A prescription for happiness: 10 things I have learned from my patients

1. 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

2. • Henry
Thoreau

3. 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?

4. Happiness
• Would
you
be
happier
1. winning
a
loMery
or
2. breaking
your
neck?
• The
answer
may
surprise
you.

5. 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.

6. 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

7. 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.

8. 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.

9. Happiness
• Happiness
books
– Barns
and
Noble
2000………..50
books
– Barns
and
Noble
2008………..2,000
books
– Amazon.com
2012…………….14,000
books

10. Happiness
• Schools
of
psychology
(posi)ve
etc),
sociology,
economics
• Topic
of
much
discussion
in
Philosophy
&
religion

11. Happiness
Economics

12. 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.

13. 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.

14. 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?

15. 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

16. 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

17. Hedonic
Treadmill

18. 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.”

19. 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”

20. 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

21. Depression
is
on
the
rise…

22. 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

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

24. Defining
our
terms
• What
is
happiness?

25. Ancient
vs.
Modern
Views
• Eudaimonea
• Happe

26. 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.

27. 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

28. A
good
life
• Human
flourishing

29. 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

30. • Don’t
expect
money
to
buy
your
happiness

32. Money
can’t
buy
you
happiness
• No,
but
our
material
needs
must
be
met
first
Easterlin
paradox

33. 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

34. 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.

35. It is more important who you live
with than where!

36. 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)”

37. • Live
with
integrity

39. 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.

40. Human
conscience
• “A
quiet
conscience
sleeps
in
thunder.”
– English
Proverb
• “A
clear
conscience
is
the
greatest
armor.”
– CHINESE
PROVERBS

42. 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)

43. • Accept
the
things
you
cannot
change

44. Let
go

45. 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

47. 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.

48. 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.

49. • Have
the
courage
to
change
the
right
things
you
can

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

51. Overcoming
learned
helplessness

52. • “Courage
is
the
finest
of
human
quali6es
because
it
guarantees
the
others”
• Sir
Winston
Churchill

54. Life
as
a
choice

55. “Our choices are
what define us.”
Katie Holmes to
Batman in Batman
Begins

57. • Pain
may
be
part
of
happiness

58. Pain
Is
a
Part
of
Happiness

60. 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

61. Making
the
best
of
it

62. 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.

63. • Keep
in
mind,
we
are
oRen
wrong

64. 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.

65. 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

66. 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

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

68. • Strive
for
balance
and
modera)on

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

70. Plan
of
life
• Exercise
your
mind
– Read
good
books
• Exercise
your
body
– Regularly.
Good
for
your
body
and
your
mind.
• Eat
healthily
• Play

71. Play

72. 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

73. • Find
a
reason
to
do
the
things
you
do

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

75. 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

77. NAMASTE
• The light in me recognizes the light in you !
• LOST, Season
5 episode 9.!

78. 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

79. Suffering
and
meaning
• “A
why
can
bear
any
how.”
• Victor
Frankl
quo6ng
Nietchze
in
Man’s
Search
for
Meaning

80. • Be
mindful
1. Of
the
present
2. Of
what
we
are
thankful
for
3. Of
our
anger
4. Of
selfishness

81. 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

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

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

84. Focus
on
the
present
• Depression
– Regrets
about
the
past
– Hopeless
about
the
future
• Anxiety
– Worry
about
the
future

85. 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

86. 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?

87. 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.

89. 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.

90. 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

92. 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

93. 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

94. 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.

95. Trying
to
hold
on
to
something
forever
• Stuff
vs.
People

96. 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.

97. • Be
open
to
love

98. 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

99. Happiness
is
love
• “Being
deeply
loved
by
someone
gives
you
strength
while
loving
someone
deeply
gives
you
courage”
• Lao
Tsu

100. Married
People
are
generally
happier

101. 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

102. Happiness
is
in
sharing
and
giving

103. Simplicity
is…
• Love
is
all
that
maPers.

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

106. 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

107. •
“In
this
world
it
is
not
what
we
take
up,
but
what
we
give
up,
that
makes
us
rich.”
• Beecher

108. THE
END

109. 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