work. Once that case is made, the second part assumes the reader is convinced and moves into application. Here the style shifts closer to 80,000 Hours: concrete cause areas, frameworks for comparing options, and practical ways to align skills and interests with problems that matter.
Below is an excerpt from Chapter 5, Fulfillment Through Others, which sits at the pivot point in the book: the move from diagnosing why we get stuck in empty ambition, to showing why altruism is not just noble but psychologically sustainable.
Before I drop in the excerpt, two quick notes. First, I’d love feedback, pushback, or suggestions from this community, anything from “this framing resonates” to “take this down.” I would really appreciate it if you signed up for the project email list here ! : Google Form. Second, a disclaimer: the target audience for this project is not fellow EA Forum readers. It’s written for the average U.S. student. I’m deliberately sacrificing comprehensiveness for accessibility, keeping the page count low and the tone punchy, with the hope that the tradeoff earns attention where EA ideas usually bounce off.
Chapter 5
Fulfillment Through Others
“For success, like happiness, cannot be pursued; it must ensue, and it only does so as the unintended side-effect of one’s personal dedication to a cause greater than oneself.”
(Man’s Search for Meaning, 1946)
In 1942, Viktor Frankl was thirty-seven years old, a rising Austrian psychiatrist with a promising career ahead of him, when the world he knew was annihilated. He had been married only two years. His young wife, Tilly, was the center of his hopes for a future that promised stability and family. He also cared for his aging parents, especially his mother, who had encouraged his studies and stood proudly by his achievements. In another timeline, Frankl would have continued lecturing in Vienna, treating patients, and building the kind of life that looks ordinary but feels extraordinary in its quiet rhythms.
The train jolted to a stop. For days, Viktor Frankl had been pressed against other bodies in the cattle car, swaying as the wheels clattered over the tracks. The stench of sweat and urine clung to the air. His wife Tilly leaned against him, silent, conserving her strength. Somewhere in the dark, his father coughed, a thin rasp that seemed to come from another world. Then the doors slammed open, and guards shouted in clipped German. Prisoners stumbled into the harsh light, blinking as they were driven onto the platform.
Frankl stepped onto the platform, the cold biting through his shoes. He turned once to see his wife’s face, pale, frightened, but composed. She tried to smile. He opened his mouth to speak, but an officer barked an order. Women to the right, men to the left. In seconds, she was gone. His parents too. Later he would learn what that separation meant, but in that moment all he had was the echo of her gaze as the line carried him away.
Inside the camp, they shaved his head, stripped his clothes, tattooed a number on his arm. He was no longer Viktor Frankl, psychiatrist. He was 119,104.
The days blurred. He hauled stones in the snow until his shoulders burned. His lips cracked from thirst, his stomach knotted with hunger that never eased. At night in the barracks, men collapsed onto wooden planks, their bodies pressed tight against each other. Sometimes in the dark, someone would whisper a prayer. Sometimes there was only silence.
Frankl, trained to observe as a psychiatrist, began to watch. He noticed a strange divergence: those who endured longest were not necessarily the strongest or the most ruthless. Many of the men with robust bodies gave up quickly, hollowed out from within. Yet others, frail and sickly, somehow clung on. One man whispered to Frankl that he lived only to see his daughter again. Another held fast to a manuscript he had begun before the war, desperate to finish the ideas he believed the world needed. Still another prisoner, with nothing left of his own family, devoted himself to comforting others at night, trading his last bits of energy to keep their spirits alive. These were not acts of pure self-preservation. They were bonds, purposes, ties that reached beyond the boundaries of one’s own body.
For himself, Frankl clung to two anchors, fragile yet unyielding. At times he imagined Tilly alive somewhere, waiting for him, her memory forming a tether that stretched across the void and held him to the possibility of reunion. At other times he returned, again and again, to the manuscript that had been confiscated on his deportation. In the silence of the barracks or in the monotony of labor, he rebuilt it page by page in his mind, rehearsing its arguments until they seemed indelible, telling himself that he would endure long enough to write them down once more. What gave these visions their power was not the prospect of personal achievement or prestige, but the belief that they might offer something to others, that his survival could prevent despair from swallowing still more lives.
Over the months he came to see how fragile survival really was. A prisoner could collapse after losing his last cigarette, or after the shattering of a final illusion of hope. Frankl watched this process with the precision of a psychiatrist and the sorrow of a man who knew he might share the same fate. It became clear to him that endurance in the camp hinged less on physical strength than on whether one could answer a single, elemental question: Why go on? Later he would give the insight its most enduring form: “Those who have a ‘why’ to live can bear almost any ‘how.’” The “how” was starvation, humiliation, and labor that ground men into dust. The “why” was reunion, creation, or service, fragile but indispensable threads that held back despair. For Frankl himself, the “why” crystallized into testimony: he would survive so that this suffering would not vanish into silence, but would be transmuted into words that might help others endure.
He emerged weighing less than forty kilograms, his parents gone, his wife lost in Bergen-Belsen, grief pressing down on him like a second captivity. Liberation did not bring back what he had lost, nor did it dissolve the silence that followed. And yet, almost immediately upon returning to Vienna, he began to write. Within nine days the words poured out, as if the insights he had guarded in silence for so long might vanish if he did not set them down at once.
The result was Man’s Search for Meaning, a book that has sold millions of copies, translated into dozens of languages, and handed from one generation to the next like a lifeline. The book however is not a simple record of survival. It was an offering, an attempt to turn unspeakable pain into something others could use. That purpose found in connection to others is not only what helps us endure, but what gives life its deepest meaning.
His famous line, “Those who have a ‘why’ to live can bear almost any ‘how,’” was not abstract philosophy. It was forged in the hunger, cold, and cruelty of Auschwitz. And his “why” was not merely personal. It was oriented outward, to all of us.
In the decades since, modern science has repeatedly confirmed the essence of Frankl’s insight: survival and fulfillment are bound to meaning beyond the self. Research on resilience shows that people who orient their lives toward commitments larger than their own comfort (family, community, or cause) recover more fully from trauma and report stronger long-term well-being. In studies of trauma survivors, those who describe their lives as guided by purpose consistently show lower rates of depression and greater psychological recovery years later.Among veterans, a strong sense of purpose has been linked to lower incidence of post-traumatic stress, suggesting that meaning does not simply ease suffering but actively shapes resilience.
This pattern persists outside moments of crisis. Longitudinal studies following thousands of people over decades reveal that those who dedicate time to others, whether through raising children, sustained volunteering, mentoring, or participation in civic institutions, report higher life satisfaction and live longer. Even after adjusting for income and baseline health, the effect remains. Altruistic involvement appears to function like a long-term protective factor, lowering stress and mortality risk while building a durable sense of worth. From a public health perspective, this suggests that altruism is not an optional moral flourish but a measurable determinant of human health and longevity.
And while the conditions of a concentration camp cannot be equated with ordinary existence, the same truth Frankl observed there surfaces in everyday life. If you think back to the moments when you felt most alive, they were rarely the ones that brought mere pleasure or recognition; they were the times when your presence clearly mattered, when you felt anchored in a way that went deeper than satisfaction. Strikingly, such moments tend to share a common feature: they were not about you.
The moments that feel most vivid, most anchored, rarely come from recognition or milestones. They come from times when you felt unmistakably useful to someone else. It might have been when you stayed with a friend through the hardest night of their life, and later they said, “I don’t know what I would have done without you.” It might have been when you guided someone through a decision, or gave time you didn’t think you had, and saw the relief in their face. Or even smaller moments. The meal you cooked, the encouragement you gave, the time you showed up when you could have looked away. These don’t always make for impressive stories at a dinner party, but they make for the kind of memories that last.
What makes these moments powerful is that they are rarely pursued directly. You did not set out to feel fulfilled; the feeling arrived as a side effect of doing something that mattered to someone else. This is the crucial clue: fulfillment resists direct pursuit, but emerges reliably as the byproduct of contribution.
That insight may sound lofty or sentimental, but it is neither. It is supported by biology, psychology, and sociology. Experiments using functional MRI show that acts of generosity activate the same reward pathways triggered by food, music, or social connection, including the ventral striatum and prefrontal cortex. Hormonal responses tell a similar story: oxytocin released during caregiving strengthens attachment, while serotonin and dopamine stabilize positive mood. These mechanisms reflect evolutionary pressures. Human survival was never secured by isolated brilliance alone, but by networks of care, by those who shared food, protected the young, and looked after one another. That evolutionary inheritance still lives in us. Our brains are coded for connection, and when we help others the nervous system responds with signals of safety and reward. In this light, altruism is not the opposite of self-interest but its most deeply adaptive form.
Sociology reinforces this picture at the collective level. Societies are held together not by isolated achievements, but by shared obligations and contributions. Émile Durkheim, writing in the late nineteenth century, observed that people who felt disconnected from their communities were more likely to experience despair and even suicide. He called this “anomie,” the condition of normlessness and isolation. Modern data continues to affirm his insight: cultures with stronger traditions of reciprocity and community care report higher levels of well-being and resilience. When people feel they matter to others, they feel more alive. When they feel replaceable, invisible, or atomized, despair creeps in.
A University of British Columbia experiment found that people randomly assigned to spend money on others reported higher happiness than those who spent the same sum on themselves, and the effect showed up across cultures and income levels. Harvard studies on volunteering show the same: those who give time to others have lower stress, stronger immune systems, and live longer. A global Gallup survey of more than 70,000 people reported that acts of kindness and generosity predicted well-being more reliably than income, career status, or education.
Taken together, these findings have far-reaching implications. For individuals, they suggest that a life of service is not merely noble but the most reliable path to resilience and fulfillment. For healthcare, they imply that fostering community involvement and volunteering may be as important to long-term health as diet or exercise. For education and career guidance, they point toward a broader definition of success, one that weighs contribution alongside salary or prestige. Altruism, ironically, might the selfish choice to make.
Frankl’s own survival illustrates the paradox he described. He drew strength from imagining a purpose beyond his immediate suffering, and after liberation he translated that experience into a book that has reached more than 12 million readers. In writing, he turned private endurance into a public resource. His words, forged in suffering, resonate because they capture both personal testimony and a framework others can draw upon. They are not only the record of one man’s experience, but also a guide for making sense of suffering and locating meaning within it. He was pointing to the most practical survival strategy humans have ever stumbled on: the surest way to build a life worth living is to bind it to something beyond yourself.
Which brings us to the essential conclusion: purpose does not spring from chasing achievement, it comes most powerfully from helping others. Altruism is not just noble or moral, it is one of the most reliable ways to anchor a life that feels meaningful. The moments that sustain people, the ones they recall decades later, aren’t the trophies. They’re the times they were useful, remembered, or depended on. That is why meaning feels so elusive when we chase it for ourselves, but so undeniable when we give it away.
Think of the ordinary examples. The father who works two jobs, not out of pride or career ambition, but to provide for his children. The neighbor who organizes meals for a family going through illness. The teacher who stays after class to mentor a struggling student. These are not dramatic or glamorous acts. They will not appear on résumés or be broadcast on social media. But when people are asked what they are most proud of, or what they cannot forget, it is often moments like these they recall. They are the quiet scaffolding of meaning. The relief on their face. The thank you in their voice. The stability in knowing that, even if your own day was chaotic, one corner of it mattered.
That’s the real shift.
I am not suggesting that personal success is meaningless. Achievement can bring stability, comfort, and moments of genuine pride. Yet left on its own, it is incomplete. It delivers a version of happiness that depends on external validation, social comparison, and continual escalation. You achieve something, enjoy the recognition for a moment, and then immediately need the next accomplishment to sustain the feeling. Altruism operates differently. The satisfaction of knowing you made someone else’s life easier or better does not depend on comparison. It registers immediately, and it endures.
Because the truth is this: the principle of outward orientation does not vanish once you leave extraordinary circumstances. You don’t have to go through extreme suffering to need a “why.” In ordinary lives, in professional careers, in the thousand choices that make up a lifetime, the same rule applies. Purpose deepens when it reaches beyond the self.
In short, If you’ve ever felt most alive not when you achieved something, but when you helped someone else, there’s a reason for that. And it might just be the most important clue your life has given you so far.
The Unlikely Path of Paul Farmer
If Frankl showed us, in extremis, that survival itself could depend on finding purpose beyond the self, then Paul Farmer shows us what happens when you take that same principle and stretch it across a lifetime. Farmer insight was forged in the grind of poverty and sharpened in the fluorescent halls of hospitals and clinics. Both men faced the same central question: What makes a life matter? And both, in their own way, answered it the same.
Paul Farmer would later become one of the most admired doctors and humanitarians of his time. He co-founded Partners In Health, brought world-class medical care to some of the poorest communities on earth, collected honorary degrees by the dozen, and was called on by presidents and UN leaders for advice. His name became a shorthand for global health equity.
But that is the ending of the story, not the beginning. Long before the accolades, before the honorary degrees, his life looked very different.
His family was not just struggling a little. His family lived in a converted school bus parked behind a trailer, six children crammed together with no running water and no reliable electricity. Showers meant sneaking into public facilities when they could. Nights were thick with Florida heat and mosquitoes that rose from the swampy air. Meals were whatever could be scraped together, and sometimes there was nothing to scrape. Poverty was not the backdrop of Farmer’s childhood; it was the defining reality, pressing in on every hour of every day. Growing up in that world meant learning early that comfort was never guaranteed, that illness could bring catastrophe, and that survival was less about careful planning than about making do with what little you had.
And yet, Paul read. Constantly. He read relentlessly, the way other children hoard toys. Each page was an escape route, not only from the heat and hunger but from the sense that life had been reduced to bare survival. Reading introduced him to a world where ideas had structure, where suffering was not meaningless, and where other people, writers, thinkers, characters, seemed to reach across time to show him that life could be more than endurance. These books didn’t hand him a career plan or a roadmap to Harvard. They gave him something more fundamental: proof that meaning could be found, even in scarcity.
He was sharp, with an intellect that stood out even when measured against privilege. Duke noticed. Then Harvard noticed. And so, Paul Farmer, the kid who once lived in a converted school bus without running water, found himself walking across campuses where blazers and Patagonia vests were uniforms, where weekend ski trips to Aspen were a matter of course, and where the casual small talk often included family names that carried weight in biotech firms or Washington policy circles. It was a different universe, one where the assumption was not whether you would succeed, but what flavor of prestige you would choose. The irony was not lost on Farmer. He had never even had a doctor himself before applying to become one. Now he was surrounded by peers debating which specialty would bring the most status, income, or research grants, as if medicine were simply another career ladder to climb.
For a while, he played along. He did the things that medical students are trained to do when they finally arrive at the gates of institutional power. He scrubbed into surgeries with the precision of someone who knew his hands mattered. He wrote the papers that proved he could master the language of academia. He performed the roles expected of him, the ones that allowed him to blend in among peers who had been born into confidence and advantage. Outwardly, he was fitting into the mold. Inwardly, a tension was building.
The turning point came not in a classroom, but in the hospitals where theory met reality. Day after day, he saw how the system sorted patients into categories of value. Efficiency was prized over empathy. Billing over healing. Reputation over reach. The best doctors competed for the patients who already had access, while millions who lacked insurance, wealth, or social status were treated as afterthoughts, if they were treated at all. Farmer recognized the pattern immediately, because he had grown up on the side of life where health care was a luxury. Now, standing inside the halls of Harvard hospitals, he was watching that inequity reproduced at scale. He could not pretend it made sense.
So in 1983, still a medical student, he chose a different path. He traveled to Haiti, not for spring break, not as a brief mission trip to feel useful, but because something in him knew he could not keep learning medicine in a vacuum of privilege. He needed to see what medicine looked like where it was most needed. He landed in a rural village called Cange, in Haiti’s Central Plateau, one of the poorest regions in the Western Hemisphere.
Cange was a place stripped bare of the infrastructure most of us take for granted. No running water. No consistent electricity. No functioning medical facilities. Patients walked for hours, sometimes barefoot, to reach care. Some carried children so weakened by tuberculosis they could barely lift their heads. Others staggered in, too frail to stand on their own. There were no CT scans, no ventilators, no supplies. Just bodies in need, illnesses untreated, and a community long abandoned by the systems that claimed to serve them.
What he saw in Cange changed him forever. He began with almost nothing: his hands, his brain, and a refusal to accept that poverty should decide who lives and who dies. He treated patients in a church sacristy, the walls doubling as clinic and sanctuary. He walked miles to check on the sick who could not afford a bus. He begged for supplies wherever he could. He studied Haitian Creole not as an academic exercise but as a tool to listen, to ask questions, and to understand what people actually needed. And crucially, when they told him, he did not lecture. He listened.
The small sacristy clinic grew. It became Zanmi Lasante, a community-based hospital that treated not only disease but the conditions that produced it: malnutrition, contaminated water, lack of housing. Over time, that work expanded into Partners In Health, an international health system that now treats millions of patients across 11 countries. Every year, PIH delivers more than 3.1 million outpatient visits, carries out 847,500 home visits, and cares for 47,000 HIV-positive patients, 41,000 chronic disease cases, and 11,300 people with malnourishment. Add to that more than 3,200 tuberculosis treatment completions, 14,500 safe surgeries, and over 155,400 prenatal care visits, all in communities where none of these services were previously available.
Nor did PIH stop at providing basic care. When the global establishment said antiretroviral drugs for HIV patients in rural Haiti were “too expensive” or “too complicated,” PIH delivered them anyway, saving lives and proving the experts wrong. When multidrug-resistant tuberculosis was deemed untreatable in places like Peru, PIH achieved cure rates exceeding 75% in over 10,500 patients, a performance that created new global standards. When health systems collapsed in Rwanda, Lesotho, Sierra Leone, and beyond, PIH went in. Always in the places others ignored. Always for the people no one else prioritized.
Farmer’s life was relentless in the most literal sense. He crisscrossed Haiti on dirt roads for days at a time just to reach small rural clinics that otherwise had no doctor. He often slept only a few hours a night, because there was always another patient waiting or another meeting where he had to fight for resources. In the mornings he treated people suffering diseases that in the U.S. would be cured quickly, but in Haiti turned deadly because there was no clean water, no consistent electricity, and no stocked pharmacies. In the afternoons he sat across from officials at the World Bank or the World Health Organization, trying to persuade them that these same patients, people whom most of the world had written off as too poor to save, were worth investing in. When cholera broke out after the 2010 earthquake, he did not sit safely behind a desk in Boston and send instructions. He flew into Port-au-Prince, stepped into the treatment tents himself, rolled up his sleeves, and helped rehydrate patients one by one.
The key detail here is not just that he worked hard. Many doctors work hard. What set him apart was where he aimed his effort. He refused to see patients as “cases” in a file or abstract numbers in a public-health chart. To him, they were family members, neighbors, people who deserved the same level of care you would demand if your child was sick. That framing seems obvious when you spell it out, but in practice it is rare. Most professionals subconsciously grade whose lives “count” more, because systems and incentives reward them for doing so. Farmer’s refusal to accept that hierarchy is what made him both respected and controversial. He could have become a tenured professor at Harvard, an elite surgeon in Boston, someone who wore crisp suits and collected accolades. Instead, he opted out of.
And crucially, he was not motivated by the performance of sacrifice. He did not chase the identity of “martyr” or “saint.” He was making what, to him, was the most rational choice. If you have scarce medical skill, why deploy it where there is already an abundance of doctors, instead of where people are dying for lack of one? If you can persuade institutions with billions of dollars at their disposal, why not direct that money toward the populations most ignored? To Farmer, this was not a sacrifice; it was efficiency. His satisfaction came not from appearances but from the blunt fact that his work had impact. That is why he described it, almost off-handedly, as “the most sensible thing” he could imagine.
Farmer once said, “The idea that some lives matter less is the root of all that is wrong with the world.” For him, that was not rhetoric, it was a clinical observation. He had seen how the assumption that some lives counted for less produced real outcomes: children dying of preventable diseases, communities cut off from even the most basic medical treatment, and international agencies dismissing entire regions as “too poor to serve.”” His point was that inequality is not just about money or abstract injustice. It is about who gets oxygen and who does not, who gets medicine and who does not, who is left to die because powerful systems quietly decided their lives were not worth the cost. His prescription was simple: put yourself where the neglect is most extreme, and do something useful there.
And while his path was extraordinary, the lesson doesn’t require you to become a global health pioneer or abandon your job to move overseas. This isn’t about emulating Farmer’s life. It’s about understanding what made his life so rich in purpose. He wanted his skills as a doctor, his values as a human being, and his daily work to line up. That alignment gave him confidence that his time was well used, even when the work was exhausting or thankless.
Most people underestimate how powerful that alignment can be. They imagine that purpose comes from chasing passion, or from stacking up recognition. Farmer’s example shows something more grounded: when your abilities, your values, and your actions point in the same direction, you remove the second-guessing that haunts so many careers. You do not spend your life worrying whether your job really matters, because the evidence is right in front of you in the people you help. That is why even thankless work, when it is coherent work, can feel worthwhile in a way that prestige cannot reproduce.
And the thing is, that kind of alignment, that kind of integrity between your abilities and the world’s needs, is not just available to saints or outliers. It is available, in degrees, to almost anyone willing to ask the right questions.
Not: What’s the most prestigious job I can get?
Not: What will make me look successful?
But instead: What is the most useful thing I can do with the skills I have?
The truth is that most adults will spend the majority of their waking life working. That time can either be directed purely toward personal stability and recognition, or it can also be used to make a measurable difference for others. The second path often produces deeper satisfaction, not because it is easier, but because it resolves a fundamental tension. People want to believe their lives matter. If their daily work reinforces that belief, the sense of purpose sticks. If their work contradicts it, the question of meaning lingers no matter how high you climb the ladder.
Fantastic read, I wish you the best with this project.
I really enjoyed the storytelling in Paul Farmer's part.
I would suggest reducing a bit the "science" part, it gets quite dense and becomes harder to read than the stories before and after (and I imagine if it gets dense for me, who chugs graduate school manuals in my free time, it's probably too much for most college students).
Feel free to count on me for beta testing, but maybe not the best idea because I'm not from the US or a native English speaker.