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

1. It’s Good to be GoodStephen G. Post, Ph.D. Center for Medical Humanities, Compassionate Care, and Bioethics – Stony Brook University

2. “PAY IT FORWARD” • Helping others contributes to happiness, health and even longevity • Start young and “pay it forward” • Evolution, neurology, social science, biomedicine, game theory, spirituality and human development converge

3. Action+Emotion

4. Virtue Its Own Reward • Emerson, “no man can sincerely help another without helping himself” • “Those who enrich others will be enriched.” (Proverbs 11:25)

5. I. SCIENCE OF STRESS • Psychiatrist Hans Selye, MD, discoverer of the “stress response” (Nature, 1936), wrote that giving “love, good will and gratitude” are good for you. • Good family counselors try to get stress levels down.

6. Bad News: Hostile Emotions • Redford B. Williams, MD, Duke • 27 Questions From the MMPI • Looked at those who took MMPI in 1950 at age 25 • 20% of high hostility quartile dead by age 50; 2% of low quartile • “acid on metal” over time • Caveat: Brief anger is a fine!

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

8. GOOD NEWS: The “Shift Effect” • Karl Menninger, MD: “Love cures – both those who give it and those who receive it.” • Lev. 19:18, “You shall not take vengeance or bear a grudge,…but you shall love your neighbor as yourself.”

9. Compassion Overcomes Hostility • When we feel empathy for another, and our “mirror neurons” are kicking in, it is hard to maintain a vengeful attitude (Michael McCullough, Beyond Revenge: The Evolution of the Forgiveness Instinct, 2008) • Forgiveness and reconciliation approaches universality (95% of known cultures (Beyond Revenge 2008, p. 122)

10. Forgiveness Wins • Fredric Luskin of Stanford (Forgive For Good, 2002) began studying Protestant and Catholic mothers whose children were killed in political-religious clashes. Forgiveness interventions lowered blood pressure, reduced stress hormones, improved depression, and enhanced self-reported health. • Confucius wrote, “If you devote your life to seeking revenge, first dig two graves.” • “Generous Tit For Tat,” Harvard’s Martin Nowak

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

12. Just Thinking of Giving Creates Joy • fMRI revealed that making a donation activated the mesolimbic pathway, and increased dopamine levels (Moll, et al., Proceedings of the National Academy of Sciences, 2006)

13. “Helper’s High” • half of helpers report a "high" feeling • 43% felt stronger and more energetic • 28% felt warm • 22% felt calmer and less depressed • 21% experienced greater feelings of self-worth • 13% experienced fewer aches and pains (Luks, Psychology Today, 1988)

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

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

16. III. GIFT-LOVE AND MENTAL HEALTH • Volunteers scored significantly higher in life satisfaction and will to live, and had fewer symptoms of depression (Musick & Wilson, Social Science and Medicine, 2003) • “Moral Treatment” 1820s • “Clubhouse Movement” 1960s

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

18. Alcoholics • The 12th Step – help another person with your problem! Bill W & Dr. Bob • 40% of those who fulfilled the 12th step were sober one year out; only 22% of those who did not (Pagano, et al., J of Studies on Alcohol, 2004)

19. MS Patients • MS patients trained to provide compassionate love • Over two years, those in this group showed “pronounced improvement in self-confidence, self-awareness, self-esteem, depression and role functioning.” (Schwartz & Sendor, Social Science and Medicine, 1999)

20. Mental Capital and Wellbeing Report: A Prescription? • Oct. 22, 2008 release of Mental Capital and Wellbeing Report, compiled by 400 British scientists in the Government’s most prestigious think tank, the Foresight Project • Five categories of activities that make the largest difference in wellbeing include, fifth of which is “giving to neighbors and communities”

21. IV. GIFT-LOVE AND PHYSICAL HEALTH • Altruism in persons with HIV significantly related to lower levels of the stress hormones cortisol and epinephrine (Ironson, in Altruism and Health, ed. S.G. Post, Oxford University Press, 2007)

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

23. Mortality Reduction • High volunteers: lowest mortality rate for both genders (30% reduction) (Oman, et al., J of Health Psychology, 1999) • Possibly associated with optimism (Duke, 900 older adults followed for 15 years, 24% reduction in mortality for high optimists.

24. Emotions and Longevity: The Nun Study • School Sisters of Notre Dame • Autobiographical writings completed at a young age (D. Danner, et al.,J of Per and Soc Psychology, 2001). Those who used high numbers of positive emotion words lived 6 to 10 years longer than those using few.

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

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

27. 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?

28. Warning! Don’t Listen to Bad Science • Robert Ardrey’sThe Territorial Imperative (1966), “innate aggression” theory • Frans de Waal in the Arnhem Zoo in 1975: “Fires start, but fires also go out. Obvious as this is, scientists concerned with aggression, a sort of social fire, have totally ignored the means by which the flames of aggression are extinguished.” • Dawkins, Sartre, Hobbes, etc. • But NOT Darwin, who saw more clearly

30. V. Rx GIFT-LOVE: Intention • Visualize first thing in the morning to focus on the importance of Gift-love • Make love a consistent “practice” – Plan one special act of Goft-love daily! • Use your special gifts! • Keep a rhythm & replenish (enjoy the people and things that nurture you)

31. Different Strokes! Find Your Strengths • Celebration – Dr. Frat • Mirth & Humor – Bob Hope • Compassion – Dame Cicely Saunders • Attentive Listening – Dan Gottleib • Creativity – Sister Leola McNair • Generativity – Jean Vanier

32. More Examples & Ways • Forgiveness - The Amish • Carefrontation – M. Scott Peck, MD • Respect – Mr. Fred Rogers • Tom Smith – loyalty (“Don’t ever throw away a whole life just because it’s a little banged up” Seabiscuit)

33. See all lives as gifts calling us to gratitude and celebration Use our creativity for uplifting purposes Lend a helping hand to others, and pass the torch Be loyal even to those who are banged up a bit Forgive and make apologies meaningful Awareness of suffering and a desire to relieve it Have courage to confront evil with love, not malice Smile in humor and mirthful joy that frees from anxiety Listen attentively so that others might feel significant Have respect and reverence so as not to manipulate others

34. VI. THE GOOD DOCTOR/NURSEMass General Hospital “For the secret of the care of the patient is in caring for the patient.” (Dr. Francis W. Peabody, 1921) Many patients feel that the most significant ethical issue in health care is being treated like a biological slab

35. A “Good” Doctor/Nurse • Just recall the doctors who you remember as really special – what was it? • It does not take a lot to offer each patient some compassionate words, even in brief encounters, and this practice isfulfilling • For professionals who are regularly confronted with suffering, “empathy over arousal” (EOA) can occur, so step away and replenish

36. 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”

37. Attitude of Gratitude • Sir John – Thanks for that fax! • www.unlimitedloveinstitute.com • www.sunysb.edu/bioethics • www.whygoodthingshappen.com