Happiness

What do we understand about happiness and what role can doctors play in helping people find happiness?

1. Happy? Speak with your doctor Aboutcancer.com

2. Historians tell us that by the 21 st century everyone was happy. Only smiley face emoji remain from this period. The following is one of a series of health related videos that can be found on the web site aboutcancer.com. The topic is how doctors made this all possible .

3. Historians tell us that by the 21 st century everyone was happy. Only smiley face emoji remain from this period. The following is one of a series of health related videos that can be found on the web site aboutcancer.com. The topic is how doctors made this all possible. Or Not

4. Is there now a science of happiness and if so is this something doctors can write a prescription for?

5. Does Your Doctor Treat Anemia? Iron deficiency anemia Existential anemia “There is but one truly serious philosophical problem and that is suicide.” Albert Camus

6. How Many Americans are Happy 1972 2016 Happy 83% 84% Very Happy 30% 28% Pretty Happy 53% 56% Not too happy 17% 16% http://gss.norc.org/

7. Things that make you happy Having children?

8. Does religion make you happy?

9. Does money make you happy?

10. Declaration of Independence, recognition that all men are “endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”  Are we supposed to be happy?

11. Is it normal to be happy? Charles Darwin Sigmund Freud Need to be suspicious to survive predators and outsiders to survive as cave men but leads to anxiety, racism and xenophobia in modern times Strong desires for food and sex to survive leads to obesity and sexual violence in modern times Only species to comprehend our mortality so how best to deal with that

12. “Pursuit of happiness is doomed” “…the intention that man should be happy is not included in the plan of creation ” Sigmund Freud

13. In 2011 , the UN General Assembly adopted a  resolution which recognized happiness as a “fundamental human goal ” and called for “a more inclusive, equitable and balanced approach to economic growth that promotes the happiness and well-being of all peoples ”. March 20 has been established as the annual International Day of Happiness and all 193 United Nations member states have adopted a resolution calling for happiness to be given greater priority.

14. Issues to Consider Is it the doctor’s role to help patients be “happy and healthy”? Are doctors happy (first heal thyself)? What do we know about happiness and how to define it? If you think you should give advice, what would it be ? Many of the slides are busy so consider pausing them

15. Holistic Medicine? Holistic medicine is a term used to describe therapies that attempt to treat the patient as a whole person. That is, instead of treating an illness, as in orthodox allopathy, holistic medicine looks at an individual's overall physical, mental, spiritual, and emotional wellbeing before recommending treatment.

16. Does The Definition of Health (or Well Being ) include Happiness?

17. Quality of Life W ell-being includes the presence of positive emotions and moods the absence of negative emotions, satisfaction with life , fulfillment and positive functioning.   In simple terms, well-being can be described as judging life positively and feeling good.

18. Meta-analysis of Benefits of Happiness (225 studies) More productive and creative at work Superior jobs and income Better leaders sand negotiators More likely to marry and have better marriages More friends and social support Stronger immune systems, physically healthier and live longer More helpful and philanthropic Lyubomirsky, Psych Bull 131:803

19. Benefits of Happiness on Health Lower incidence of stroke and cardiovascular disease If have CHD more likely to survive at 11 years If lung cancer more likely to be alive at 3 years Less likely to be on disability at 11 years Less likely to die in a car accident at 8 years Less likely to die of all causes at 28 years Lyubomirsky

20. Cold Virus Study Healthy volunteer complete happiness measurement Then received nasal drops of a rhinovirus Then quarantines for 5 days and monitored for 1 month Happier volunteers were less likely to develop a cold Cohen. Psych Med 65:652

21. A  Duchenne smile  involves contraction of both the zygomatic major muscle (which raises the corners of the mouth) and the orbicularis oculi muscle (which raises the cheeks and forms crow's feet around the eyes). Hillary… real smile or fake smile? Smile… Live Longer?

22. Positive Emotion and Health Study of 1952-1953 MLB baseball cards …players with a smile on their face lived 11 years longer Mills College Year Book Photos – genuine smile, 30 years later happier marriage and lower divorce rates Nun study – 1930’s / essay with positive emotion, 60 Years later the survival was much longer

23. If Medicine’s role is to optimize public ‘well being’, then is it the doctor’s job to ensure their patients are happy? Is there a new 21 st Century Job Description : Fix sick people Partner with people to assist and guide them into pursuing and achieving a long, happy, healthy and meaningful lives. Most doctors would say I’m not your mother! I’m not your life coach! I’m not your spiritual advisor! I can’t even make myself happy!

24. Issues to Consider Is it the doctors role to help patients be “happy and healthy”? Are doctors happy (first heal thyself)? What do we know about happiness and how to define it? If you think you should give advice, what would it be? Put on your own oxygen mask before attempting to assist others

25. Are doctors still Happy?

26. Life Satisfaction by Occupation and Income

27. Life Satisfaction by Occupation and Income

28. Burnout and Satisfaction With Work-Life Balance Among US Physicians Relative to the General US Population Arch Intern Med.  2012;172(18):1377-1385 Frustrated by the way they spend their time

29. Burnout by Specialty Emergency Medicine Internal Medicine Neurology Family Practice Otolaryngology Radiation Oncology Pathology Pediatrics Dermatology Preventive Medicine

30. Which specialty produces the happiest doctors ? Specialty Stick with Specialty Stick with Medicine Dermatology 73% 55% Orthopedics 67% 50% Cardiology 59% 61% Ophthalmology 56% 60% Gastroenterology 55% 55% Radiology 52% 49% Oncology 51% 67% Pediatrics 51% 67% Neurology 47% 60% Emergency Med 42% 68% Ob-Gyn 40% 67% Nephrology 37% 66% Family Practice 32% 73% Internal Med 25% 71% All data courtesy of Medscape's 2015 Physician Compensation Survey. Presentation by Madelyn Kearns, HIMSS Media. Insurance system that pays for procedures but not for thinking (cognitive tasks)

31. 63% had 6 figure educational debts!

32. Nurses are even more unhappy than doctors Medscape researchers reviewed online survey responses from more than 8,200 nurses working in the U.S. between August and October 2015. - 40% of these advanced practice nurses (APNs) still said they would choose a different career if they had a chance to do it all again - 44% of Registered nurses ( RNs) said they would choose a different profession . - The vast majority of nurses – 68 percent of APNs, 78 percent of RNs and 88 percent of LPNs/LVNs – said they were dissatisfied with where they worked .

33. Issues to Consider Is it the doctors role to help patients be “happy and healthy”? Are doctors happy (first heal thyself)? What do we know about happiness and how to define it? If you think you should give advice, what would it be?

34. Eudaimonia Term for the highest human good, takes virtue and its exercise to be the most important constituent in eudaimonia but acknowledges also the importance of external goods such as health, wealth, and beauty.

35. Hedonism Hedonism is a school of thought that argues that pleasure and happiness are the primary or most important intrinsic goods and the proper aim of human life.

36. “ All I wanna do is have some fun, I got a feeling I’m not the only one” Sheryl Crow Hedonic Pleasure Wastin’ away again in Margaritaville, Searchin’ for my lost shaker of salt Jimmy Buffett

37. Subjective Well Being High positive mood + Low negative mood + High Life-satisfaction According to a participant’s own self-ratings

38. World Wide Surveys About Importance of Happiness Importance Rating U.S. Greece Germany S. Africa China Argentina Diener. Soc Ind Res 2000;34:7

39. 2017 World Happiness Report People are asked to rank their life from worst possible to best possible on a scale of 1 to 10. (Cantril Ladder) Despite economic growth, US and China declined (US is #14 score of 6.99) and the average global score is 5.3 NY Times March 20, 2017

40. US Happiness Score, 2006 - 2016

41. Public Trust in Government: 1958-2015 Rise in Economic Inequality in the US, 1962-2014

42. Suicide rates and Happiness rates around the World Is suicide less common in happy countries?

43. Suicide rates and Happiness rates around the World NO! Suicide rates are higher in happier countries ! May be dangerous to be unhappy when everyone else is happy (i.e. why Facebook makes you crazy!) Happiness is relative! Happiness

44. Issues to Consider Is it the doctors role to help patients be “happy and healthy”? Are doctors happy (first heal thyself)? What do we know about happiness and how to define it? If you think you should give advice, what would it be?

45. Doctor Miller’s Recommended Happiness Guru’s Ed Diener, Ph.D., is Professor of Psychology at the University of Illinois,

46. Google these people (Sonja Lyubomirsky, Martin Seligman, Tal Ben- Shahar , Dan Gilbert, Raj Raghunathan, Ed Diener) Go to their web sites Watch their videos and TED talks (? Apps) If they resonate then buy or download their books (then recommend them to others)

47. Happiness Myths (life experiences) from Sonja Lyubomirsky I will be happy only when… - I get married - I have children - I find the right job - I’m rich I can’t be happy if… - I’ve gotten divorced - I’m single - I don’t have much money - My dreams don’t come true - I’ve gotten sick - I’m old

48. Genetics 50% Intentional Activities 40% Life Circumstances 10% Total Happiness Maybe we obsess too much about the importance of these life circumstances.

49. Does Money Make You Happy?

50. Day to day mood (emotional well being) caps at $75,000 per year for family. Life satisfaction continues to rise with income 450,000 Americans polled by Gallup in 2008 and 2009. Participants were asked how they had felt the previous day and whether they were living the best possible life for them.

51. High income improves evaluation of life but not emotional well-being Daniel Kahneman  and Angus Deaton PNAS  September 21, 2010  vol. 107 Positive affect – “were you happy yesterday?” Low stress – “did you feel stressed yesterday?” Not blue – “did you feel sad yesterday?” Ladder – “how satisfied are you with your life overall?”

52. Positive affect – “were you happy yesterday?” Low stress – “did you feel stressed yesterday?” Not blue – “did you feel sad yesterday?” Positive Affect Not blue Stress Free

53. Ladder – “how satisfied are you with your life overall?” Ladder

54. Most studies show U Curve for Age and Happiness

55. Most studies show U Curve for Age and Happiness

56. Percent of Americans with Fair or Poor Self-Rated Health in 2010 Obviously health gets worse with age People have more health problems as they age, so how can they be happier?

57. Most studies show U Curve for Age and Happiness

58. Most studies show U Curve for Age and Happiness

59. Doesn’t Have to Start Declining in Old Age

60. Life Satisfaction by Age Age (years) Age (years ) Western Countries Former Soviet Union Sub-Saharan Africa Latin America and Caribbean Women Men

61. Proportion of respondents who reported that they experienced a lot of worry yesterday , based on data in Gallup- Healthways Wellbeing Index Poll Age and Worry

62. Marriage Widowhood Divorce Life Satisfaction of Marital Events Years 8.0 7.5 7.0 6.5 6.0 5.5 5.0 - 5 -4 -3 -2 -1 0 1 2 3 4 5 6 7 With time we adapt to both good changes and bad changes in our lives

63. Happiness and Birth of a Child Years , before and birth of a chil d

64. Are stupid people happier than smart people? Is ignorance bliss? Trump watching the Solar Eclipse

65. Are dogs happier than people? Maybe leading the simple life is best

66. "The unexamined life is not worth living" Socrates How did things work out for Socrates?

67. “To forget one's purpose is the commonest form of stupidity” Friedrich Nietzsche How did things work out for Nietzsche?

68. Maslow’s Hierarchy of Needs (1943) Does healthy human developmental psychology lead as past our basic needs to ultimately reach self-actualization ( reach your full potential) or self-transcendence (higher goals outside yourself in altruism and spirituality)?

69. Formula for Happiness: Reality Expectations Can you accept and improve reality and modify your expectations? Should you distort reality and lower expectations?

70. Why is it Hard to Prescribe Happiness? Genetics (we are all born with a pre-determined ‘set point’ for happiness Happiness is a life-long trait “Hedonic adaptation” (hedonic treadmill) we adapt to all things positive

71. You can’t control genetics , and most people think that changing life circumstances is the way tp find happiness, but it may be   how we   react   to life circumstances that determines our happiness... by a factor of 4 to 1! Invest in personal relationships / Commit to meaningful goals / Take care of your body and soul Live in the present / Practice gratitude and positive thinking / Learn coping strategies Intentional Activities 40% Life Circumstances 10% Total Happiness Genetics 50%

72. You can’t control genetics , and most people think that changing life circumstances is the way tp find happiness, but it may be   how we   react   to life circumstances that determines our happiness... by a factor of 4 to 1! Invest in personal relationships / Commit to meaningful goals / Take care of your body and soul Live in the present / Practice gratitude and positive thinking / Learn coping strategies Intentional Activities 40% Life Circumstances 10% Total Happiness Genetics 50%

73. Strategies to Try to Boost Happiness Expressing gratitude and appreciation Practicing acts of kindness Coping well with adversity Nurturing optimist thinking Learning to forgive Savoring the moment Investing in relationships Committing to significant life goals Practicing your religion Meditating regularly Engaging in physical activity or exercise From Lyubomirsky and Diener

74. Happy Boosting Exercises 1. Savoring the moment (focus on something beautiful or meaningful) 2. Remembering happy days (try to replay the positive emotions) 3. Acts of kindness journal 4. Strengthening social relationships (calling or writing an old friend) 5. Goal evaluation and tracking (strive for realistic goals and move foreword) 6. Gratitude journal 7. Expressing gratitude personally 8. Thinking optimistically (think about your best possible future scenario) From Lyubomirsky and Diener

75. Dr. Tal Ben- Shahar https://wholebeinginstitute.com/ http://www.talbenshahar.com/ http://www.happier.tv/

76. Spiritual:  Leading a meaningful life and mindfully savoring the present. Physical:  Caring for the body and tapping into the mind/body unity. Intellectual:  Engaging in deep learning and opening to experience. Relational:  Nurturing a constructive relationship with self and others. Emotional:  Feeling all emotions, reaching towards resilience and optimism. https://wholebeinginstitute.com/

77. Dr. Tal Ben- Shahar Four Basic Archetypes of Happiness Decision Making Hedonism: living entirely for pleasurable activities Rat Race: postpone present happiness in order to be happy in the future Nihilism: believe no matter what they do they will never be happy Happiness: live in both today and tomorrow, they engage in activities that are both pleasurable and meaningful “Enjoy the journey on your way to a destination you deem valuable” Watch whole course: youtube.com/ watch?v =K8qpn6kNfPc

78. http:// www.actionforhappiness.org

79. TED Talk Emily Esfahani Smith 4 Pillars of a Meaningful Life Belonging: being in a relationship where you are valued for who you are intrinsically and you value others as well Purpose: less about what you want but what you give Transcendence: Stepping beyond yourself: transcendence states (state of flow) Storytelling : the story you tell yourself about your self (narrative)

80. You get to compose your narrative.

81. Watch "What makes a good life? Lessons from the longest study on happiness | Robert Waldinger https://youtu.be/8KkKuTCFvzI Surveys of millennials on major life goal site money (80%) fame (50 %) And we are encouraged to work harder “Lean in” Harvard study of adult development followed people for 75 years 724 men half were college students and other poor local boys Good relationships keep us happier and healthier Social connections critical Quality of the relationship is critical (best predictor of health and longevity) Also best predictor of mental health (memory)

82. https://ppc.sas.upenn.edu/ Positive Psychology  is the scientific study of the strengths that enable individuals and communities to thrive. ( Martin Seligman ) The field is founded on the belief that people want to lead meaningful and fulfilling lives, to cultivate what is best within themselves, and to enhance their experiences of love, work, and play.

83. The new era of positive psychology Martin Seligman is the founder of positive psychology, a field of study that examines healthy states, such as happiness, strength of character and optimism. http://go.ted.com/Jm2b9A

84. Flourish or Well Being is all About PERMA P = positive emotion E = engagement (flow) R = good relationships M = meaning and purpose (future oriented) A = achievement or accomplishment We value these 5 elements differently (each is measurable and teachable)

85. Flourish or Well Being is all About PERMA P = positive emotion E = engagement (flow) R = good relationships M = meaning and purpose (future oriented) A = achievement or accomplishment We value these 5 elements differently (each is measurable and teachable)

86. Flourish or Well Being is all About PERMA P = positive emotion E = engagement (flow) R = good relationships M = meaning and purpose (future oriented) A = achievement or accomplishment We value these 5 elements differently (each is measurable and teachable)

87. Flourish or Well Being is all About PERMA P = positive emotion E = engagement (flow) R = good relationships M = meaning and purpose (future oriented) A = achievement or accomplishment We value these 5 elements differently (each is measurable and teachable)

88. Flourish or Well Being is all About PERMA P = positive emotion E = engagement (flow) R = good relationships M = meaning and purpose (future oriented) A = achievement or accomplishment We value these 5 elements differently (each is measurable and teachable)

89. Flourish or Well Being is all About PERMA P = positive emotion E = engagement (flow) R = good relationships M = meaning and purpose (future oriented) A = achievement or accomplishment We value these 5 elements differently (each is measurable and teachable)

90. The Pleasant Life Having as many pleasures as possible Learning the skills to amplify them Draw Backs: experience of positive emotion is 50% heritable and not very malleable, and rapid habituation

91. The Good Life Absorbed in Activity (Flow rather than pleasure or positive affectivity) Identify your Signature Strengths Recraft your life to use these strengths

92. The Meaningful Life Identify your Signature Strengths Use them in the service of something larger than yourself

93. Life Satisfaction = Pleasure (positive emotion) + Good Life (Engagement) + Meaning Correlation : # 1 Meaning p <.001 #2 Good Life p <.001 # 3 Pleasure = marginal The Full Life vs the Empty Life Pleasure Engagement Meaningful

94. authentichappiness.sas.upenn.edu/home https:// www.authentichappiness.sas.upenn.edu/testcenter you can use the 50,000 words associated with PERMA on social media to measure this, go to http://wwbp.org/

95. wwbp.org/

96. wwbp.org/

97. ppc.sas.upenn.edu/learn-more/readings-and-videos/video-lectures-leading-scholars Positive Psychology What makes life worth living? University of Michigan psychology professor Christopher Peterson Simplest advice: “ Other people matter .” anything that builds relationships will make you happy Happiness is often an indicator of a life well lived but not the goal . Happiness is the product of our pursuits for a meaningful life

98. Happiness is Not The Goal Feeling unhappy (like feeling physical pain) it may be a warning that something’s wrong. Find out what’s wrong and fix it! If there’s nothing to fix…then do your Zen thing! Remove the spoon!

99. Self determination theory All human beings have three basic psychological needs - Autonomy-doing what you choose - Competence-doing it well - Relatedness- connecting with others

100. If You’re So Smart, Why Aren’t You Happy ? Raj Raghunathan M : Progression towards Mastery (really good at something) A : Autonomy , a sense of control over your own life The Three Big Goals to pursue after meeting your basic necessities (MBA) B : Belonging , sense of deep connectivity with at least one other person

101. There are Two Routes to the Big Three “Abundance”: Approach “Scarcity” Approach Mastery Pursuing Passion Chasing Superiority (flow, focus on the present) Belonging Need to Love (and Give) Need to be Loved Autonomy Internal Control External Control

102. Dr. Miller’s Take on the Subject of Happiness Understand the genetic implications Does anyone want your advice? Different advice for different types of people Connecting with someone (or something) what’s the work around Can we fix medicine?

103. Some people are born less happy and will have to work harder if they want ‘positive emotional’ type happiness, otherwise don’t worry about it!

104. Miller Classification of People Simple People : Motto “I’d rather be fishing.” Shallow People : Motto “Whoever has the most toys at the end wins!” Serious People : Motto “I wonder if there is more to life?”

105. Grow Past Narcissism

106. Avoid materialism Discover a truth and share it (cynic) “a man who knows the price of everything and the value of nothing” Oscar Wild “The meaning of life is to find your gift. The purpose of life is to give it away .” Picasso

107. Advice for Young People Some people make things happen Some people watch things happen Some people say “what’s happening?” < 1% 50% 50%

108. Should We Group People by Intelligence? Henry Goddard, 1910, Director Vineland Training School for Feeble-Minded Girls and Boys IQ Range Technical Title 0 – 25 Idiot 26 – 50 Imbecile 51 - 70 Moron Note to Donald, Moron was best group

109. We are all Idiot Savants! Even the most simple person has an area of genius(strength), we need to help them find it (Don’t sell yourself short!) Even the brightest person has large areas of stupid (Don’t flatter yourself, or you’re not all that!)

110. Advice for stupid people …”Just keep watching TV… most of that stuff is real.” Also unless you are the most successful person in your family…don’t go on Facebook! Advice for smart people … Christopher Hitchens “Most admirable quality a sense of the absurd , favorite virtue an appreciation for irony , …” You can’t hide from the reality of a world with gross inequality and senseless tragedy. Oh yea…and you’re dying!

111. Humor is mankind's greatest blessing. Mark Twain Importance of Developing a S ense of Humor Total absence of humor renders life impossible. – Colette If I had no sense of humor, I would long ago have committed suicide. Mahatma Gandhi Imagination was given to man to compensate him for what he is not; a sense of humor to console him for what he is. Francis Bacon You don't stop laughing because you grow older. You grow older because you stop laughing. Maurice Chevalier Everything is funny, as long as it's happening to somebody else. Will Rogers

112. Find someone who would notice if you were dead. The Waltons First choice would be family and then friends…. (Epicurus favored friends over romantic relationships) Best chance of finding someone, get a rescue dog (or turtle) Most probable solution…get a robot! (companion cat)

113. Anthropomorphic Personification Tom Hanks with his BFF ‘Wilson’ a soccer ball from Cast Away Joaquin Phoenix falls in love with his phone’s OS (operating system)

114. How do we fix medicine so doctors and nurses are happy again? Assume doctors and nurses are people who favor eudemonia (life of meaning) Assume they need to feel competent, have some control, and time to spend with family and friends (belonging) Solution: stop making them waste their time typing into a computer!!!

115. Are computers making doctors smarter and happier? If there is anything wrong, this computer will help me find it. 2016 study doctors spent 2 hours on EMR for every 1 hour patient care

116. Thomas L. Friedman: "Thank You for Being Late" Talks at Google https://youtu.be/nuF2JKeM2CY The train ( exponential growing information technology) has now left us behind (capable of only linear learning )

117. AI into IA (intelligent assistance, or assistants, or algorithms) Thomas L. Friedman: "Thank You for Being Late" Talks at Google https://youtu.be/nuF2JKeM2CY

118. State Marijuana Laws in 2017 Map Will there be other Social Consequences that impact medicine? Physician - assisted suicide  is legal in five  US states . in Oregon, Vermont, Washington and California. It is an option given to individuals in Montana via court decision. 2017

119. Can Doctors Prescribe Happiness? For a patient? No For themselves? Yes For society? Maybe Aboutcancer.com ‘noblesse oblige’

120. "The only thing necessary for the triumph of evil is for good men to do nothing." Edmund Burke ( or intelligent people to say nothing… Dr. M ) ‘noblesse oblige’ Physicians should be public health advocates and societies' resident social philosophers and public intellectuals and lead (or at least, engage) in a conversation about what it means to flourish in the 21 st century. Edmund Burke (1729 – 1797)

121. Go to www.aboutcancer.com/ or youtube.com/user/ robertmillermd /videos The goal is not to ‘feel happy’ but to ‘be happy’ because you are enjoying every day as you journey towards a meaningful life