The Human Journey
The Pursuit of Health

Creating a Sustainable Future

The Pursuit of Health

Does Mind Matter?

The Pursuit of Health and Happiness

Stress Matters

The focus of modern, Western medicine has been largely on intervening in the body machine with drugs and surgery. Nonetheless, psychosocial factors play a major role in who gets sick, the course of their illness, as well as the recovery from illness.

Chest pain, back pain, dizziness, headache, difficulty breathing, inability to sleep, abdominal pain and lack of energy. Sound familiar? These are the most common reasons people consult a physician.

But despite how common these ailments are, less than half of all people displaying these symptoms are appropriately diagnosed by their doctors – even after a thorough patient history, physical exam and medical testing. Doctors either don’t diagnose or do so inaccurately because they’ve failed to consider a very common root cause of human suffering and the source of many physical symptoms- namely, psychological stress.

While some patients – about 10 to 20 percent – exhibit extreme anxiety and depression indicative of a major psychiatric disorder, most people have what is best termed “everyday psychological distress.” This more common type of psychological distress has a major impact on daily physical and social functions. It even produces disabilities equivalent to diabetes, hypertension or arthritis.

The majority of Americans report unhealthy stress levels. And 1 in 5 people quantify their stress level as “extremely high.” What’s perhaps even more worrisome is that only 37 percent of Americans feel they’re able to adequately manage their stress. Most commonly, stress originates from work, financial pressures, family responsibilities, relationships and personal health concerns.

Ironically, stress negatively impacts the aspects of people’s lives that cause it in the first place. For instance, 70 percent of individuals who are stressed experience physical symptoms, lower productivity at work, and disruptions in their family and social lives.

Furthermore, adults with high stress levels are less likely to eat healthily, engage in physical activity, get enough sleep or moderate their alcohol consumption. These behaviors – often caused by stress – lead to additional health problems like depression, cardiovascular disease and even a greater susceptibility to colds. Stress can even affect our genes and speed up the aging process. Women with high stress levels experience a shortening in portions of their DNA with results equivalent to nearly a decade of accelerated aging compared to women with less stress.

We know stress-related symptoms take a toll on individual health. But studies also show the dire impact stress has on our nation’s work productivity and overall health care system. A third of U.S. workers report feeling extremely stressed at work. And this job-related stress is costing American industry an estimated $300 billion a year in absenteeism, turnover, diminished productivity and on-the-job accidents. Meanwhile, health care expenditures are nearly 50 percent greater for workers who report high levels of stress.

Early childhood stress seems to exert an exceptionally powerful influence throughout life. A long-term study of 17,000 people, found that Adverse Childhood Experiences (ACEs) are:

1) Very common

  1. 11% experienced emotional abuse
  2. 28% experienced physical abuse
  3. 21% experienced sexual abuse
  4. 15% experienced emotional neglect
  5. 10% experienced physical neglect
  6. 13% witnessed their mothers being treated violently
  7. 27% grew up with someone in the household using alcohol and/or drugs
  8. 19% grew up with a mentally-ill person in the household
  9. 23% lost a parent due to separation or divorce
  10. 5% grew up with a household member in jail or prison

2) Have profound, lasting, and damaging effects throughout life. The more categories of trauma experienced in childhood, the greater the likelihood of experiencing:

  1. alcoholism and alcohol abuse
  2. chronic obstructive pulmonary disease (COPD)
  3. ischemic heart disease (IHD)
  4. liver disease
  5. smoking
  6. obesity
  7. depression
  8. suicide attempts
  9. poor health-related quality of life
  10. illicit drug use
  11. risk for intimate partner violence
  12. multiple sexual partners
  13. sexually transmitted diseases (STDs)
  14. unintended pregnancies
  15. fetal death
Early Childhood Stress

The total lifetime economic burden resulting from new cases of fatal and nonfatal child maltreatment in the United States is approximately $124 billion in 2010 dollars. This economic burden rivals the cost of other high profile public health problems, such as stroke and Type 2 diabetes.

Fortunately, there is evidence that some of this child maltreatment and its health, social and economic consequences can be prevented.

The Other Side Of Stress: Why Positive Moods and Mindset Matters

Change your Mindset, Change the Game Change your Mindset, Change the Game

Some stress can actually be positive, particularly when it motivates necessary lifestyle changes and builds resilience. Interestingly, the effect of stress on health and well-being, seems to be moderated by your view or “mindset” regarding the impact of stress. People who view stress as potentially helpful, something to be used and embraced (“stress-is-enhancing mindset”), fare much better than those who see stress as something that makes you sick and to be avoided and reduced (stress-is-debilitating mindset”). The good news is that these stress mindsets can be altered. In one experiment, when “stress-is-enhancing” videos were shown to people, their symptoms of anxiety and depression, as well as work performance improved. (Crum, Alia J., Peter Salovey, and Shawn Achor. "Rethinking stress: The role of mindsets in determining the stress response." Journal of Personality and Social Psychology 104.4 (2013): 716.)

How to make stress your friend How to make stress your friend

In a study of over 28,000 people those who reported both a lot of stress and the perception that stress affects their health had a 43% increased risk of death. In fact, believing that stress is harmful to health may have caused over 20,000 premature deaths per year, making this the 15th leading cause of death in America. (Does the perception that stress affects health matter? The association with health and mortality. Keller, Abiola; Litzelman, Kristin; Wisk, Lauren E.; Maddox, Torsheika; Cheng, Erika Rose; Creswell, Paul D.; Witt, Whitney P.Health Psychology, Vol 31(5), Sep 2012, 677-684) Seeing the upside of stress is not about deciding whether stress is either all good or all bad. It’s about how choosing to see the good in stress can help you meet the challenges in your life. (McGonigal, Kelly The Upside of Stress: Why Stress Is Good for You, and How to Get Good at It (pp. xxiii-xxiv). Penguin Publishing Group. 2015)

Studies show that positive and negative moods influence physical health and longevity independently. Mounting evidence demonstrates that happiness, pleasure, joy, optimism, excitement and sense of humor each have positive biological and physiological effects. So, while counteracting chronic stress and reducing negativity is important, another key to better health is finding happiness.

People who report that they are very happy (with less negative and more positive emotion and optimism) live 4 to 10 years longer than unhappy individuals. More so, those extra years are also lived healthier. Further, people who express positive emotions like joy, cheerfulness, and enthusiasm are 22 percent less likely to develop heart disease than those who don’t. In fact, in a study of nearly 100,000 women, optimists were 30 percent less likely to die from coronary heart disease than pessimists. Happiness, even expressed in a given day, is a statistical predictor of health. In one study, those who reported a more positive mood in one 24-hour period experienced a 50 percent lower death rate over the next five years compared to those who were less happy that day.

The game that can give you 10 extra years of life The game that can give you 10 extra years of life

Since happiness – and its many forms – can improve one’s health raises an important question: Can we choose to be happy? If we’re generally unhappy, can we reset this emotion or are some people too influenced by genetics, upbringing, and environment to modify their emotional state?

Of course, separating cause and effect is difficult here. Does one’s negativity cause stress that causes negative health outcomes? Likewise, can day-to-day happiness alone reverse negative health trends? Evaluating the impact of stress levels on lifestyle change is complex.

Factors like genetics and the environment can impact both disease prevalence and mood. But regardless of etiology, when faced with such adversity, happy people optimize their health and cope better than those who are unhappy.

Happily, there is mounting evidence that our moods and happiness can be modified by some simple activities and interventions that reshape our thoughts and moods each day.

Healthy Pleasures: The Health Benefits of Sensuality, Optimism and Altruism

Healthy Pleasures Healthy Pleasures

Imagine a medical treatment that can help lower your blood pressure, decrease your risk for heart disease and cancer, boost your immune function and block pain. It’s safe, inexpensive and readily available. The main side effects include feeling good, an increased sense of well-being and greater self-confidence.

Would you take it?

Many of us couldn’t begin to imagine such a treatment. But it turns out this remedy is readily available and inexpensive. And best of all, this “miracle drug” is produced by our brains in response to pleasure, happiness, optimism and positive mood.

“Mind-body” medicine – increasing our positive thoughts and emotions to influence physical health – is safer than medications sold through pharmacies, produces fewer negative side effects and provides longer-lasting results. But unlike swallowing a pill, such medicines require people to contribute time, energy and practice.

1. Savor Your Senses
Healthy Pleasures: The New Science of Happiness Healthy Pleasures: The New Science of Happiness

Our senses – touch, taste, sight, smell and hearing – allow us to learn about and enjoy the world around us. Human beings evolved to seek out experiences that are pleasurable because they either increased individual or group survival. For example, our ancestors who sought out a variety of taste sensations and foods, were more likely to get a healthier mix of nutrients, survive, and pass on this propensity to later generations. We rely on our senses to protect ourselves from danger, but our sensory nervous system also has the power to reduce stress. To enjoy the positive health outcomes of our senses, try some of these mind-body medicines on for size.

Enjoy nature. Individuals who take time to look at nature – soaring trees, lush woods and wide-open parks – report a better mood, less stress and even recover from surgery quicker.

Experience touch. Human touch can calm the heart, lessen headaches, speed childbirth and increase survival in premature infants.

Listen to music: The emotional impact of music can reduce stress. In fact, music therapy has been used to improve mood in depression. In addition, music often results in movement and exercise adding to one’s physical well-being. And for people engaged in physical activity, music enhances the experience. As a result, listening to music has been shown to have a beneficial effect on blood pressure, heart rate, respiratory rate, anxiety and pain.

Take a siesta. People who nap frequently enjoy a nearly 40 percent reduction in deaths from heart conditions.

Eat chocolate. Numerous studies have demonstrated the health benefits of modest amounts of dark chocolate: from lowering blood pressure to reducing the risk of stroke and heart disease. And remember to savor each bite.

Kiss. According to the Western Journal of Communication, couples who engage in more romantic kissing are less stressed, experience higher relationship satisfaction and even have lower cholesterol levels.

2. Practice Happiness

Much of our distress comes not from the stress triggers themselves but from our own interpretations about our situation. These mental stories can be altered with positive results.

The How of Happiness The How of Happiness

Rethink stress and embrace a healthy perspective. When feeling stressed, ask yourself these questions: Is this really as important as I think? If it is, will it be important in a week, a month, a year? Can I impact the situation by taking actions that will make a difference? Am I being objective about the impact or simply assuming the worst outcome? Am I taking the actions of others too personally? Sometimes, just pausing to consider such questions can lessen stress and help you adopt a more positive, optimistic frame of mind.

Do what you love. Enjoyable leisure activities can enhance well-being by acting as breathers, restorers and stress buffers. While different for everyone, they may include spending quiet time alone, visiting and dining with friends, belonging to clubs and religious groups, and pursuing hobbies. Research found that people who enjoyed these activities report greater life satisfaction and a lower incidence of depression. They also have lower blood pressure, reduced stress hormones, less obesity, better sleep and improved physical function.

One-Moment Meditation One-Moment Meditation

Be present. Studies show that people report a better mood when they are focused on the present vs. when their minds wander. Surprisingly, the positive benefits of “mindfulness” apply to both pleasant and unpleasant activities. Remember, right now is literally the only time to be alive – and the only moment in which you can experience happiness. And it only takes a moment.

Take vacations. According to one study, taking regular vacations can lower cardiovascular risk by 30 percent.

Laugh heartily. Patients prescribed a humorous video for 30 minutes a day experienced a reduction in blood pressure, stress, need for medications and recurrent heart attacks. Even a forced smile can lower stress levels.

Be playful. Playfulness is “the predisposition to frame a situation in such a way as to provide oneself (and possibly others) with amusement, humor and/or entertainment.” Research indicates that adult playfulness is correlated with overall well-being, life satisfaction, increased physical activity and greater fitness.

Practice Gratitude

Practice gratitude. Individuals who focus on what they are grateful for tend to experience less stress and depression, enjoy improved health, report fewer symptoms, and sleep better than those who embrace a “victim” mentality. Here’s a suggestion on how to practice gratitude: At the end of each day for two weeks, make a list of three things that happened over the previous 24 hours for which you are grateful. Then, write a note letting the individuals involved know how much you appreciate them.

3. Indulge In Altruism

People who volunteer and care about something other than themselves (think: people, pets, plants and the planet) tend to be both happier and healthier. In fact, helping others can buffer stress and reduce a person’s risk of death.

Help others. One of the most reliable ways to feel better is to do good for someone else. For example, pet owners enjoy a reduced rate of heart attacks compared to those without pets.

Better to give than receive

It’s better to give than to receive. Contrary to common belief, money can buy happiness – especially if it is given to others. In a novel experiment, participants received a sum of money. Half of them were instructed to spend the money on themselves and the other half on others. People who spend money on others feel significantly happier than those who spend money on themselves.

Kindness counts. Don’t let yourself forget about your good deeds. You can measurably improve your happiness simply by keeping a journal of your efforts to help others.

Embracing Happiness And Health

Healthy Pleasures

Many people worry that to promote health they have to adopt extremely restrictive diets, engage in punishing exercise, avoid all salt and shun cholesterol. Although each of these in moderation can contribute to improved health, participating in pleasurable activities also adds to happiness and health.

Scientific evidence now suggests that for most people, doing what is pleasurable actually pays off in both immediate enjoyment and better long-term health. The healthiest, most robust people seem to indulge in many small daily pleasures and cultivate a positive, optimistic view of their lives.

So taking a siesta, playing with a pet, talking to a friend, looking at nature, smelling a sweet scent, laughing at a funny movie and scores of other healthy pleasures may measurably improve your life, your health – and your happiness.

Mind & Body Health Handbook Mind & Body Health Handbook

At the same time, neither commercially produced drugs nor “mind-body” prescriptions are cure-alls. Both have their usefulness and their limitations. Mental imagery, relaxation or other mind-body techniques are ineffective in treating medical problems such as infections, cancers and advanced heart disease.

But before concluding that there is a pill for every problem, remember that traditional treatment with drugs and surgery are also not effective for a variety of medical problems, particularly those that result from stress and mild mood disorders. For these patients, a combination of mind-body techniques and traditional medical care produces the best outcomes.

The Way Forward

While it might seem at first from reading this article that I am somehow against medical care. Not so. I have practiced medicine for 35 years and many of my patients have benefited greatly from the care that I and my colleagues have provided. And the future is bright for medical care. With advances in biotechnology and medical science we will certainly develop better preventive medicines and interventions tailored to individuals based on their genetics and risks. This emerging development is sometimes referred to as Precision Medicine or Personalized Medicine.

At the same time, the arguments made above suggest some prudent and realistic approaches to optimizing health and minimizing harm as well as costs.

At least do no harm. Clinicians need to provide evidence-based medicine: using effective diagnostic and therapeutic approaches, and protecting patients from unnecessary, potentially harmful and costly tests and treatments. Physicians and patients need to engage in conversations about the overuse of tests and procedures and help patients make smart and effective care choices. Clinicians need to be honest with patients about the limitations of medical science, and patients need to be realistic in their expectations and demands. Clinicians need to help reduce the burden of treatment imposed on patients by visits to the doctor, medical tests, medication management, and lifestyle change that challenge patients in caring for themselves.

Apply Behavioral Science. Just as the quality and efficiency of care has been improved by applying the principles of quality control and efficiency derived from manufacturing and industry, so too can the experience and effectiveness of care be improved through the application of behavioral science. (David S. Sobel, MD, “Behavior Change and Beyond: Health, Confidence and Healthy Pleasures”: video lecture, 100 minutes)

Partner with Patients. Educate, equip and empower patients as the true primary care providers. This includes self-care for acute and chronic conditions as well as shared decision-making that aligns with and respects patients’ values. A critical component of self-care is ensuring that each person has made their wishes known by completing and discussing with family and physicians an Advance Care Planning document. This clarifies a person’s wishes for life sustaining treatment if they have a critical accident, injury or illness and cannot speak for themselves. It is also critical that alternatives are created to help people remain independent and functional in the face of aging and end-of-life illnesses. (Atul Gawande, MD Being Mortal)

Rebalance Investments in Health. In light of the broader causes of health realign investment of resources to reflect the imperatives for preventive care, behavior change, and social determinants of health.