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What does the Harvard Study of Adult Development teach us about the social impact of healthy relationships at work and at home?

In one of my roles (working as a trainee psychiatrist in the public health sector), I am continually asking the question, ‘what is causing this patient to present to me, at this time, with this particular pattern of symptoms?’ I am fortunate in my current workplace – a child and adolescent mental health clinic – that there is a holistic approach to mental health. My colleagues and I work within a schema that throughout the first two decades of life, mental well-being is due to a complex interplay of factors: genetic predisposition, personality traits, temperament, socioeconomic setting, ethnic background, sexual orientation, gender, trauma, developmental history, family structure, other co-existing medical problems….the list is extensive.

This gives rise to the question, how do we support someone in coming to a place of mental well-being with simply medication and talking therapy when there are so many variables? (This is a slight over-simplification; we also engage NGOs, allied health professionals, etc.) It’s clear that we cannot mitigate for societal attitudes to gender or sexual orientation or certain temperaments which may result in adverse effects on those individuals.

The primary role as a doctor, especially in the mental health sector where we measure DALYs (disability adjusted life years) and QALYs (quality-adjusted life years) – both measures of how life is affected by disease burden – is trying to promote the best life possible for that individual.

A lot of our role in the mental health sector is creating connection for people who are disenfranchised; they may be isolated, unemployed, or disengaged from the usual support available in society. This process is often facilitated by therapy, hospitalisation for severe mental illness, and medication. But the biggest role we offer is a relational one. This is a professional relationship, but through which we hope to model the connect that people can potentially have out in the world.

This led me to wonder about the role of relationship in creating happy and healthy workplaces and society. I am interested in social impact, which is a great sign of the growing awareness of our interconnectedness, and that positive flow-down from corporations results in better communities.

Since his TED talk, What Makes a Good Life? Lessons from the World’s Longest Study on Happiness, in November 2015 Professor Robert Waldinger, Clinical Professor of Psychiatry at Harvard Medical School, has been an oft-quoted figure. In his blog he writes,

More than half of the complaints that patients bring to their doctors are emotional in origin. Most often, they include troubled or absent connections with loved ones. Studies have shown that loneliness increases our risk of developing heart disease, diabetes, dementia, and a host of other ailments. A troubled marriage can be as hazardous to physical health as cigarette smoking. Depression is one of the costliest, most prevalent, and most under-diagnosed illnesses in the developed world.

We know that sustained, trusting connections with our physicians have enormous diagnostic and therapeutic value…

Human connections are essential aspects of both illness and cure. A health care system that provides insufficient time and reward for attending to these connections remains doomed to higher costs and lower quality, no matter who pays the bill.

Professor Waldinger knows a thing or two about connection and relationships in his role as Director of the Harvard Study of Adult Development at Massachusetts General Hospital. Briefly, the study was established in the 1930s and the men – and only men, which I’ll come to later – were selected from two different cohorts: the Harvard Cohort (the Grant Study) were 268 Caucasian men from the Harvard classes of 1939-1944. The second cohort, the Boston Cohort (the Glueck study) was a group of 456 Caucasian men from Boston neighbourhoods between the ages of eleven and sixteen. These children and adolescents have been followed up to the present day, and the study has now moved on to the Harvard Second Generation Study.

A mentionable issue with the Harvard Study is that it is a prospective study of men only.  During the studies, once the original men partnered, their wives were also included in the study. In the Second Generation Study, obviously the female offspring of these men will also be included. Does this mean that we cannot extrapolate the findings to women, people of different ethnicity, or sexual orientation? I don’t think it does, but it is helpful to bear in mind that these minority groups will have faced other challenges in life which are unique to them and which Caucasian men, regardless of their socioeconomic or educational background, will not have faced.

The findings of the study, according to Professor Waldinger, were that the quality of relationships was the biggest predictor of someone’s experience of happiness, contentment, and overall well-being – physically and mentally. In his TED Talk, he says:

So what have we learned? What are the lessons that come from the tens of thousands of pages of information that we’ve generated on these lives? Well, the lessons aren’t about wealth or fame or working harder and harder. The clearest message that we get from this 75-year study is this: Good relationships keep us happier and healthier. Period.

Most of (but not all) know instinctively how important relationships are to our enjoyment of life. People who may not have as much desire for close relationship with others are probably outliers on the bell curve, and I’m sure that there are some who would consider themselves emotionally and mentally fulfilled in their solitude. But what the Harvard Study suggests, is that relationships are integral not only to our mental wellness but also to our physical health.

It’s easy for me to apply this theory in the mental health sector, but much harder to apply in practice in mental health and other areas of medicine. Imagine telling a successful man in his mid-50s that the risk of his high cholesterol could be offset by partaking in close and supportive relationships with a life partner and a few steady friendships! This is what the study suggests, although how we determine the bare minimum of what constitutes a mutually close and supportive relationship is difficult.

At an organisational and even sector level, how can we improve our intra-organisational wellness and external social impact by promoting the lifestyle to support these recommendations? How can we reformulate ‘happiness’ and ‘the good life’ as something that is not defined as material possessions, professional success, or achievement based on working to a degree which undermines relationships and physical and mental health? I wonder if we can resist the valuable pull of technology to speed up processes and improve productivity, without it sucking in our humanity as it goes. This is a challenge, but one that we can surely meet as intelligent beings that can recognise the danger of automation and lack of power-off in our lives.

I’ll leave you with the wise words of Holly Butcher, a 27 year-old woman who died on 4th January 2018 from Ewing’s sarcoma. She writes,

It’s a strange thing to realise and accept your mortality at 26 years young. It’s just one of those things you ignore. The days tick by and you just expect they will keep on coming; Until the unexpected happens. I always imagined myself growing old, wrinkled and grey- most likely caused by the beautiful family (lots of kiddies) I planned on building with the love of my life. I want that so bad it hurts. That’s the thing about life; It is fragile, precious and unpredictable and each day is a gift, not a given right. I’m 27 now. I don’t want to go. I love my life. I am happy.. I owe that to my loved ones. But the control is out of my hands…

Remember there are more aspects to good health than the physical body.. work just as hard on finding your mental, emotional and spiritual happiness too. That way you might realise just how insignificant and unimportant having this stupidly portrayed perfect social media body really is…Give, give, give. It is true that you gain more happiness doing things for others than doing them for yourself. I wish I did this more. Since I have been sick, I have met the most incredibly giving and kind people and been the receiver of the most thoughtful and loving words and support from my family, friends and strangers; More than I could I ever give in return. I will never forget this and will be forever grateful to all of these people. It is a weird thing having money to spend at the end.. when you’re dying…

Don’t feel pressured to do what other people might think is a fulfilling life.. you might want a mediocre life and that is so okay. Tell your loved ones you love them every time you get the chance and love them with everything you have. Also, remember if something is making you miserable, you do have the power to change it – in work or love or whatever it may be. Have the guts to change. You don’t know how much time you’ve got on this earth so don’t waste it being miserable. I know that is said all the time but it couldn’t be more true.

 

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Five (+2) favourite quotes thus far from Tim Ferriss’ ‘Tribe of Mentors’

If you’re reading this on your phone, on social media, whilst I share life hacks from a book subtitled ‘Short Life Advice From the Best In The World’ – then shame on you.  Sit down. Turn off your phone. Pour a cup of coffee. Then read the book yourself.

But failing that, here are some of my favourite curiosity-inducing, potentially  life-changing quotes to disrupt your 2018:

1. Kyle Maynard – first quadruple amputee to reach summits of Mount Kilimanjaro and Mount Aconcuagua without prosthetics, champion wrestler and CrossFit instructor. Phew.

If happiness is just above the status quo, bliss is what makes you feel most alive. Expect it will take courage to follow your bliss, and expect it will suck at times. Expect you’re going to have to take risks for it. Expect others won’t necessarily understand.

2. Debbie Millman – the ‘Queen of Branding’, founder and host of Design  Matters podcast (excellent – a must-listen), editorial and creative director of Print magazine, and co-founder of world’s first masters in branding at NYC School of Visual Arts. She also has an incredible life story – check it out here.

Busy is a decision…If we use busy as an excuse for not doing something what we are really, really saying is that it’s not a priority…

One piece of advice I think [a smart, driven college student] should ignore is the value of being a “people person.” No one cares if you are a people person. Have a point of view, and share it meaningfully, thoughtfully, and with conviction.

3. Naval Ravikant – angel investor, CEO of [lots of sexy-sounding Silicon Valley-esque companies I’ve never heard of]. Smart enough to have cashed in on Twitter and Uber. And smart enough to say,

Suffering is a moment of clarity, when you can no longer deny the truth of a situation and are forced into uncomfortable change. Inside suffering is the seed of change…

Ignore: The news. Complainers, angry people, high-conflict people. Anyone trying to scare you about a danger that isn’t clear and present…

Self-esteem is just the reputation you have with yourself. You’ll always know.

4. Lewis Cantley – professor of cell biology and chief of Harvard’s Division of Signal Transduction. He discovered the cell signalling pathway phosphoinositide 3-kinase (PI3K), a significant advance in cancer research. He has also been involved in significant treatments for diabetes and autoimmune diseases.

Choose a profession that is really easy for you to do and that also allows you to be creative…One should not pursue a profession just because it is viewed, at the time you begin college, as the one that will have the most jobs of where you will make the most money. If you are uncertain of your talent, get a broad education that does not narrow your options. The best skill is to be able to communicate efficiently both in writing and speaking…

The worst recommendation [in my area of expertise] is to keep your ideas and data a secret until you have a paper describing these results accepted into a journal. Anytime I have a crazy idea or see an unexpected result, I talk about it with my colleagues to see if they have seen anything similar and whether they think my idea is crazy. This is the fun of science. Multiple scientists with different experiences and expertise can collaborate and get to the right answer much faster than a single scientist.

5. Jerzy Gregorek – born in Poland, emigrated to the US in 1986, and subsequently won four World Weightlifting Championships. In 1998 he earned a Masters in Fine Arts in writing from the Vermont College of Fine Arts. His poems and translations have appeared in multiple places, including The American Poetry Review.

I bought a bracelet for $19.95 with the first letters of each word of a sentence: IARFCDP…They are the key to my personal proverb, a line that brings awareness and helps me see through my own emotional storms. It means: I Am Responsible For Calming Down People. Sometimes it helps me to teach what I need to learn myself…

“Hard choices, easy life. Easy choices, hard life.” Nothing truly meaningful or lasting has ever been created in a short period of time.

5+1 (bonus quotes, because I’m greedy): Anna Holmes – writer and editor who has worked with The Washington Post, The New Yorker, and The New York Times. Creator of website Jezebel which discusses the intersection of gender, race, and culture.

“Follow your curiosity, wherever you can find it.” Embracing a curious mind and always trying to learn more – about others, about yourself, about the world and our place within it – is an important way to express yourself.

5+2: Annie Duke – one of the top poker players in the world. In 2004 she won her first World Series of Poker bracelet. She won the $2 million invitation-only World Series of Poker Tournament of Champions in 2004. Prior to becoming a professional poker player she had a National Science Foundation Fellowship at the University of Pennsylvania to study cognitive psychology. She blogs at Annie’s Analysis on the science of smart decision-making.

Seek out dissenting opinions. Always try to find people who disagree with you, who can honestly and productively play devil’s advocate. Challenge yourself to truly listen to people who have differing ideas and opinions than you do…The fact is, when two extreme opinions meet, the truth lies generally somewhere in the middle. Without exposure to the other side, you will naturally drift toward the extremes and away from the truth of the matter. Don’t be afraid of being wrong. Because being wrong is just an opportunity to find more truth…

Stay flexible and open to opportunities as they come your way…Be open to what the world brings your way. Don’t be afraid to change jobs or careers, no matter how much time you have already put into something. There is no urgency to have it all figured out…

If you define failure as merely losing, then you will think failure is just an outcome. And you might try to adjust your play to avoid losing even though your decisions were great (or repeat poor strategies just because you won executing them once). This would be the equivalent of deciding it is wise to run red lights just because you made it through safely a few times…What matters is the decisions I made along the way, and every decision failure is an opportunity to learn and adjust my strategy going forward. By doing this, losing becomes a less emotional experience and more an opportunity to explore and learn.

Okay, signing out. Heading off to the bush for a few days without phone and internet. It will be all nature, books, wine, and quiet.

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What would happen if we lived compassion in 2018?

On January 1st 2017, I wrote:

This morning, Eva was discussing about aiming to ‘make friends with discomfort’ in 2017. For her, the discomforts are many and multifaceted and are not limited to the discrete physical symptoms associated with treatment for breast cancer. The complex psychological effects of living with this illness and its treatment continue to surprise us, as well as the inevitable emotional instability associated with tiredness and stress and anxiety…[we] discussed further this making friends with discomfort and amended it to making friends with vulnerability and discomfort. The last weeks’ journey has been one of vulnerability in different ways. The sensation of being vulnerable to a life-threatening disease process; the vulnerability towards treatment; the vulnerability of our family to this massive emotional and practical upheaval; the emotional and psychological vulnerability we have all felt as individuals…

The last couple of years we have discussed personal intentions for the year ahead. For example, a couple of years ago my wife suggested ‘making friends with uncertainty’. Of course, by the end of each calendar year we had not risen to such fabulous heights of enlightenment that we had perfected dealing with these complex feelings and experiences. However, like goal-setting, identifying an area for personal growth is the minimal start needed in the process of change. Rather than choosing an arbitrary or completely abstract concept (perhaps making friends with vulnerability is a completely unrelateable issue for you…I would argue it’s not, but that’s another story…) choose something which you see would make demonstrable, tangible difference in your life right now if you learned that lesson. For us, these were concrete, workable concepts that we felt we could pursue in the year ahead.

Last night (New Year’s Eve, in bed by 9.15pm, thank you very much), after writing my first blog post yesterday, I was assailed by the predictable onslaught of doubts and negative self-talk: ‘what the hell are you on about? What is ‘curiosity, disrupted’? What is the deal with that shitting comma? Yes, I know it’s a fabulous grammatical tool which will bamboozle your readers with its utterly disruptive ambiguity, but really? And how pretentious is blogging anyway? Like there aren’t enough blogs in the world. And just because you had a few compliments on last year’s blog (where you obviously hijacked your wife’s experience of cancer to express your own existential angst, you bastard) you now feel like 2018 is begging for another edition of your own naval-gazing self-absorption? What about the Rohingya? Do you think they give a shit about your blog? Go to Mosul if you think you are such a gift to the world.’

Although my own internal, unfiltered, uninvited monologue sounds perhaps rather extreme when written down verbatim, I imagine it’s not too different from that which runs through the minds of us all when we choose to present our wares to the world. For many this can be sharing your creativity, whether that be in artistic form or a presentation to the board suggesting an innovative solution to a complex problem. We are called in our base human-ness to share ourselves. Some choose to do it for artistic expression’s sake; others do it to put food on the table.

Once I’d retired to bed positively bursting with optimism about my latest blog, sans phone (intention number two), I turned to the pile of books on my bedside table: The Compassionate Mind by Paul Gilbert, Tribe of Mentors by Tim Ferriss, Finding My Virginity by Richard Branson, Rising Strong by Brene Brown, The Art of Happiness by the Dalai Lama and Howard C Cutler, The Mindful Path to Self-Compassion by Christopher Germer, and Bringing Yoga to Life by Donna Farhi. (No, you’re not mistaken; it’s like the self-help section of a major bookshop vomited up Bali in the middle of Silicon Valley.) All are in various states of readedness.

I picked up the first one, Paul Gilbert’s brilliant analysis of the old mind/brain v the new mind/brain, and how the biological and social evolution of the human prefrontal cortex has caused all sorts of irritating habits along with its ability to meta-analyse our internal states. He describes three types of affect (emotion) regulation systems in the human brain which he describes as:

  1. The driven, excited, vitality system: this is incentive/resource-focused, and is characterised by wanting, pursuing, achieving, and consuming. It has an activating effect on us.
  2. The content, safe, connected system: this is non-wanting/affiliative-focused, and is characterised by safeness and kindness. It has a soothing effect on us.
  3. The anger, anxiety, disgust system: this is threat-focused, and is characterised by protection and safety-seeking. It can have both activating and inhibitory effects on us.

These systems can also be conceptualised as relatively discrete but closely interlinked neurobiological and hormonal systems.  It’s not difficult to look at ourselves in our day-to-day lives and see how and when these affective systems are driving us. (Affect is a fancy word for emotions in this context.) Emotional intelligence is the concept that by being aware of what is happening at an affect level, we can better gauge what is transpiring both in our own internal state as well as that of others. Again, it is not difficult to figure out why this is important in business, organisational reform, the doctor-patient relationship, politics, romantic and parent-child relationships, etc etc. But how often do we do it?

He later writes,

…We require both a sophisticated and an agreed form of welfare-focused social organization to contain our potential tribalism and abusive power hierarchies, and we must also recognize that, if we don’t understand and train our minds very carefully and learn to be wary of  allowing ‘new brain/mind’ competencies to be directed by ‘old brain/mind’ passions, we’re going to be in trouble…We are a species that has evolved to thrive on kindness and compassion.

That last sentence struck me. We have evolved to thrive on kindness and compassion.

It makes sense on first pass; we know that we ‘feel’ better when others are kind and compassionate towards us…but we rationalise it along the lines of, ‘I don’t live in a world where I can expect to feel pleasurable feelings all time.’ Which is true.

So what does compassion actually mean? Is it a weak sense of gushing over pictures of malnourished orphans on the other side of the world? Is it something only nurses feel? Is it intrinsically related to the maternal and the feminine – that whole stereotyped characteristic which is not championed and modeled by the (generally) male leaders we follow? (A whole other issue and problem which I would love to write about at some point.)

Compassion is derived from the Latin com- ‘togther’, and pati– ‘to suffer’.

To suffer with. To suffer together.

As a doctor, I am galled by the focus on ‘personal resilience’ which is extolled as the answer to the ‘tribalism and abusive power hierarchies’ that haunt my archaic and ponderous profession. A medical school colleague of mine was found dead late at night in the operating theatre changing rooms back in Scotland in August. In Australia, stories abound over the past few years of doctors who have suicided in the pursuit of what was traditionally considered an altruistic and compassionate vocation.

So what would happen if we lived compassion? I have clues and ideals and visions of what could happen, and I will strive in my relationships and professions and society to be a ‘compassion disruptor’. To be explicit: it is not about simply being nice to people or ourselves. Compassion is about stepping out of our comfort zone and proactively engaging with our own, and others’, suffering.

Here are some examples of questions about how compassion could disrupt:

  • In a meeting, a manager publicly humilates a colleague for a genuine mistake they have made. How would you engaging in their suffering affect them? Do you fall on the side of, ‘they made a mistake so they deserve this’, or ‘we all make mistakes and it is not helping the situation by humiliating the perpetrator of it.’ Mike Maples Jr., a partner at Floodgate, a venture capital firm that specialises in startups, says, ‘I find it is better to be focused on honoring the discovery of the truth rather than determining who is to blame.’ Would being compassionate, focusing on the ‘discovery of the truth’ (e.g. a root-cause analysis to identify the chain of events leading to the mistake) rather than lambasting an individual be more helpful?
  • When facing a client, and presenting a solution to the problem they have presented you with, you end up receiving all the credit and praise. You know, however, that a junior associate was the one who came up with the paradigm. The client knows your CEO personally and is likely to mention you favourably. How would compassion towards your junior colleague affect this situation? You know that they stayed late finishing the proposal; how would you empathising with them ‘in their suffering’ change your response? The moral or ethical answer is not difficult to deduce; but would you choose to believe that being seen as charitable and humble is something you would rather be valued for rather than being perceived as cut-throat and win-at-all-costs?
  • As a doctor in a busy emergency department, you are faced with an emotionally dysregulated young person who has self-harmed. They have presented to your ED multiple times, and have a history of cannabis and alcohol misuse. You have treated other family members of this person, who have a selection of forensic charges and substance abuse issues between them. How could the situation be defused by you responding with compassion? How have people usually responded to this young person – both professionals and other family members throughout his/her life? Is acting compassionately likely to smooth the transition of this patient through the ED to the appropriate inpatient setting, or as appropriate to be discharged with follow-up? How does your previous experience with this patient, and other similar clinical scenarios, affect your decision to ‘suffer with’ or to reduce your emotional engagement with this patient?

In 2018, I wonder how we can change our relationships if we acted compassionately? How could we treat ourselves differently (more effectively) if we responded with an awareness of our old mind/brain – that reactive, defensive, safety-seeking part that avoids danger, and which is hijacked by the new mind/brain which chastises us for being in the situation of experiencing those feelings?

If we can change in our intimate relationships?

If we can change in our family relationships?

If we can change in our professional relationships?

If we can change in our societal relationships?

If we can change in our relationship with and to the Other, seeing our selves reflected there?

It could be great.

(But honestly, that f***ing comma.)

 

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