Happiness

Happy?
Speak with your doctor
Aboutcancer.com

Historians tell us that by the 21st century everyone was happy.
Only smiley face emoji remain from this period.
The following is one of a series of health related videos that
can be found on the web site aboutcancer.com.
The topic is how doctors made this all possible.

Historians tell us that by the 21st century everyone was happy.
Only smiley face emoji remain from this period.
The following is one of a series of health related videos that
can be found on the web site aboutcancer.com.
The topic is how doctors made this all possible. Or Not

Is there now a
science of
happiness and if
so is this
something
doctors can write
a prescription

Does Your Doctor Treat Anemia?
Iron deficiency
anemia
Existential
anemia
“There is but
one truly
serious
philosophical
problem and
that isAlbert Camus

How Many Americans are
Happy
1972 2016
Happy 83% 84%
Very Happy 30% 28%
Pretty Happy 53%
56%
Not too happy 17% 16%
http://gss.norc.org/

Things that make you
happy
Having children?

Declaration of Independence, recognition that all
men are “endowed by their Creator with certain
unalienable Rights, that among these are Life,
Liberty and the pursuit of Happiness.”
Are we supposed to be happy?

Is it normal to
be happy?
Charles Darwin Sigmund Freud
• Need to be suspicious to survive predators and
outsiders to survive as cave men but leads to anxiety,
racism and xenophobia in modern times
• Strong desires for food and sex to survive leads to
obesity and sexual violence in modern times
• Only species to comprehend our mortality so how best
to deal with that

“Pursuit of
happiness is
doomed”
“…the intention that man should
be happy is not included in the
plan of creation” Sigmund Freud

In 2011, the UN General Assembly adopted a resolution which recognized happiness as
a “fundamental human goal” and called for “a more inclusive, equitable and balanced
approach to economic growth that promotes the happiness and well-being of all
peoples”.
March 20 has been established as the annual International Day of Happiness and all
193 United Nations member states have adopted a resolution calling for happiness to

Issues to Consider
1.Is it the doctor’s role to help patients
be “happy and healthy”?
2. Are doctors happy (first heal thyself)?
3. What do we know about happiness and how to define
it?
4. If you think you should give advice, what would it be?
Many of the slides are busy so consider pausing them

Holistic Medicine?
Holistic medicine is a term used to describe
therapies that attempt to treat the patient as a
whole person.
That is, instead of treating an illness, as in
orthodox allopathy, holistic medicine looks at an
individual's overall physical, mental, spiritual,
and emotional wellbeing before recommending
treatment.

Does The Definition of Health (or
Well Being) include Happiness?

Quality of Life
Well-being includes the presence of positive emotions
and moods the absence of negative emotions,
satisfaction with life, fulfillment and positive functioning.
In simple terms, well-being can be described as judging
life positively and feeling good.

Meta-analysis of Benefits of
Happiness (225 studies)
• More productive and creative at work
• Superior jobs and income
• Better leaders sand negotiators
• More likely to marry and have better marriages
• More friends and social support
• Stronger immune systems, physically healthier and live
longer
• More helpful and philanthropic
Lyubomirsky, Psych Bull 131:803

Benefits of Happiness on Health
• Lower incidence of stroke and cardiovascular
disease
• If have CHD more likely to survive at 11 years
• If lung cancer more likely to be alive at 3 years
• Less likely to be on disability at 11 years
• Less likely to die in a car accident at 8 years
• Less likely to die of all causes at 28 years
Lyubomirsky

Cold Virus Study
• Healthy volunteer complete happiness
measurement
• Then received nasal drops of a rhinovirus
• Then quarantines for 5 days and
monitored for 1 month
• Happier volunteers were less likely to
develop a cold
Cohen. Psych Med 65:652

A Duchenne smile involves contraction of both
the zygomatic major muscle (which raises the
corners of the mouth) and the orbicularis oculi
muscle (which raises the cheeks and forms
crow's feet around the eyes).
Hillary… real smile or
fake smile?
Smile… Live Longer?

Positive Emotion and Health
Study of 1952-1953 MLB baseball cards…players with a smile on
their face lived 11 years longer
Mills College Year Book Photos – genuine smile, 30 years later
happier marriage and lower divorce rates
Nun study – 1930’s / essay with positive emotion, 60 Years later the
survival was much longer

If Medicine’s role is to optimize public ‘well
being’, then is it the doctor’s job to ensure
their patients are happy?
Is there a new 21st Century Job Description:
1. Fix sick people
2. Partner with people to assist and guide them into pursuing and
achieving a long, happy, healthy and meaningful lives.
Most doctors would say
1. I’m not your mother!
2. I’m not your life coach!
3. I’m not your spiritual advisor!
4. I can’t even make myself happy!

Issues to Consider
1. Is it the doctors role to help patients be “happy and
healthy”?
it?
Put on your own oxygen mask
before attempting to assist
others

Life Satisfaction by Occupation and
Income

Burnout and Satisfaction With Work-Life Balance Among US
Physicians Relative to the General US Population
Arch Intern Med. 2012;172(18):1377-1385
Frustrated by
the way they
spend their time

Burnout by
Specialty
Emergency Medicine
Internal Medicine
Neurology
Family Practice
Otolaryngology
Radiation Oncology
Pathology
Pediatrics
Dermatology
Preventive Medicine

Which specialty produces the happiest doctors?
Specialty Stick with Specialty Stick with Medicine
Dermatology 73% 55%
Orthopedics 67% 50%
Cardiology 59% 61%
Ophthalmology 56% 60%
Gastroenterology 55% 55%
Radiology 52% 49%
Oncology 51% 67%
Pediatrics 51% 67%
Neurology 47% 60%
Emergency Med 42% 68%
Ob-Gyn 40% 67%
Nephrology 37% 66%
Family Practice 32% 73%
Internal Med 25% 71%
All data courtesy of Medscape's 2015 Physician Compensation Survey. Presentation by
Madelyn Kearns, HIMSS Media.
Insurance system
that pays for
procedures but not
for thinking
(cognitive tasks)

Nurses are even more unhappy
than doctors
Medscape researchers reviewed online survey
responses from more than 8,200 nurses working in the
U.S. between August and October 2015.
- 40% of these advanced practice nurses (APNs) still said they would choose
a different career if they had a chance to do it all again
- 44% of Registered nurses (RNs) said they would choose a different
profession.
- The vast majority of nurses – 68 percent of APNs, 78 percent of RNs and 88
percent of LPNs/LVNs – said they were dissatisfied with where they worked.

Issues to Consider
healthy”?
3.What do we know about happiness
and how to define it?

Eudaimonia
Term for the highest human good, takes virtue
and its exercise to be the most important
constituent in eudaimonia but acknowledges also
the importance of external goods such as health,
wealth, and beauty.

Hedonism
Hedonism is a school of thought that
argues that pleasure and happiness are
the primary or most important intrinsic
goods and the proper aim of human life.

“All I wanna do is
have some fun, I got
a feeling I’m not the
only one”Sheryl Crow
Hedonic Pleasure
Wastin’ away again in
Margaritaville, Searchin’
for my lost shaker of
saltJimmy Buffett

Subjective Well Being
High positive mood + Low
negative mood + High Life-
satisfaction
According to a participant’s own

World Wide Surveys About
Importance of Happiness
Importance
Rating
U.S. Greece Germany S. Africa China Argentina
Diener. Soc Ind Res 2000;34:7

2017 World Happiness Report
People are asked to rank their life from worst possible to best possible on a scale of 1 to 10.
(Cantril Ladder) Despite economic growth, US and China declined (US is #14 score of 6.99)
and the average global score is 5.3
NY Times March 20, 2017

US Happiness Score, 2006 -
2016

Public Trust in
Government: 1958-
2015
Rise in
Economic
Inequality in
the US, 1962-
2014

Suicide rates and Happiness rates around
the World
Is suicide
less common
in happy
countries?

Suicide rates and Happiness rates around
the World
NO! Suicide rates are
higher in happier
countries!
May be dangerous to be
unhappy when everyone
else is happy (i.e. why
Facebook makes you
crazy!)
Happine

Issues to Consider
healthy”?
it?
4.If you think you should give advice,
what would it be?

Doctor Miller’s Recommended Happiness
Guru’s
Ed Diener, Ph.D., is
Professor of Psychology
at the University of Illinois,

1.Google these people (Sonja Lyubomirsky,
Martin Seligman, Tal Ben-Shahar, Dan Gilbert,
Raj Raghunathan, Ed Diener)
2.Go to their web sites
3.Watch their videos and TED talks (? Apps)
4.If they resonate then buy or download their
books (then recommend them to others)

Happiness Myths (life experiences)
from Sonja Lyubomirsky
I will be happy only when…
- I get married
- I have children
- I find the right job
- I’m rich
I can’t be happy if…
- I’ve gotten divorced
- I’m single
- I don’t have much money
- My dreams don’t come true
- I’ve gotten sick
- I’m old

Genetics
50%
Intentional
Activities
40%
Life
Circumstance
s
10%
Total
Happiness
Maybe we obsess too much about the importance of these life
circumstances.

Day to day mood (emotional well being) caps at $75,000 per
year for family. Life satisfaction continues to rise with income
450,000 Americans polled by Gallup
in 2008 and 2009.
Participants were asked how they had
felt the previous day and whether they
were living the best possible life for
them.

High income improves evaluation of life but not emotional well-being
Daniel Kahneman and Angus Deaton PNAS September 21, 2010 vol. 107
Positive affect – “were you happy yesterday?”
Low stress – “did you feel stressed yesterday?”
Not blue – “did you feel sad yesterday?”
Ladder – “how satisfied are you with your life overall?”

Positive affect – “were you happy yesterday?”
Low stress – “did you feel stressed yesterday?”
Not blue – “did you feel sad yesterday?”
Positive Affect
Not blue
Stress Free

Ladder – “how satisfied are you
with your life overall?”
Ladder

Most studies show U Curve for Age and
Happiness

Percent of Americans with Fair or
Poor Self-Rated Health in 2010
Obviously health gets
worse with age
People have more health problems as they age,
so how can they be happier?

Doesn’t Have to Start Declining in Old Age

Life Satisfaction by Age
Age (years) Age (years)
Western Countries Former Soviet Union
Sub-Saharan Africa Latin America and
Caribbean
Women
Men

Proportion of respondents who reported that they experienced a lot of worry
yesterday, based on data in Gallup-Healthways Wellbeing Index Poll
Age and Worry

Marriage
Widowhood
Divorce
Life Satisfaction of Marital Events
Years
8.0
7.5
7.0
6.5
6.0
5.5
5.0
-5 -4 -3 -2 -1 0 1 2 3 4 5 6 7
With time we adapt to
both good changes and
bad changes in our lives

Happiness and Birth of a Child
Years , before and birth of a child

Are stupid people happier than
smart people?
Is
ignorance Trump watching the Solar Eclipse

Are dogs happier than
people?
Maybe leading the simple life is best

"The unexamined life is not worth
living"
Socrates
How did
things work
out for
Socrates?

“To forget one's purpose is the
commonest form of stupidity”
Friedrich Nietzsche
How did
things
work out
for

Maslow’s Hierarchy of Needs (1943)
Does healthy human developmental psychology lead as past our
basic needs to ultimately reach self-actualization( reach your full
potential) or self-transcendence (higher goals outside yourself in
altruism and spirituality)?

Formula for Happiness:
Reality
Expectations
Can you accept and improve
reality and modify your
expectations?
Should you distort reality
and lower expectations?

Why is it Hard to Prescribe Happiness?
• Genetics (we are all born with a pre-determined ‘set
point’ for happiness
• Happiness is a life-long trait
• “Hedonic adaptation” (hedonic treadmill) we adapt
to all things positive

You can’t control genetics, and most people think that changing life circumstances is the way tp
find happiness, but it may be how we react to life circumstances that determines our happiness...
by a factor of 4 to 1!
Invest in personal relationships / Commit to meaningful goals / Take care of your body and soul
Live in the present / Practice gratitude and positive thinking / Learn coping strategies
Intentional
Activities
40%
Life
Circumstance
s
10%
Total
Happiness
Genetics
50%

Strategies to Try to Boost Happiness
• Expressing gratitude and appreciation
• Practicing acts of kindness
• Coping well with adversity
• Nurturing optimist thinking
• Learning to forgive
• Savoring the moment
• Investing in relationships
• Committing to significant life goals
• Practicing your religion
• Meditating regularly
• Engaging in physical activity or exercise
From Lyubomirsky and Diener

Happy Boosting Exercises
1. Savoring the moment (focus on something beautiful or
meaningful)
2. Remembering happy days (try to replay the positive emotions)
3. Acts of kindness journal
4. Strengthening social relationships (calling or writing an old friend)
5. Goal evaluation and tracking (strive for realistic goals and move
foreword)
6. Gratitude journal
7. Expressing gratitude personally
8. Thinking optimistically (think about your best possible future
scenario)
From Lyubomirsky and Diener

Dr. Tal Ben-Shahar
https://wholebeinginstitute.com/
http://www.talbenshahar.com/
http://www.happier.tv/

Spiritual: Leading a meaningful life and mindfully savoring the
present.
Physical: Caring for the body and tapping into the mind/body
unity.
Intellectual: Engaging in deep learning and opening to
experience.
Relational: Nurturing a constructive relationship with self and
others.
Emotional: Feeling all emotions, reaching towards resilience
and optimism.
https://wholebeinginstitute.com/

Dr. Tal Ben-Shahar
Four Basic Archetypes of Happiness Decision
Making
1. Hedonism: living entirely for pleasurable activities
2. Rat Race: postpone present happiness in order to be happy in
the future
3. Nihilism: believe no matter what they do they will never be happy
4. Happiness: live in both today and tomorrow, they engage in
activities that are both pleasurable and meaningful
“Enjoy the journey on
your way to a
destination you deem
valuable”
Watch whole course:

http://www.actionforhappiness.org

TED Talk
Emily Esfahani Smith
4 Pillars of a Meaningful Life
1. Belonging: being in a relationship where you are valued for who
you are intrinsically and you value others as well
2. Purpose: less about what you want but what you give
3. Transcendence: Stepping beyond yourself: transcendence states
(state of flow)
4. Storytelling: the story you tell yourself about your self (narrative)

You get to compose your narrative.

Watch "What makes a good life? Lessons from the
longest study on happiness | Robert Waldinger
https://youtu.be/8KkKuTCFvzI
Surveys of millennials on major life goal site money (80%) fame (50%)
And we are encouraged to work harder “Lean in”
Harvard study of adult development followed people for 75 years 724 men half were
college students and other poor local boys
Good relationships keep us happier and healthier
1. Social connections critical
2. Quality of the relationship is critical (best predictor of health and longevity)
3. Also best predictor of mental health (memory)

https://ppc.sas.upenn.edu/
Positive Psychology is the scientific study of the
strengths that enable individuals and communities to
thrive. (Martin Seligman)
The field is founded on the belief that people want to
lead meaningful and fulfilling lives, to cultivate what is
best within themselves, and to enhance their
experiences of love, work, and play.

The new era of positive psychology
Martin Seligman is the founder of positive psychology, a field of study that examines
healthy states, such as happiness, strength of character and optimism.
http://go.ted.com/Jm2b9A

Flourish or Well Being is all About PERMA
P = positive emotion
E = engagement (flow)
R = good relationships
M = meaning and purpose (future
oriented)
A = achievement or accomplishment
We value these 5 elements differently (each is measurable and

The Pleasant Life
• Having as many pleasures as possible
• Learning the skills to amplify them
Draw Backs: experience of positive emotion is 50% heritable and not very
malleable, and rapid habituation

The Good Life
• Absorbed in Activity (Flow rather than pleasure or positive affectivity)
• Identify your Signature Strengths
• Recraft your life to use these strengths

The Meaningful Life
• Identify your Signature Strengths
• Use them in the service of something larger than yourself

Life Satisfaction = Pleasure (positive emotion) + Good Life
(Engagement) + Meaning
Correlation:
#1 Meaning p <.001
#2 Good Life p <.001
#3 Pleasure = marginal
The Full Life vs the Empty Life
Pleasure Engagement Meaningful

authentichappiness.sas.upenn.edu/home
https://www.authentichappiness.sas.upenn.edu/testcenter
you can use the 50,000 words associated with PERMA on social media to measure this, go to
http://wwbp.org/

ppc.sas.upenn.edu/learn-more/readings-and-videos/video-lectures-leading-
Positive Psychology
What makes life worth living?
University of Michigan psychology professor Christopher Peterson
• Simplest advice: “Other people matter.” anything that
builds relationships will make you happy
• Happiness is often an indicator of a life well lived but
not the goal. Happiness is the product of our pursuits
for a meaningful life

Happiness is Not The Goal
Feeling unhappy (like feeling physical pain) it may be a
warning that something’s wrong.
Find out what’s wrong and fix it!
If there’s nothing to fix…then do your Zen thing!
Remove the spoon!

Self determination theory
All human beings have three basic
psychological needs
- Autonomy-doing what you choose
- Competence-doing it well
- Relatedness- connecting with others

If You’re So Smart, Why Aren’t You Happy? Raj Raghunathan
M: Progression towards Mastery
(really good at something)
A: Autonomy, a sense of control over
your own life
The Three Big Goals to pursue after meeting your basic
necessities (MBA)
B: Belonging, sense of deep
connectivity with at least one other
person

There are Two Routes to the Big Three
“Abundance”: Approach “Scarcity” Approach
Mastery
Pursuing Passion Chasing Superiority
(flow, focus on the present)
Belonging
Need to Love (and Give) Need to be Loved
Autonomy
Internal Control External Control

Dr. Miller’s Take on the Subject of
Happiness
1.Understand the genetic implications
2.Does anyone want your advice?
3.Different advice for different types of
people
4.Connecting with someone (or something)
what’s the work around
5.Can we fix medicine?

Some people are born less happy and will have to work harder if they want
‘positive emotional’ type happiness, otherwise don’t worry about it!

Miller Classification of People
Simple People: Motto “I’d rather
be fishing.”
Shallow People: Motto “Whoever
has the most toys at the end wins!”
Serious People: Motto “I wonder if
there is more to life?”

Avoid materialism Discover a truth
and share it
(cynic) “a man who knows
the price of everything and
the value of nothing”
Oscar Wild
“The meaning of life is to
find your gift. The purpose
of life is to give it away.”
Picasso

Advice for Young People
Some people
make things
happen
Some people
watch things
happen
Some people
say “what’s
happening?”
< 1% 50% 50%

Should We Group People by Intelligence?
Henry Goddard, 1910,
Director Vineland Training
School for
Feeble-Minded Girls and
Boys
IQ Range Technical Title
0 – 25 Idiot
26 – 50 Imbecile
51 - 70 Moron
Note to Donald,
Moron was best group

We are all Idiot
Savants!
Even the most simple person has an area
of genius(strength), we need to help them
find it (Don’t sell yourself short!)
Even the brightest person has large areas
of stupid (Don’t flatter yourself, or you’re
not all that!)

Advice for stupid people…”Just keep watching TV…
most of that stuff is real.” Also unless you are the most
successful person in your family…don’t go on Facebook!
Advice for smart people…
Christopher Hitchens
“Most admirable quality a sense of the
absurd, favorite virtue an appreciation
for irony, …”
You can’t hide from the reality of a world
with gross inequality and senseless
tragedy. Oh yea…and you’re dying!

Humor is mankind's greatest blessing.
Mark Twain
Importance of Developing a Sense of Humor
Total absence of humor renders life impossible. – Colette
If I had no sense of humor, I would long ago have committed suicide. Mahatma Gandhi
Imagination was given to man to compensate him for what he is not;
a sense of humor to console him for what he is. Francis Bacon
You don't stop laughing because you grow older. You grow older
because you stop laughing. Maurice Chevalier
Everything is funny, as long as it's happening to somebody else.
Will Rogers

Find someone who would notice if you
were dead.
The Waltons
First choice would be family and then
friends….(Epicurus favored friends over romantic
relationships)
Best chance of finding someone,
get a rescue dog (or turtle)
Most probable solution…get a robot!
(companion cat)

Anthropomorphic Personification
Tom Hanks with his BFF
‘Wilson’ a soccer ball from Cast
Away
Joaquin Phoenix falls in
love with his phone’s
OS (operating system)

How do we fix medicine so doctors and nurses are
happy again?
1. Assume doctors and nurses are people who favor
eudemonia (life of meaning)
2. Assume they need to feel competent, have some
control, and time to spend with family and friends
(belonging)
3. Solution: stop making them waste their time typing
into a computer!!!

Are computers making doctors smarter and
happier?
If there is anything wrong, this
computer will help me find it.
2016 study
doctors spent 2
hours on EMR for
every 1 hour
patient care

Thomas L. Friedman: "Thank You for Being Late" Talks at Google
https://youtu.be/nuF2JKeM2CY
The train
(exponential
growing
information
technology) has
now left us behind
(capable of only
linear learning)

AI into IA (intelligent
assistance, or assistants,
or algorithms)
Thomas L. Friedman: "Thank You for Being Late" Talks at Google
https://youtu.be/nuF2JKeM2CY

State Marijuana Laws in 2017 Map
Will there be other
Social Consequences
that impact medicine?
Physician-assisted
suicide is legal in five US
states. in Oregon, Vermont,
Washington and California. It
is an option given to
individuals in Montana via
court decision. 2017

Can Doctors Prescribe Happiness?
1.For a patient? No
2.For themselves? Yes
3.For society? Maybe
Aboutcancer.com
‘noblesse
oblige’

"The only thing necessary for the triumph of
evil is for good men to do nothing." Edmund
Burke (or intelligent people to say nothing…
Dr. M)
‘noblesse oblige’
Physicians should be public health advocates and
societies' resident social philosophers and public
intellectuals and lead (or at least, engage) in a
conversation about what it means to flourish in the 21st
century.
Edmund Burke
(1729 – 1797)

Go to
www.aboutcancer.com/
or
youtube.com/user/robertmillermd/videos
The goal is not to ‘feel happy’ but to ‘be
happy’ because you are enjoying every
day as you journey towards a
meaningful life

Happiness

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