It’s Good to be GoodIt’s Good to be GoodStephen G. Post, Ph.D.Stephen G. Post, Ph.D.

Center for Medical Humanities, Center for Medical Humanities, Compassionate Care, andCompassionate Care, and

Bioethics – Stony Brook UniversityBioethics – Stony Brook University

““PAY IT FORWARD”PAY IT FORWARD”

Helping others contributes to Helping others contributes to happiness, health and even happiness, health and even longevitylongevity

Start young and “pay it forward”Start young and “pay it forward” Evolution, neurology, social

science, biomedicine, game theory, spirituality and human development converge

Action+EmotionAction+Emotion

Virtue Its Own RewardVirtue Its Own Reward

Emerson, “no man can Emerson, “no man can sincerely sincerely help another without helping help another without helping himself” himself”

““Those who enrich others will be Those who enrich others will be enriched.” (enriched.” (Proverbs 11:25)Proverbs 11:25)

I. SCIENCE OF STRESSI. SCIENCE OF STRESS

Psychiatrist Hans Selye, MD, Psychiatrist Hans Selye, MD, discoverer of the “stress discoverer of the “stress response” (response” (Nature, Nature, 1936), wrote 1936), wrote that giving “love, good will and that giving “love, good will and gratitude” are good for you.gratitude” are good for you.

Good family counselors try to get Good family counselors try to get stress levels down.stress levels down.

Bad News: Hostile EmotionsBad News: Hostile Emotions

Redford B. Williams, MD, Duke Redford B. Williams, MD, Duke 27 Questions From the MMPI 27 Questions From the MMPI Looked at those who took MMPI in Looked at those who took MMPI in

1950 at age 251950 at age 25 20% of high hostility quartile dead 20% of high hostility quartile dead

by age 50; 2% of low quartileby age 50; 2% of low quartile ““acid on metal” over time acid on metal” over time Caveat: Brief anger is a fine!Caveat: Brief anger is a fine!

Bad News: Angry HeartsBad News: Angry Hearts

Drawing on the national ARIC Drawing on the national ARIC (Atherosclerosis Risk in (Atherosclerosis Risk in Communities) researchers Communities) researchers reported that angry middle-aged reported that angry middle-aged people (N=12,986, men and people (N=12,986, men and women) are three times more women) are three times more likely to experience cardiac arrest likely to experience cardiac arrest than less angry counterparts (J.E. than less angry counterparts (J.E. Williams, et al., Williams, et al., CirculationCirculation, 101 , 101 (17), 2005, 2034-2039).(17), 2005, 2034-2039).

GOOD NEWS: The “Shift GOOD NEWS: The “Shift Effect”Effect”

Karl Menninger, MD: “Love cures Karl Menninger, MD: “Love cures – both those who give it and – both those who give it and those who receive it.” those who receive it.”

Lev. 19:18, “You shall not take Lev. 19:18, “You shall not take vengeance or bear a grudge,…vengeance or bear a grudge,…but you shall love your neighbor but you shall love your neighbor as yourself.”as yourself.”

Compassion Overcomes Compassion Overcomes HostilityHostility

When we feel empathy for another, and our When we feel empathy for another, and our “mirror neurons” are kicking in, it is hard to “mirror neurons” are kicking in, it is hard to maintain a vengeful attitude (Michael maintain a vengeful attitude (Michael McCullough, McCullough, Beyond Revenge: The Evolution Beyond Revenge: The Evolution of the Forgiveness Instinct, of the Forgiveness Instinct, 2008)2008)

Forgiveness and reconciliation approaches Forgiveness and reconciliation approaches universality (95% of known cultures (universality (95% of known cultures (Beyond Beyond RevengeRevenge 2008, p. 122) 2008, p. 122)

Forgiveness WinsForgiveness Wins

Fredric Luskin of Stanford (Fredric Luskin of Stanford (Forgive For GoodForgive For Good, , 2002) began studying Protestant and 2002) began studying Protestant and Catholic mothers whose children were killed Catholic mothers whose children were killed in political-religious clashes. Forgiveness in political-religious clashes. Forgiveness interventions lowered blood pressure, interventions lowered blood pressure, reduced stress hormones, improved reduced stress hormones, improved depression, and enhanced self-reported depression, and enhanced self-reported health. health.

Confucius wrote, “If you devote your life to Confucius wrote, “If you devote your life to seeking revenge, first dig two graves.”seeking revenge, first dig two graves.”

““Generous Tit For Tat,” Harvard’s Martin Generous Tit For Tat,” Harvard’s Martin Nowak Nowak

Happiness PollsHappiness Polls

2005 Time Poll on major sources 2005 Time Poll on major sources of happiness (77% “relationship of happiness (77% “relationship with your children”; 76% “your with your children”; 76% “your friends and friendships”; 75% friends and friendships”; 75% “contributing to the lives of “contributing to the lives of others”; 62% “religious or others”; 62% “religious or spiritual life and worship” spiritual life and worship”

Just Thinking of Giving Just Thinking of Giving Creates JoyCreates Joy

fMRI revealed that making a fMRI revealed that making a donation activated the donation activated the mesolimbic pathway, and mesolimbic pathway, and increased dopamine levels (Moll, increased dopamine levels (Moll, et al., et al., Proceedings of the Proceedings of the National Academy of SciencesNational Academy of Sciences, , 2006)2006)

““Helper’s High”Helper’s High”

half of helpers report a "high" feelinghalf of helpers report a "high" feeling 43% felt stronger and more energetic43% felt stronger and more energetic 28% felt warm28% felt warm 22% felt calmer and less depressed22% felt calmer and less depressed 21% experienced greater feelings of 21% experienced greater feelings of

self-worthself-worth 13% experienced fewer aches and 13% experienced fewer aches and

pains (Luks, pains (Luks, Psychology TodayPsychology Today, 1988), 1988)

Is It Just Selfishness?Is It Just Selfishness?

““If you want to define selfishness If you want to define selfishness so widely as to include the warm so widely as to include the warm glow that people feel after giving glow that people feel after giving selflessly to others, then we need selflessly to others, then we need more of it.” Stephen G. Post, more of it.” Stephen G. Post, ABC 20/20ABC 20/20, August 24, 2007), August 24, 2007)

Money Can Buy Money Can Buy Happiness! Happiness!

632 Americans surveyed about their 632 Americans surveyed about their spending habits. Income NOT related to spending habits. Income NOT related to happiness, but those who spent more happiness, but those who spent more on gifts and charities were happier. on gifts and charities were happier. Boston employees tracked before & Boston employees tracked before & after received a bonus. Those spending after received a bonus. Those spending more on others were more on others were happier. Researchers gave college happier. Researchers gave college students either $5 or $20, and told them students either $5 or $20, and told them to spend it either on themselves or to spend it either on themselves or others. At the end of the day, those who others. At the end of the day, those who spent it on others reported more spent it on others reported more happiness. Making a donation of just $5 happiness. Making a donation of just $5 can improve your mood. can improve your mood. Science, Science, March March 2008. Harvard Business School.2008. Harvard Business School.

III. GIFT-LOVE AND MENTAL III. GIFT-LOVE AND MENTAL HEALTH HEALTH

Volunteers scored significantly Volunteers scored significantly higher in life satisfaction and will higher in life satisfaction and will to live, and had fewer symptoms to live, and had fewer symptoms of depression (Musick & Wilson, of depression (Musick & Wilson, Social Science and MedicineSocial Science and Medicine, , 2003)2003)

““Moral Treatment” 1820sMoral Treatment” 1820s ““Clubhouse Movement” 1960sClubhouse Movement” 1960s

Emotions and Health: Emotions and Health: YouthYouth

300 pre-teens in the Bay Area followed 300 pre-teens in the Bay Area followed every ten years since the 1920s. Those every ten years since the 1920s. Those who identified compassion and who identified compassion and generosity as important were healthier generosity as important were healthier and happier 50 years later (protected and happier 50 years later (protected from depression & some physical from depression & some physical illnesses). Giving in high school illnesses). Giving in high school predicted good mental and physical predicted good mental and physical health into late adulthood (Wink & health into late adulthood (Wink & Dillon, Dillon, In the Course of a LifetimeIn the Course of a Lifetime, 2007), 2007)

AlcoholicsAlcoholics

The 12th Step – help another The 12th Step – help another

person with your problem! Bill W person with your problem! Bill W & Dr. Bob& Dr. Bob

40% of those who fulfilled the 40% of those who fulfilled the 1212thth step were sober one year step were sober one year out; only 22% of those who did out; only 22% of those who did not (Pagano, et al., not (Pagano, et al., J of Studies J of Studies on Alcoholon Alcohol, 2004), 2004)

MS Patients MS Patients

MS patients trained to provide MS patients trained to provide compassionate lovecompassionate love

Over two years, those in this Over two years, those in this group showed “pronounced group showed “pronounced improvement in self-confidence, improvement in self-confidence, self-awareness, self-esteem, self-awareness, self-esteem, depression and role functioning.” depression and role functioning.” (Schwartz & Sendor, (Schwartz & Sendor, Social Social Science and Science and Medicine, 1999)Medicine, 1999)

Mental Capital and Mental Capital and Wellbeing Report: A Wellbeing Report: A

Prescription?Prescription? Oct. 22, 2008 release of Oct. 22, 2008 release of Mental Mental

Capital and Wellbeing Report, Capital and Wellbeing Report, compiled by 400 British scientists in compiled by 400 British scientists in the Government’s most prestigious the Government’s most prestigious think tank, the think tank, the Foresight ProjectForesight Project

Five categories of activities that Five categories of activities that make the largest difference in make the largest difference in wellbeing include, fifth of which is wellbeing include, fifth of which is “giving to neighbors and “giving to neighbors and communities”communities”

IV. GIFT-LOVE AND IV. GIFT-LOVE AND PHYSICAL HEALTH PHYSICAL HEALTH

Altruism in persons with HIV Altruism in persons with HIV significantly related to lower significantly related to lower levels of the stress hormones levels of the stress hormones cortisol and epinephrine cortisol and epinephrine (Ironson, in (Ironson, in Altruism and HealthAltruism and Health, , ed. S.G. Post, Oxford University ed. S.G. Post, Oxford University Press, 2007)Press, 2007)

Just Thinking of Doing Good Just Thinking of Doing Good

In a Harvard University study, a In a Harvard University study, a film about Mother Teresa’s work film about Mother Teresa’s work showed increases in the showed increases in the protective antibody salivary protective antibody salivary immunoglobulin A (S-IgA) immunoglobulin A (S-IgA) (McClelland, et al., (McClelland, et al., Psychology Psychology and Healthand Health, 1988), 1988)

Mortality ReductionMortality Reduction

High volunteers: lowest mortality High volunteers: lowest mortality rate for both genders (30% rate for both genders (30% reduction) (Oman, et al., reduction) (Oman, et al., J of J of Health PsychologyHealth Psychology, 1999), 1999)

Possibly associated with optimism Possibly associated with optimism (Duke, 900 older adults followed (Duke, 900 older adults followed for 15 years, 24% reduction in for 15 years, 24% reduction in mortality for high optimists. mortality for high optimists.

Emotions and Longevity: Emotions and Longevity: The Nun Study The Nun Study

School Sisters of Notre Dame School Sisters of Notre Dame Autobiographical writings Autobiographical writings

completed at a young age (D. completed at a young age (D. Danner, et al.,Danner, et al.,J of Per and Soc J of Per and Soc Psychology,Psychology, 2001). Those who 2001). Those who used high numbers of positive used high numbers of positive emotion words lived 6 to 10 years emotion words lived 6 to 10 years longer than those using few. longer than those using few.

Mortality ReductionMortality Reduction

National study of older adults by National study of older adults by Stanford University researchers: Stanford University researchers: “….more frequent volunteering is “….more frequent volunteering is associated with delayed mortality associated with delayed mortality even when the effects of socio-even when the effects of socio-demographics, medical and disability demographics, medical and disability characteristics, self-ratings of physical characteristics, self-ratings of physical activity and social integration and activity and social integration and support are controlled.” (Harris & support are controlled.” (Harris & Thoreson, Thoreson, J of Health Psychology, J of Health Psychology, 2005)2005)

Mortality ReductionMortality Reduction

University of Michigan University of Michigan researchers, in a longitudinal researchers, in a longitudinal study of older adults, after study of older adults, after correcting for all variables, correcting for all variables, concluded “In this study, older concluded “In this study, older adults who reported giving support adults who reported giving support to others reduced mortality.” This to others reduced mortality.” This was true whether the adults were was true whether the adults were helping neighbors, friends, helping neighbors, friends, relatives, or a spouse (Brown, et relatives, or a spouse (Brown, et al. al. Psychological SciencePsychological Science, 2003) , 2003)

Your Test Question!

How do our complex brains, unique imaginations, communicative abilities, reasoning powers, moral sense, and spiritual promptings give rise to this remarkable yet not at all uncommon practice of unselfish love for our neighbors, or for those we do not even know? Why is this practice good for us?

Warning! Don’t Listen to Warning! Don’t Listen to Bad ScienceBad Science

Robert Ardrey’s Robert Ardrey’s The Territorial Imperative The Territorial Imperative (1966),(1966), “ “innate aggression” theory innate aggression” theory

Frans de Waal in the Arnhem Zoo in 1975: Frans de Waal in the Arnhem Zoo in 1975: “Fires start, but fires also go out. Obvious as “Fires start, but fires also go out. Obvious as this is, scientists concerned with aggression, this is, scientists concerned with aggression, a sort of social fire, have totally ignored the a sort of social fire, have totally ignored the means by which the flames of aggression means by which the flames of aggression

are extinguishedare extinguished.”.” Dawkins, Sartre, Hobbes, etc. Dawkins, Sartre, Hobbes, etc. But But NOT NOT Darwin, who saw more clearlyDarwin, who saw more clearly

V. Rx GIFT-LOVE: V. Rx GIFT-LOVE: IntentionIntention

Visualize first thing in the morning Visualize first thing in the morning to focus on the importance of Gift-to focus on the importance of Gift-lovelove

Make love a consistent “practice” – Make love a consistent “practice” – Plan one special act of Goft-love Plan one special act of Goft-love daily! daily!

Use your special gifts! Use your special gifts! Keep a rhythm & replenish (enjoy Keep a rhythm & replenish (enjoy

the people and things that nurture the people and things that nurture you)you)

Different Strokes! Find Your Different Strokes! Find Your Strengths Strengths

Celebration – Dr. FratCelebration – Dr. Frat Mirth & Humor – Bob Hope Mirth & Humor – Bob Hope Compassion – Dame Cicely Compassion – Dame Cicely

SaundersSaunders Attentive Listening – Dan Attentive Listening – Dan

GottleibGottleib Creativity – Sister Leola McNairCreativity – Sister Leola McNair Generativity – Jean VanierGenerativity – Jean Vanier

More Examples & Ways More Examples & Ways

Forgiveness - The AmishForgiveness - The Amish Carefrontation – M. Scott Peck, Carefrontation – M. Scott Peck,

MD MD Respect – Mr. Fred RogersRespect – Mr. Fred Rogers Tom Smith – loyalty (“Don’t ever Tom Smith – loyalty (“Don’t ever

throw away a whole life just throw away a whole life just because it’s a little banged up” because it’s a little banged up” SeabiscuitSeabiscuit) )

See all lives as gifts calling us to gratitude and celebration

Forgive and make apologies meaningful

Lend a helping hand to others, and pass the torch

Have courage to confront evil with love, not malice

Smile in humor and mirthful joy that frees from anxiety

Have respect and reverence so as not to manipulate others

Listen attentively so that others might feel

significant

Awareness of suffering and a

desire to relieve it

Be loyal even to those who are

banged up a bit

Use our creativity for uplifting purposes

VI. THE GOOD VI. THE GOOD DOCTOR/NURSEDOCTOR/NURSE

Mass General HospitalMass General Hospital

““For the secret of the care of the For the secret of the care of the patient is in caring for the patient.” patient is in caring for the patient.” (Dr. Francis W. Peabody, 1921) (Dr. Francis W. Peabody, 1921)

Many patients feel that the most Many patients feel that the most significant ethical issue in health significant ethical issue in health care is being treated like a care is being treated like a biological slabbiological slab

A “Good” Doctor/NurseA “Good” Doctor/Nurse

Just recall the doctors who you Just recall the doctors who you remember as really special – what was remember as really special – what was it? it?

It does It does notnot take a lot to offer each take a lot to offer each patient some compassionate words, patient some compassionate words, even in brief encounters, and this even in brief encounters, and this practice practice isis fulfilling fulfilling

For professionals who are regularly For professionals who are regularly confronted with suffering, “empathy confronted with suffering, “empathy over arousal” (EOA) can occur, so step over arousal” (EOA) can occur, so step away and replenish away and replenish

Virtues, More Than Quandaries

Often quandaries (a feeding PEG? forced C-section?) do not allow much objectivity

Virtues tend to be more objective (e.g., compassion, attentiveness, equanimity, diligence, loyalty, integrity, & humility in a doctor)

Aristotle - a virtuous person more likely to do the right thing, with “luck”

Attitude of GratitudeAttitude of Gratitude

Sir John – Thanks for that fax!Sir John – Thanks for that fax! www.unlimitedloveinstitute.com www.sunysb.edu/bioethics www.whygoodthingshappen.com