A  prescrip)on  for  

Happiness    

10  things  I  have  learned    from  my  pa6ents  

Dr.  Timothy  Lau  Dis)nguished  Teacher  Program  Member  

Faculty  of  Medicine  Director  of  Undergraduate  Psychiatric  Educa)on  

Geriatric  Psychiatry,  The  Royal  

•  Henry  Thoreau  

Before  we  begin…  

•  Who  here  would  describe  themselves  to  be  extremely  happy?  

•  What  do  you  think  the  happiest  age  is?  •  Who  amongst  us  is  here  to  try  and  make  someone  else  happy?  

Happiness  

•  Would  you  be  happier    1.  winning  a  loMery  or    2.  breaking  your  neck?  

•  The  answer  may  surprise  you.  

Winning  a  loMery?  

•  Ecsta)c  at  first.  •  BUT…winning  the  loMery  tends  to  have  a  terrible  effect  on  social  rela)onships.    – People  almost  always  get  jealous  and  become  alienated  from  their  friends  and  their  family  members.  

– They  oRen  loose  what  really  maMers,  the  people  in  their  lives.  

Breaking  your  neck?  •  "Much  recent  data  show  that  people  fare  reasonably  well  in  a  variety  of  tragic  and  trauma6c  circumstances…Paraplegics  are  generally  quite  happy  people  

•  …blind  people  o@en  say  the  worst  problem  they  have  is  that  everyone  assumes  they  are  sad.  People  do  feel  devastated  if  they  go  blind,  but  it  does  not  last”  – Dan  Gilbert,  Professor  of  Psychology,  Harvard  –  See  TED  (Ideas  Worth  Spreading)  talks  for  the  principle  of  synthe)c  happiness    

Breaking  your  neck?  

•  It  is  the  triumph  of  the  human  spirit  that  allows  us  to  find  joy  and  survive  in  the  bleakest  of  situa)ons.  

•  People  who  suffer  long,  terrible  traumas  oRen  have  tremendous  senses  of  humour.    

Having  less  

•  May  help  us  focus  on  what’s  important.  – Finding  meaning  in  our  struggles.  

•  Having  less  helps  us  see  how  every  moment,  nothing  is  taken  for  granted,  everything  is  a  giR  – You  don’t  need  to  visit  third  world  countries  to  see  how  poor  children  can  be  incredibly  cheerful.  

Happiness  

•  Happiness  books  – Barns  and  Noble  2000………..50  books  – Barns  and  Noble  2008………..2,000  books  

 – Amazon.com  2012…………….14,000  books  

Happiness  

•  Schools  of  psychology  (posi)ve  etc),  sociology,  economics  

•  Topic  of  much  discussion  in  Philosophy  &  religion  

Happiness  Economics  

Happiness  Economics  •  Gross  na)onal  happiness  (GNH)  is  a  concept  introduced  by  the  King  of  Bhutan  in  1972  as  an  alterna)ve  to  GDP.    – Slipping  in  2011  United  Na)ons  Human  Development  Index.    #144  

•  In  2006,  Thailand  also  ins)tuted  an  index.  – The  Thai  GNH  index  is  based  on  a  1-­‐10  scale  with  10  being  the  most  happy.    As  of  May  13,  2007,  the  Thai  GNH  measured  5.1  points.    

Happiness  Economics  

•  Australia,  China,  France  and  the  United  Kingdom  are  also  coming  up  with  indexes  to  measure  na)onal  happiness.    

•  North  Korea  also  announced  an  interna)onal  Happiness  Index  in  2011  through  Korean  Central  Television.    – North  Korea  itself  came  in  second,  behind  #1  China.  

Why  is  happiness  important?  

•  Mental  wellness  – We  will  not  truly  understand  ourselves  nor  be  able  to  help  others  unless  we  knew  as  much  about  mental  wellness  as  we  do  about  mental  illness.    

•  Happiness  and  Depression  – Are  they  incompa)ble?  

Happiness  vs.  Depression  

•  Jerome  Wakefield  of  New  York  University  and  Allan  Horwitz  of  Rutgers  have  penned  “The  Loss  of  Sadness:  How  Psychiatry  Transformed  Normal  Sorrow  into  Depressive  Disorder”  

•  Has  our  preoccupa)on  with  happiness  paradoxically  come  at  the  cost  of  sadness  

Hedonic  Treadmill  

•  Happiness  is  oRen  imprecisely  equated  with  pleasure.    

•  If,  for  whatever  reason,  one  does  equate  happiness  with  pleasure,  then  the  paradox  of  hedonism  arises.    

•  When  one  aims  solely  towards  pleasure  itself,  one's  aim  is  frustrated.  

•  THOUGHT  EXPERIMENT    

Hedonic  Treadmill  

Pleasure  paradox  

•  John  Stuart  Mill,  the  u)litarian  philosopher,  in  his  autobiography:  

•  "But  I  now  thought  that  this  end  [one's  happiness]  was  only  to  be  aPained  by  not  making  it  the  direct  end…Ask  yourself  whether  you  are  happy,  and  you  cease  to  be  so.”    

Pleasure  paradox  

•  Viktor  Frankl  in  Man's  Search  for  Meaning:  •  “Happiness  cannot  be  pursued;  it  must  ensue,  and  it  only  does  so  as  the  unintended  side  effect  of  one's  personal  dedica6on  to  a  cause  greater  than  oneself”  

The  problem  with  pleasure  •  Pleasure  IS  NOT  the  same  as  happiness  •  Quick  Fixes  – Modern  man  tends  to  reach  for  superficial  quick  fixes  like  extravagant  purchases  and  ice  cream  (or  other  comfort  foods)  to  suppress  nega)ve  feelings  that  overcome  us.    

•  They  don’t  last  –  Indeed,  a  body  of  research  shows  instant  indulgences  do  calm  us  down—for  a  few  moments.    

–  But  they  leave  us  poorer,  physically  unhealthy,  and  generally  more  miserable  in  the  long  run  

Depression  is  on  the  rise…  

Depression  

•  In  the  western  world  clinical  or  major  depression  is  growing  at  an  incredible  rate.  

•    WHY?  •  Depression  is  the  leading  cause  of  disability  and  its  effects  are  increasing.    –  4th  in  2000  by  2020  2nd  WHO  

•  10  )mes  more  people  suffer  from  major  depression  now  than  in  1945    

•  850  000  lives  lost  to  suicide  each  year  

The  changing  rate  of  major  depression.  Cross-­‐na)onal  comparisons.  Cross-­‐Na)onal  Collabora)ve  Group.  JAMA  1992;268:3098-­‐3105.  

Defining  our  terms  

•  What  is  happiness?  

Ancient  vs.  Modern  Views  

•  Eudaimonea  

•  Happe  

Happiness  as  an  end  •  “Happiness"  is  oRen  thought  of  as  merely    subjec)ve  contentment.    How  you  feel.  – From  the  Old  english  word  ‘Hap’  which  refers  to  fortune,  luck  or  chance.    Something  that  happens  to  you.  

•  Eudaimonia  refers  to  an  objec)vely  desirable  life.      – A  choice-­‐virtue,  a  final  state.      – A  result  of  something  good  that  you  chose.  

Happiness  as  an  end  

•  Eudaimonia    – (Greek:  εὐδαιμονία)  is  a  Greek  word  commonly  translated  as  'happiness‘.    – Etymologically,  it  consists  of  three  words  •  "eu"  ("good")      •  "daimōn"  ("spirit").    Happiness  is  a  maMer  of  the  soul.  •  “ia”  las)ng  state,  permanent  

A  good  life  

•  Human  flourishing  

Aristotle  

•  Summum  Bonum  – The  purpose  and  end  to  life    – The  chief  excellence;  the  highest  aMainable  good.  

– ARISTOTLE  said  that  happiness  is  the  greatest  good.    Never  as  a  means  to  anything  else.  

10  Lessons….  

YOGI  BERRA  

•  Don’t  expect  money  to  buy  your  happiness  

Money  can’t  buy  you  happiness  

•  No,  but  our  material  needs  must  be  met  first  

Easterlin  paradox  

Money  and  happiness  

•  "Although  the  people  in  the  West  have  for  decades  got  richer,  they  have  not  become  happier.…    

•  Studies  show  that  people  are  not  happier  today  than  50  years  ago.  And  this  is  despite  the  fact  that  the  real  median  income  in  this  period  has  more  than  doubled.    

•  Richard  Layard,  Bri)sh  Economist  

Status  anxiety  •  Some  are  more  obsessed  with  status  than  others,  but  to  some  extent  we're  all  aMuned  to  how  we're  doing  in  life  rela)ve  to  those  around  us.    

•  To  help  prevent  status  worries  from  ge�ng  to  you,  carefully  decide  who  you  want  to  be  around.    

•  Owning  the  smallest  mansion  in  a  gated  community  could  make  you  feel  worse  off  than  buying  the  biggest  house  in  a  less  affluent  neighborhood.  

 

It is more important who you live with than where!

Op)ons  make  us  miserable  

•  The  paradox  of  choice    –  facing  many  possibili)es  leaves  us  stressed  out—and  less  sa)sfied  with  whatever  we  do  decide.    

– Having  too  many  choices  keeps  us  wondering  about  all  the  opportuni)es  missed.  

•  By  having  some,  but  overall  fewer  op)ons  – “The  secret  to  happiness  is  low  expecta6ons.”  (Barry  Schwartz  TED  Talk)”  

 

•  Live  with  integrity  

Happiness  is  living  your  values  

•  Be  authen)c    –  (provided  you  are  not  an  authen)c  jerk,  or  an  authen)c  heroin  addict)  

•  Follow  your  conscience  –  If  you  aren't  living  according  to  your  values,  you  won't  be  happy,  no  maMer  how  much  you  are  achieving.    

– Some  people,  however,  aren't  even  sure  what  their  values  are.    

Human  conscience  

•  “A  quiet  conscience  sleeps  in  thunder.”  – English  Proverb    

•  “A  clear  conscience  is  the  greatest  armor.”  – CHINESE  PROVERBS  

Character  •  Character  is  an  integra)on  of  what  the  great  minds  of  an)quity  used  to  call  the  virtues.    Those  powers  of  the  mind  and  will  and  heart  built  up  through  repeated  prac)ce.      

•  Jus)ce  (fairness)  •  For)tude  (courage)  •  Temperance  (self  control)  •  Prudence  (wisdom  or  sound  judgment)  

•  Accept  the  things  you  cannot  change  

Let  go  

Acceptance  •  Some  things  are  out  of  our  control  •  Arguably  the  most  important  ones  – Our  family,  our  temperament,  our  natural  abili)es  (intellectual,  physical),  our  disabili)es/illnesses,  when  we  are  born,  when  we  die…etc  

•  Serenity  prayer  

Don’t  try  to  be  something  you  are  not.  

•  Some  people  are  born  happy  – Twin  correla)ons.  – Personality-­‐  extroversion,  neuro)cism  

•  The  tyranny  of  the  posi)ve  a�tude.    – Looking  on  the  bright  side  isn't  possible  for  some  people    

– When  you  put  pressure  on  people  to  cope  in  a  way  that  doesn't  fit  them,  it  not  only  doesn't  work,  it  makes  them  feel  like  a  failure  on  top  of  already  feeling  bad.  

Don’t  try  to  be  something  you  are  not.  

•  Defensive  pessimism    – Anxious  people  oRen  use  this  to  help  them  get  things  done,  which  in  turn  makes  them  happier.    

– A  naturally  pessimis)c  person  can  set  low  expecta)ons  for  an  upcoming  presenta)on  and  review  all  of  the  imagined  bad  outcomes  to  prepare  carefully  and  increase  chances  of  success.  

•  Have  the  courage  to  change  the  right  things  you  can  

“You  miss  every  shot  you  do  not  take.”    Wayne  Gretsky  

Overcoming  learned  helplessness  

•  “Courage  is  the  finest  of  human  quali6es  because  it  guarantees  the  others”  

•  Sir  Winston  Churchill  

Life  as  a  choice  

“Our choices are what define us.”

Katie Holmes to Batman in Batman Begins

•  Pain  may  be  part  of  happiness  

Pain  Is  a  Part  of  Happiness  

Pain  

•  “I  wish  the  ring  had  never  come  to  me.”  Frodo  •  “So  do  all  who  live  to  see  such  6mes.    But  that  is  not  up  to  us  to  decide.    What  we  have  to  decide  is  what  to  do  with  the  6me  we  have  been  given.”    LOTR  FOTR  1:46:20s  

•  Gandalf  

Making  the  best  of  it  

Doing  the  best  you  can  with  what  you  have  

•  If  you're  climbing  a  mountain,  you  some)mes  have  to  backtrack  or  surmount  obstacles  or  thrash  your  way  through  tangled  shortcuts  

•  as  long  as  you  keep  moving  upward,  you'll  reach  the  summit.    

•  Keep  in  mind,  we  are  oRen  wrong    

We  are  oRen  wrong  

•  We  might  think  we  know  what  will  make  us  happy  and  what  made  us  happy.    

•  Things  are  almost  never  as  bad—or  as  good—as  we  expect  them  to  be.    – Your  promo)on  will  be  quite  nice,  but  it  won't  be  a  24-­‐hour  parade.    

– Your  breakup  will  be  very  hard,  but  also  a  learning  experience,  and  maybe  even  energizing.    

ORen  wrong  

•  We  are  terrible  at  predic)ng  our  future  feelings  accurately  with  emo)onal  reasoning  

•  We  recall  beginnings  and  endings  far  more  intensely  than  those  long  "middles,"  whether  they're  even�ul  or  not.  

•  Princeton  Colonoscopy  trial    

ORen  wrong  

•  Cogni)ve  distor)ons  – Automa)c  thoughts  •  All  or  nothing  thinking  •  Personaliza)on  

– Core  beliefs  – Views  about  ourselves,  the  world  and  the  future  

Self  esteem  

•  “Someone  cannot  take  away  your  self  esteem  unless  you  give  it  to  them”      

•  Gandhi  

•  Strive  for  balance  and  modera)on  

Plan  of  life  

•  Set  goals  – Search  for  balance  – Things  in  modera)on  •  Live  simpler,    • Work  less,    •  Spend  more  )me  with  family  

Plan  of  life  

•  Exercise  your  mind  – Read  good  books    

•  Exercise  your  body  – Regularly.    Good  for  your  body  and  your  mind.    

•  Eat  healthily  •  Play  

Play  

Dance    

as  though  no  one  is  watching  you  

Love    

as  though  you  have  never  been  hurt  before  

Sing    

as  though  no  one  can  hear  you  

Live    

as  though  heaven  starts  on  earth    

•  Find  a  reason  to  do  the  things  you  do  

Being  grounded  

•  Believe  in  something  or  fall  for  anything  •  G.K.  Chesterton  

Being  grounded  

•  People  who  have  a  religious  faith  and  prac)ce  it  regularly  live  longer,  are  happier,  and  are  healthier.  

•  Handbook  of  Religion  and  Mental  Health.    Koenig  

NAMASTE  

•  “The light in me recognizes the light in you”!

•  LOST, Season 5 episode 9.!

Finding  a  reason  

•  To  find  hope  – Perhaps  in  our  origin  and  end  

•  To  find  meaning  – An  undiscovered  purpose  

•  To  love  – To  be  connected  within  and  without  with  it  all  

Suffering  and  meaning  

•  “A  why  can  bear  any  how.”      

•  Victor  Frankl  quo6ng  Nietchze  in  Man’s  Search  for  Meaning  

•  Be  mindful  1.  Of  the  present  2.  Of  what  we  are  

thankful  for  3.  Of  our  anger  4.  Of  selfishness  

Mindfulness:  Focus  on  the  present  

•  “Do  not  look  back  on  happiness  or  dream  of  it  in  the  future.  You  are  only  sure  of  today;  do  not  let  yourself  be  cheated  out  of  it.”  

•  -­‐  Henry  Ward  Beecher  

Each  day  as  a  giR.    Each  day  is  a  new  day.  

•  “The  past  is  history,  the  future  is  a  mystery,  but  today  is  a  gi@—that’s  why  they  call  it  ‘the  present’”  

Focus  on  the  present  

•  Depression    – Regrets  about  the  past  – Hopeless  about  the  future  

•  Anxiety  – Worry  about  the  future  

One  day  at  a  )me  

•  When  things  seem  daun)ng,  take  it  one  step,  one  day  at  a  )me.  

•  “When  you  want  to  move  a  mountain  start  with  small  rocks.”    CHINESE  PROVERB  

Happiness  and  perspec)ve  •  In  the  moment  –  Time  skews  our  percep)ons  of  happiness.    –  Parents  look  back  warmly  on  their  children's  preschool  years,  for  example.    

–  But  when  asked  in  the  moment,  childcare  tasks  rank  very  low  on  the  list  of  what  makes  people  happy,  below  napping  and  watching  TV.    

•  Stepping  back  – Would  a  spirited  stretch  of  raising  children  or  a  steady  stream  of  dozing  off  on  the  couch  each  day  in  between  soap  operas  illustrate  a  "happier"  )me?    

Be  thankful  for  what  you  have  

“It’s  not  about  gedng  what  you  want  it’s  about  wan6ng  what  you’ve  already  got.”  Sheryl  Crow,    Every  day  is  a  winding  road.    

Gra)tude  

•  NIH  Study  Lyubomirsky  U  of  California  –  The  gra)tude  journal  –  Taking  the  )me  to  conscien)ously  count  their  blessings  once  a  week  significantly  increased  subjects'  overall  sa)sfac)on  with  life  over  a  period  of  six  weeks  

•  Gra)tude  exercises  can  do  more  than  liR  one's  mood.    – At  the  University  of  California  at  Davis,  psychologist  Robert  Emmons  found  they  improve  physical  health,  raise  energy  levels  and,  for  pa)ents  with  neuromuscular  disease,  relieve  pain  and  fa)gue.    

The  grass  is  greener  on  the  other  side…  

•  While  you  are  reaching  for  something,  be  careful  not  to  loose  what  you  already  have  

•  Wan)ng  oRen  feels  beMer  than  actually  ge�ng  

Bruce  Almighty  clip  

•  “Why  don’t  you  buy  me  a  big  ship.    That  will  make  me  happy”  

•  Time  1:03:28s  •  “Love  me….I  already  did”  •  Time  1:09:30s  

Forgiveness  

•  Le�ng  go  of  hatred  •  Forgiveness  means  le�ng  go  the  possibility  of  a  beMer  past  

•  Forgiveness  is  like  le�ng  a  prisoner  go  free  only  to  discover  that  the  prisoner  was  you  

East  meets  West  

•  The  problem  of  the  self  and  selfishness  •  We  are  unhappy  when  our  eyes  are  turned  inwards.    Happiest  when  we  are  thinking  of  others.  

Trying  to  hold  on  to  something  forever  

•  Stuff  vs.  People  

Detachment  

•  Yoda  speaking  with  Anakin  about  Padme    •  REVENGE  OF  THE  SITH  @34  minutes  

The  danger  of  having  hope  in  something  hopeless.  Holding  on  no  maMer  what  the  cost.  

•  Be  open  to  love  

Happiness  Is  Other  People  

•  Make  strong  personal  rela)onships  your  priority.    

•  Good  rela)onships  are  buffers  against  the  damaging  effects  of  all  of  life's  inevitable  letdowns  and  setbacks.  

•  The  basis  for  IPT  for  depression  

Happiness  is  love  

•  “Being  deeply  loved  by  someone  gives  you  strength  while  loving  someone  deeply  gives  you  courage”  

•  Lao  Tsu  

Married  People  are  generally  happier  

The  importance  of  family

•  Patients, as they get older, often wish they had spent more time with their family and that they had more children

– F Forget – A About – M Me – I I – L Love – Y You

Happiness  is  in  sharing  and  giving  

Simplicity  is…  •  Love  is  all  that  maPers.  

HAPPY EVER AFTER

•  Happiness involves a choice •  To find yourself you have to give yourself away •  Happier giving than receiving •  Love and happiness

10  Lessons  1.  Money  can  only  buy  so  much  2.  Live  with  integrity  3.  Don’t  try  to  be  something  you  are  not  –  Acceptance  and  changing  only  what  you  can  

4.  Have  the  courage  to  change  the  things  you  can  5.  Pain  may  be  part  of  happiness  6.  Remember  we  are  oRen  wrong  7.  Strive  for  balance  8.  Be  grounded  9.  Be  mindful  10. Be  open  to  Love  

•   “In  this  world  it  is  not  what  we  take  up,  but  what  we  give  up,  that  makes  us  rich.”        

•  Beecher  

THE  END  

Happiness  by  age…  

Proc  Natl  Acad  Sci  U  S  A.  2010  Jun    A  snapshot  of  the  age  distribu)on  of  psychological  well-­‐being  in  the  United  States.  Stone  AA,  Schwartz  JE,  Broderick  JE,  Deaton  A.  

PEW  Research  Center