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.