EP. 61: EVIDENCE-BASED LESSONS ON LIVING A GOOD LIFE

May 9

WITH ROBERT WALDINGER, MD

The director of the Harvard Study of Adult Development, the world’s longest-running scientific study on human happiness, shares lessons learned on leading a fulfilling life.

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Episode Summary

Since 1938, the Harvard Study of Adult Development has followed the lives of hundreds, and eventually thousands, of American adults, with the goal of discovering what enables people to live healthier, more meaningful lives. Joining us in this episode is Dr. Robert Waldinger, professor of psychiatry at Harvard Medical School and the current director of the study. He is the author of the book The Good Life: Lessons from the World's Longest Scientific Study of Happiness. Over the course of our conversation, we explore the origins and evolution of the study, what adult development actually means, whether happiness is a choice, how social media shapes our relationships, Dr. Waldinger's interests in Zen Buddhism, and the key to leading a fulfilling life.

Dr. Robert Waldinger is Clinical Professor of Psychiatry at Harvard Medical School, Director of the Center for Psychodynamic Therapy and Research at Massachusetts General Hospital, and Director of the Harvard Study of Adult Development. He is a practicing psychiatrist and psychoanalyst, he teaches Harvard medical students and psychiatry residents, and he is on the faculty of the Boston Psychoanalytic Institute. He is also a Zen priest.
Dr. Waldinger earned his bachelor’s degree from Harvard College and his MD from Harvard Medical School.
In this episode, you will hear about:
• What drew Dr. Waldinger to the field of psychiatry - 1:53
• Dr. Waldinger’s reflections on the work and daily practice of a psychiatrist - 3:31
• An overview of the Harvard Study of Adult Development, the longest running scientific study on happiness - 6:54
• The medical and psychosocial concepts of “adult development” - 9:49
• The most important and surprising findings of the Study of Adult Development - 16:20
• Why relationships are critical to health and happiness - 23:07
• How social media distorts reality and why it can be quite harmful to mental health - 29:37
• Whether happiness is a choice - 34:48
• The impact of Zen Buddhism on Dr. Waldinger’s life and work - 43:55
• Dr. Waldinger’s advice to clinicians on leading fulfilling careers - 50:02
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:02] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build healthcare institutions that nurture the doctor patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across healthcare, from doctors and nurses to patients and health care executives, those who have collected a career's worth of hard earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:03] Since 1938, the Harvard Study of Adult Development has followed the lives of hundreds and eventually thousands of American adults, with the goal of discovering what enables people to live healthier, more meaningful lives. Joining us in this episode is Dr. Robert Waldinger, a psychiatrist at Harvard Medical School and the current director of the study. He is the author of the book The Good Life, which describes the major findings of the study. Over the course of our conversation, we explore the origins and evolution of the study, what adult development even means, whether happiness is a choice, the role of social media in shaping our relationships, Dr. Waldinger's work as a Buddhist teacher, and the key to leading a fulfilling life. Bob, thank you for joining us and welcome to the show.
Robert Waldinger: [00:01:51] It's a pleasure to be here.
Henry Bair: [00:01:53] To kick us off. Can you tell us what first drew you to a medical career?
Robert Waldinger: [00:01:57] I didn't expect to have a career in medicine. And in fact, I thought I wanted to be a lawyer because my dad was a lawyer. And then I realized I didn't know anything about law. I didn't like it. And I really liked biology and science. And particularly I studied history of science as an undergrad and really got into it and then decided, okay, that's probably not what I want to do for my profession, but working with people in a way that uses science seemed like a good move. And then I got into psychiatry and really loved that. And the rest is history.
Tyler Johnson: [00:02:39] Can you talk a little bit about what I mean, you mentioned it so quickly there, but how did you get into psychiatry or what drew you that direction?
Robert Waldinger: [00:02:48] It was just my gut. I just found it the most interesting thing in medicine. Like I realized that a lot of medical illnesses I didn't care that much about, like we learned about all the different types of thyroid tumors. But unless somebody I knew had that thyroid tumor, I didn't really care very much. Whereas when when I was reading about psychiatry, when I was talking with patients, it was awesome. I just I kept wanting to read more. I kept wanting to see more patients and I thought that was a really good sign about what would keep me interested through my career. So today I have three patients later this afternoon. I still love seeing patients.
Tyler Johnson: [00:03:31] Can I ask you this might sound like a funny question, but, you know, I think that when most of us when we're young, we have this kind of archetype of what a doctor is that I think is set by maybe if you have, you know, strep throat or something. Strep throat is great, right? Because you go to the doctor, there's a very clearly defined test that's either positive or negative. And then if it's positive, then we have a very clearly defined treatment, which is this, you know, whatever, ten day course of antibiotics. And then you take the antibiotics and then you get better and then you're done. Right? And so I think a lot of us think that that's how medicine is supposed to work. And in some cases, you know, though, it becomes more complex and some and in some cases much more difficult, there are still vestiges of that even in more complicated medicine, Right? If you have a blocked coronary artery, you can get a stent or you can get a coronary artery bypass graft or, you know, if you break your arm, you can have an orthopedist fix it or whatever.
Tyler Johnson: [00:04:28] Then there are other areas of medicine where both the process of diagnosis and the process of therapy become significantly more complicated. And then you have psychiatry where at least to a non-psychiatrist, it often feels like both the attempt to give someone a diagnosis and the attempt to help them get better from the diagnosis are almost never straightforward, right? I mean, at least to a non-psychiatrist, the DSM-V feels very you know, "you need to have some of these and some of these, but it could be this or it could be that. And then how to help someone get better. It could be this medicine, but if it doesn't work, try this other medicine. Or maybe you don't even need a medicine. Maybe you need something," you know? So I guess can you talk a little bit about if it's very much not just you have this infection and here's your antibiotic, Like how do you think about what you do as a psychiatrist? What is the work of a psychiatrist and how do you think about that in your daily practice?
Robert Waldinger: [00:05:30] Well, think about it as suffering and helping relieve suffering. Right. And so certainly psychiatric conditions, mental disorders cause an enormous amount of suffering. And we have so much that we can do to relieve that suffering, in fact, more in many cases than many other medical conditions. But what's different is that mental disorders don't fit neatly into the medical model where these define symptoms, make up this condition. And there are these treatments that often diagnoses overlap, that treatments overlap that a treatment that works for one condition is often applicable for a certain person who has a different condition. And so what it means is tolerance for blurred boundaries, tolerance for ambiguity and a willingness to try and see what works. Now there's more of that in regular medicine than most of us acknowledge. But we it's it's all over psychiatry. That said, psychiatry has a hugely positive track record in terms of actually being able to help relieve the conditions that it sets out to treat.
Henry Bair: [00:06:54] Thank you for sharing how you think about treating your patients. Of course, you are now most known for leading the Harvard Study of Adult Development, the longest running scientific study on happiness. So let's talk about that. Can you briefly walk us through the history and the mission of the study?
Robert Waldinger: [00:07:11] So the study was radical for its time. It actually was two studies, and I'll explain. But both of those studies were studies of well-being. They were studies of normal development. And most research that gets done and certainly the research done before 1938 when these studies were founded. Most research is about what goes wrong in development because we want to be able to help. And these studies were radical because they said, let's study what goes right. So there were two studies, 1938, one Harvard University Student Health Service. They picked a group of sophomores, 19 year olds who were thought by their deans to be fine, upstanding young men. And these were meant to be studies of normal development from adolescence into young adulthood. So, of course, you know, now we we chuckle at this because if you want to study normal development, you study all white men from Harvard like, no, we don't do that. And we're constantly having to explain to NIH why they should continue to fund us. But at that time, that's what they wanted to do. That's what the the investigators at Harvard Student Health Service wanted to study. In addition, at Harvard Law School, they began a study of juvenile delinquency and they got a group of boys from Boston's poorest neighborhoods, but not just poorest neighborhoods, but most troubled families. So these were families known on average to five social service agencies for domestic violence, for parental illness and substance abuse. And there was a delinquent group of boys who had already gotten into trouble by, say, middle school, and there was a non delinquent group. And the question was, how does this non-delinquent group of boys, boys born with so many strikes against them? How do those kids manage to stay out of trouble and stay on good developmental paths? So that was our study. What we followed. Eventually we took that non-delinquent group. Combined it with the Harvard College undergraduate group and ended up with 724 original participants. And then we brought in their wives. And since then, we've brought in all their children, more than half of whom are female. And now we have 724 families, over 2000 people.
Tyler Johnson: [00:09:49] Can I? Before we go on more with the specifics of the study, one thing that I think would be helpful to many of our listeners that I know is just not in my personal lexicon until the last few years is that you have mentioned multiple times or mean the underlying sort of impetus behind the study is to study "adult development." But I think that's actually a little bit of a almost feels like a little bit of a contradiction or it's implicitly seems like a contradiction in our culture for the following reason. If you're becoming a doctor or any health care professional, pretty much everybody spends some time in their psychiatry block learning the developmental milestones, right? So there's this idea that when you're, let's say, I don't know, 0 to 12 or something, that there are these things that you're supposed these landmarks that you're supposed to meet, right? And they're super, super concentrated in the first year, as is obvious to anybody who thinks about it, right? You're learning to walk and make sounds and say your first word and all that stuff. And then as you sort of progress through childhood, those milestones get further and further apart. And the idea that is sort of baked into all of that is that by the time you get to be 12, 15, 18 something, you've sort of reached all the milestones and your development is done. You are a fully baked adult and now there's no other I don't know, you just go on adulting for the rest of your life and there's no more development to do. So as a psychiatrist and also as a leader of this study, can you just talk about what does adult development even mean? I mean, are adults really supposed to go on developing or like, what does that even look like?
Robert Waldinger: [00:11:25] I'm so glad you asked about that, because it's it is exactly what you say that we've always assumed. Well, you know, once I get to be about 18, I'm done. Right. So, Tyler, think about this. Are you the same as you were when you were 18?
Tyler Johnson: [00:11:39] Oh, identical. That was identical.
Robert Waldinger: [00:11:42] Exactly right. You just sort of look like an 18 year old. Right. You know, And you're acting like an 18 year old. Yeah, exactly. Exactly. So people began to say, wait a minute, if we actually look at adulthood, there's enormous change across the adult life span, right? There's enormous change from age 18 to age, you know, 95, 100. And that there's a great deal that's worthy of investigation, of study. So the field of adult lifespan development really began with people like my predecessor, George Valiant, who said there is so much to be learned here. Erik Erikson was actually one of the first theorists who talked about stages of adulthood beyond the childhood milestones. So now adult developmental science is a very established scientific endeavor. Most of the adult developmentalists are psychologists, but some of us are outliers. Some of us psychiatrists and other people study it as well. And I think that that one of the things we do when we ask people to think about their place in the lifespan is we sometimes ask them to bring a photo of themselves when they were much younger as an adult and say, How did life look to you back then in that photo and how does life look different now?" And people are often amazed at how much they have changed over the span of adult life that they've lived so far.
Tyler Johnson: [00:13:16] So let me ask one one final question on this and then we can go back to talking more about the study and its findings. But so the traditional way that you learn in medical school is that for those childhood milestones, there is a prescribed order and progression and that children are supposed to meet certain milestones by certain ages. And if they don't do that, that's a red flag and something that needs to be investigated. That's largely why you learn about it as part of your pediatric training, right, is to know when you should be looking for certain things. Now, we could make an argument that especially with the emergence of the recognition of neurodiversity and other things, that, you know, some of that has potentially been called into question in some ways. But but nonetheless, that's sort of the overarching framework. When we think about adult development, are there similar milestones that adults should be meeting, or is it more a recognition that adults could go in this path or this path or this path or this path and it's more a descriptive than prescriptive science? Does that question make sense?
Robert Waldinger: [00:14:23] Yeah, well, the milestones in adulthood are not as heavily concentrated on motor function. Right. Or cognitive development as they are, you know, it's so obvious with kids and even with adolescents. There is cognitive development and motor development, physical development in adulthood, of course, and obviously there is decline, but it's not nearly as dramatic. What is, though, more studied now, is psychosocial development. So in adulthood, actually there was a wonderful theorist, Bernice Neugarten, a psychologist who had a theory of psychosocial development that basically talked about our concern with whether our own personal development is what she called either on time or off time. Meaning am I on time in finding a job, settling on a career, finding a mate, having children, retiring, whatever it might be? Am I on time or am I off time? And what she pointed out was that it matters a lot to us what our peers are doing and what our expectations for adult development have been as we grow up. And she said that that there's a great deal of distress that people can manifest around this whole issue of not feeling like they are on time. And, you know, you think about that if you know, people are not partnered or don't have kids and have wanted to, that's the kind of thing that we're talking about.
Henry Bair: [00:16:02] That's really interesting to think about adult development as a venture into the rest of adulthood. I'll definitely be keeping that in mind as well.
Tyler Johnson: [00:16:09] I'll be keeping track of your milestones. Henry. Have a little card at home where I check them off. Okay.
Robert Waldinger: [00:16:15] Ah, Henry, just stay the same. Just. Just freeze yourself right now. And don't change one bit.
Henry Bair: [00:16:20] Oh, goodness. I'm not sure if that's the best idea for anyone. So back to the study. It's been going on for almost nine decades now, and it looks like you found out a lot so far, right enough for you to have written a whole book on it, which we will link to in the notes to this episode. But can you spoil some of the book for us here? What are some of the most interesting findings of the study and some of the most surprising?
Robert Waldinger: [00:16:48] All right. Well, I will spoil the book for you. The biggest surprise when we were looking at what predicts who thrives as they go through life. So what wasn't a surprise was that taking care of your health really matters. And for a bunch of health care professionals, many of whom are listening to this, that's not going to be a surprise. It's going to be old news. Okay. So we know. Don't smoke, don't abuse substances, get regular exercise, eat well, get enough sleep. I sound like your grandmother, Right. But what the surprise was that when we looked at the people who stayed healthier longer as they went through their lives and lived longer. The people who were healthiest were the people who had the best relationships with other people, both in terms of number of connections and the warmth of those connections. And that was a surprise. In fact, we didn't believe the data at first because it stands to reason that if you have better relationships, you'll be happier. But how could the people who had better relationships be less likely to get coronary artery disease or type two diabetes or arthritis? Like how could that possibly be a thing? And then other research groups began to find the same thing. And as we know, what we look for is replication. We look for multiple studies pointing in the same direction so that we can have confidence in a particular finding. So now we've been looking at the mechanisms by which that happens, by, you know, how do relationships get into our bodies and change our physiology. So that's the biggest surprise. And the book, The Good Life, is really a deep dive into how relationships matter, how they influence our lives as we go through life.
Tyler Johnson: [00:18:48] You know, I feel like that's such a poignant and topical idea for so many reasons. I just was reading yesterday in the Wall Street Journal, there was an article that was published based on polling data that The Wall Street Journal did together with some other reputable polling agencies that demonstrates this really to me, staggering finding where they just have been asking for the last 25 years. In effect, do the following things matter to you a lot? And some of the findings were not particularly surprising to me. For instance, the percentage of people, adults in the United States who really value patriotism, for instance, has significantly declined over the last 25 years. That is not particularly surprising to me, given many recent current events and whatever. But what was really surprising to me is that the percent of us adults who said that community really mattered to them has plummeted by like 25 percentage points in the last 25 years. And, you know, it's one thing to not succeed at creating community, but it's a whole different thing to say. It doesn't even matter to you that you're not even trying to create community. And clearly that's not you know, community doesn't track exactly with relationships per se, but you can make an argument that a community is a network of relationships, right? But it's just to say and I think this is also gets tangled up with the rise of the digital world over the last 25 years, Right. Where we seem to all be connected and yet have fewer and fewer relationships. And there's the epidemic of loneliness that Vivek Murthy has talked about. And I mean, it it feels like though you and your colleagues are presenting so much data about the importance of relationships, I would argue that there are many markers from all different parts of society saying that in a lot of ways we are getting worse at creating and sustaining them.
Robert Waldinger: [00:20:45] Yep, you are absolutely right. And one of the reasons why I stepped out of my comfort zone and first gave a TED Talk in 2015 and then we wrote this book was because this was frightening to us because the more our study was showing and other studies were showing that relationships really matter and community really matters, the more the trends were going in completely the other direction, as you say. Right? So social isolation. Robert Putnam's work has been so influential, the sociologists bowling alone. And then he revisited that. And these indicators of investing in social capital keep going down. And so we really said we need to get this out there. And the irony is that. You know, when I gave that TED talk, I gave a TED Talk in a little elementary school auditorium in suburban Boston. Right. And I thought, it's a TED event. I thought it would get a few thousand views. I worried that my research colleagues would think I had really sold out. But anyway, it's become the ninth most watched TED talk in the history of Ted. And you know, it is because people are hungry for this. People are really worried about it. They are starved for it. And so I think that the finding that community isn't as important maybe coupled with the the myth and the sense that while I have all I need on social media, that for many people there's a there's a, I think, a false sense of connectedness when we simply scroll through other people's Instagram feeds. So there's a great deal of worry about isolation. Loneliness is a big pandemic. Now we're aware of that. One in 3 or 4 people in the United States say that they are lonely much of the time. And we know that loneliness is associated with just the opposite of what I was talking about with relationships. Loneliness is associated with earlier health decline, both cognitive and physical. So all of these trends are going in the wrong direction.
Henry Bair: [00:23:07] So, Bob, you've stressed the importance of relationships, as Tyler mentioned, and as you've touched upon, we often get drawn into a false sense of connection and community when we use social media. Can you tell us then what are the kinds of relationships that actually help us become happier and healthier? What does a good relationship look like?
Robert Waldinger: [00:23:30] Well, it is a tricky question because we get these benefits from all kinds of relationships, not just intimate relationships by any means. So we're talking family, friends, also work mates for sure, and even casual connections. There's a whole set of research on what are called weak ties, and it's a bad name for it. I think of it more as casual ties, like the person who you have a little chat with who makes you your coffee and the coffee shop every morning, or the person who delivers your mail and you chat with a little bit. We get little hits of well-being even from those more casual, more superficial, if you will, relationships. And so all of it matters. What we do know from our research is that everybody needs at least 1 or 2 people who are really close who they feel have their back. When times get tough, we call it in my world, secure attachment where people feel like somebody is there for me and that makes the world a safer place. And we know that that's associated with better cognitive health, with slower physical decline. And we think that even shy people need at least 1 or 2 people like that in their life. But then it varies a lot. You know, you if you're shy, you might not want many people in your life and that might be just fine. If you're an extrovert, you may need a lot of folks in your life.
Tyler Johnson: [00:25:03] Two thoughts come to mind as we're talking about this one, which you and Henry have both sort of alluded to somewhat directly, is that now maybe, I don't know, six months or so ago, we had this really impactful conversation with Anna Lemke where she talked about the fact that she is also a psychiatrist. She works at Stanford, but she talked about the fact that she works with college students. So her driving thesis for much of her work is that we live in a world where almost everyone is addicted to many things, right? We're addicted to social media. We're addicted to junk food. We're addicted to alcohol. We're addicted to basically anything that will kind of buzz our brains. It's so readily available. It's omnipresent. Right? And so we're just addicted to dopamine hits from, you know, Facebook and TikTok and Instagram and whatever. So she talked about that often when she works with Stanford undergraduate students, one of the things that she has to do is, in effect, to have them almost literally physiologically detox from their social media feeds or their digital lives in order to allow them to reawaken to real life and to real relationships and and all the rest of it. Right. Which is just to say that I think there is a sense in which we have to make what initially feels like a sacrifice of laying down some of that digital footprint and maybe stepping back from Twitter or, you know, whatever it is, in order to clear the space inside of us or to enter what Dr. Lemke called the great quiet to allow ourselves the kind of space in our souls to be able to engage in meaningful relationships. By the same token, one point that I want to make that and I would also love to hear your thoughts about this, is that I think in particular for medical trainees and especially for those who are on their way to becoming doctors, I think that one thing that is really, really important to remember is that no number of publications, no amount of grant funding, no number of gold stars from your medical school or your residency program or the place you become an attending is going to be an adequate substitute for the nourishing substance of longitudinal relationships with the people who matter the most to you. Right? If you give up your relationship with your kids or your spouse or your parents or your best friends or whatever, because you want to get tenure or you want to become the chair of the department or you want to whatever, right? Just get an A on your anatomy test. Like you have to keep those things in a balanced proportion. Is that fair to say?
Robert Waldinger: [00:27:48] Yeah. We asked our original participants when they got to be 80. We said, Looking back on your life, what are you proudest of and what do you regret the most? And the single most common regret by far was I wish I hadn't spent so much time at work, and I wish I had spent more time with the people I care about. And these were people who, some of whom were quite famous, very prominent, won lots of awards, some of the Harvard guys and all of them to a person when we asked what they were proudest of. Said something about relationships. It wasn't I won this award or in one case, I became president of the United States or, you know, it wasn't those things. It was I was a good friend. I was a good mentor. I was a good parent. It was always about their connections. And so what's really clear is that our connections end up being the things that matter the most, that endure, that are actually going to live on after us, actually, you know, because if you think about it, even the look at all the buildings that are named after people, most of us don't know who those people ever were. Right. You know, it's not going to it's not going to last. You know, nobody's going to remember us except the people who we mattered to. And so to give up, you know, my important relationships to get some academic promotion or to become some department chair, I'm not going to be that satisfying in the end, which is different from doing work that you care about. So doing the work of something that you love that's satisfying, that's important, but that's different from climbing the next rung of a ladder.
Henry Bair: [00:29:37] When I browse social media, I realize that practically no one posts moments when they are sad or when they have failed.
Robert Waldinger: [00:29:47] That's right.
Tyler Johnson: [00:29:49] That's because there aren't any. Henry. You're the only one. Sorry.
Robert Waldinger: [00:29:53] Exactly.
Henry Bair: [00:29:54] That's what it feels like.
Robert Waldinger: [00:29:56] We've all got it figured out. Henry.
Henry Bair: [00:29:58] Oh, boy. Well, it looks like I'm going to have to go back in post and edit out the part where I just admitted I'm the only person who has ever failed. Well, anyway, what's striking is that even though I know it's a filter, I know that people only post the best moments of their lives, it still affects me when I compare my life with what other people project as their happiness. So can you tell us what are some of our misconceptions about happiness? What is true happiness?
Robert Waldinger: [00:30:30] Well, your experience is so common, right? One of my Zen teachers once said "We're always comparing our insides to other people's outsides." And that's what you're describing, right? Where we we look at other people's curated lives on, you know, Twitter or Instagram or wherever. And and we think, oh my God, everybody else is having a great life except me. There is some research about social media, about how we use it and what makes a difference in wellbeing. And the research suggests that if we use social media to actively connect with other people, it raises our wellbeing. So I'll give you an example. One of my friends during the COVID lockdown. Reconnected with friends from elementary school and they've all started having coffee every Sunday morning on Zoom and they are just thrilled. They are so happy doing this right. But then I have patience. Many of them young adults or adolescents who scroll through other people's Instagram feeds and become more depressed, more anxious, have that terrible sense of FOMO. Right. And what we know, again, from good research is that that lowers well-being, that the more we compare ourselves to other people, the less happy we are. So the bottom line seems to be that actively using social media to connect with other people can enhance well-being, but that passively consuming other people's curated lives is almost guaranteed to lower well-being.
Tyler Johnson: [00:32:16] Yeah, that really tracks. You know, I've followed a lot of discourse. Yes. I note the irony on Twitter of this sort of discussion back and forth about has the digital revolution of the last 20 years been a net positive or a net negative for society writ large? I'm pretty firmly in the camp that it has been, I think, a net negative. Having said that, though, I agree with you and what what you cite from the research that I think it's I don't think it is unavoidably net negative. I think that we have allowed it to proliferate in such a way that in many cases it's kind of fallen to the lowest common denominator so that we have just kind of passively allowed it to become this comparison factory that leaves us, you know, chronically feeling like we are underachieving and under happy and under fulfilled and under everything. Right? We're just like under humans because. Because we've just sort of almost lazily defaulted to that. But I agree with you that COVID was a fantastic example of times of a time when many people, I think, woke back up and we saw some of the potential. Right. You can argue that the rise of the Black Lives Matter movement during COVID was largely a response to the fact that there were so many people on social media who were able to activate around a common cause so quickly because everybody was on their computers all the time. Right. Which is just to say that there is the potential for positive activation, but it's just so much easier, so much of the time to have it concentrate on disinformation and on comparison, you know, comparing our lives to other people. It really can become toxic.
Robert Waldinger: [00:34:03] Well, and the problem is that that the software is designed to keep us hooked on that stuff. So we know anger, outrage sells. Right? So that that'll get us to click on whatever clickbait is held in front of us. That the software is designed to grab our attention and then hold it, because that's how people make money. And so what we have to do is be probably more intentional and take not take the path of least resistance, which is to get stuck in these rabbit holes.
Tyler Johnson: [00:34:39] Yeah, it's like the monetization of our baser impulses, right? Yeah, It just makes lots of money.
Robert Waldinger: [00:34:45] Yeah, absolutely. And the monetization of attention.
Henry Bair: [00:34:48] So I'm going to ask you what might be a provocative question. And you may answer this as a psychiatrist, as the leader of the study, or from your own personal experiences. The question is this: Is happiness a choice?
Robert Waldinger: [00:35:04] Uh, no, it can be. It can be a choice sometimes, but many times it's not a choice. I like to think of it this way. Happiness is more like an accident. It happens to us. But we can do things that make ourselves more accident prone. So you can. You can set up certain conditions that mean make it more likely that you're going to be content, that you're going to feel good more of the time. Or you can set up conditions that are more likely to make you miserable more of the time. But whether we can say, I'm going to be happy the rest of this, this day, right? I can't say that something awful may happen and I won't be happy. Right. That's not always my choice.
Tyler Johnson: [00:35:50] You know, we gather from reviews that we see and emails that we get and whatever that many of the people who listen to this podcast are in what has sometimes been called the decade of decision, right? So they're sort of college students through maybe residence fellowship, something like that. So 20 to 30, let's say early 30s. And I think that that, you know, as I'm kind of just passing out of that period and as even with a little bit of a remove, as I look back on that, it's so clear to me now, even not that far out from there, how much of an impact those decisions have on the way that my life is playing out. Right? Where did I go to college? What is my career? Who did I marry? When did we decide to have children? Right. You know, all of those things that you're kind of making those decisions. So if you had a person in that time period who just came to you and said, okay, you Bob, are the world's expert on what adults can do to make themselves prone to the accident of happiness, as you just put it. Give me your list of your top 4 or 5 things. What should I be doing for the next ten years or not doing, doing or not doing to make myself accident prone? So you've mentioned the relationship piece and that can be part of this, but what would your list of things be?
Robert Waldinger: [00:37:11] So the top two that I've mentioned, take care of your relationships, invest in your relationships, hugely beneficial for so many reasons in all parts of your life. Invest in your health. Somebody once said Take care of your body like you might need it for a hundred years because you might. Right. So take care of it. So those are the top two. And then pay attention to the things you love and when you can turn toward them. Not always feasible, but pay attention to that and pay attention to the things you don't like, even if other people think you're supposed to like them, you know, and turn away from them when you can. Right? So, I mean, I've had jobs that I really didn't like in medicine, and it was so helpful to finally get to the point that, No, no, no. I need to turn away from this, even though everybody thinks it's a great thing to do. I don't like it. And and so what I would say is really pay attention to what lights you up and and try to steer yourself toward that as much as you can and really pay attention to those things that sap your energy and don't do them if you don't have to.
Tyler Johnson: [00:38:33] One of the most helpful things that I hope anyway, that we do on this podcast is to say things that are important and countercultural within the culture of medicine. And I actually think that the two things that you just said because right, it sounds like when we have on here a Harvard psychiatrist who's in charge of the most, you know, impressive, long running whatever, whatever study about adult happiness, and we ask him, well, what should you do and not do? And your answer is do stuff you like and don't do stuff you don't like. It's kind of like, well, wait a minute, shouldn't there be a refund? That's what you learned after 89 years of this stuff. Yeah, but you know.
Robert Waldinger: [00:39:13] But but I'm also talking about it from my own life. So I'll give you an example. When I was going through Harvard Med School, there was a lot of bias about psychiatry being a waste of time. And actually one of my teachers said, You're wasting your career if you go into psychiatry. And it took me a while, you know, because as there were all these people I looked up to saying, Don't do it. Oh, you know, you're probably either crazy or you're not a very good student if you want to go into psychiatry. Well, thank God I went into psychiatry. I mean, I've been so happy. I found it fascinating. Right. What if I had believed those people and gone into a field that I really didn't care about? It would it wouldn't have been hard to do that because, you know, our teachers are very influential. I was also told, you know, you should be on track to be a department chair. And so I started taking administrative positions in academic departments and realized, I hate that stuff. I absolutely hate doing that stuff. I'm glad other people like doing it, but it's not for me. Again, something that was valued in medicine, certainly valued in academic medicine. And so that's why in some ways I know it sounds trivial to say, do the stuff you like, don't do the stuff you don't like. But especially when we've all been good performers, you know, you you get to be a medical student and you get to be a doctor by jumping through a lot of hoops and getting a lot of A's. How do you step back from that and say, okay, but now what do I really care about? Even if they don't give me an A for it?
Tyler Johnson: [00:40:50] No and actually, that was that was precisely my point in mentioning that this is an important countercultural point because, I mean, I'm sort of teasing you about that's what you learned after 90 years. But but that's the entire thing is that I so I'm a like a sort of a primary mentor for cohorts of medical students at Stanford and some of my mentees. Every once in a while someone sends me an email and says, Oh, can we go for a walk? Right? And then we go for a walk and talk about something. And I would say that one of the top two talks that I have with my mentees is the talk where I give them permission to not try to be the department chair in 20 years or to not go into the hardest, most prestigious, whatever specialty that they're research mentor wants them to go into or to not work for a zillion hours to publish this paper that they don't really care about or whatever. Right? Because just what you said, almost by definition, to get into medical school, you have to become so good at pleasing other people and investing your time and energy in things that other people tell you to care about, that you forget that you can give yourself permission to just say, No, actually, I don't want to do that and I'm going to do this other thing. I'm going to sing in a choir or belong to the dance team, or just go on a walk with my friends or whatever.
Robert Waldinger: [00:42:09] Yeah. And there's something so liberating when we eventually get to the point where we give ourselves permission to do that. And so how great that you as a mentor give some people permission to do it because we often do need other people to help us get there. Yeah.
Tyler Johnson: [00:42:25] And like I remember, I didn't realize it at the time, but when I was in college I had to work a lot to pay a large part of my way through college. And it got to the point when I was, let's see, a sophomore in college, I had been really, really into singing and especially singing into choirs, but between my pre-med classes and working a lot, I just couldn't fit the choir rehearsals in anymore. And so in retrospect, it was like I sort of took that part of myself and kind of laid it on the altar or laid it to the side. And I didn't sing in a choir from when I was a sophomore in college until a few years after I had finished my fellowship. So that's a total of almost 15 years. Then I had this opportunity to once I was an attending and you know, had a life again, I had an opportunity to try out for a choir and it was unimaginably fulfilling and refreshing and beautiful. It was like a part of myself that had been dead for a decade all of a sudden woke up and found life again. And I just hadn't even realized how much I had given up during that time when I was, you know, being a resident and whatever at the hospital.
Robert Waldinger: [00:43:36] Yeah, absolutely. Absolutely. And that's what we need to keep helping people pay attention to that You really can follow what you care about and you don't have to give things up maybe for short periods of time during crunch times. But other than that, don't give up the stuff you love.
Henry Bair: [00:43:55] You've already mentioned this earlier, but I want to make sure that we give it the full consideration that it deserves. You talked about your interest in Zen Buddhism and you're an active practitioner, is that correct? Yeah.
Robert Waldinger: [00:44:08] I'm also a Zen teacher. I'm a roshi.
Henry Bair: [00:44:11] Oh, well, that's incredible. And on this program, we love delving into the more spiritual, the more metaphysical aspects of the work that doctors do. So can you tell us what first drew you to Zen Buddhism and in what ways, if any, it has impacted your work?
Robert Waldinger: [00:44:28] Yeah, well, I started reading about Buddhist philosophy when I was actually in my psychiatry residency, and a psychologist who I worked with at the hospital said that she and her partner had done a silent retreat one weekend in their apartment. And I said, What's that? And she said, Well, you just you don't speak. And you sit and you meditate and you walk. And you said you did what? And so she handed me a book and I read this book and I thought, God, this is this makes more sense than any philosophical framework I've ever encountered. It was Jon Kabat-Zinn's book "Wherever You Go, There You Are." Very simple introduction to Buddhist thinking. And then I found that meditating was really helpful to me and that I enjoyed it. I just found it nourishing. And then gradually I wandered into a Zen meditation group not so far from my house and started practicing Zen, studying with a teacher, working with Zen koans, and gradually realizing that this is a part of my life that is so important that I want it to occupy a lot of space. And so I started training to be a teacher, ordained as a priest, and now it's my my wife calls sometimes my big fat hobby.
Robert Waldinger: [00:45:59] It's like it takes up a lot of time outside of my work. But I found it so helpful and it and it does it influences my practice for sure because Zen is kind of an amalgam of Buddhism and Taoism and it has a very existential flavor about it. It's like, Well, what what does it mean to be a human being? What does it mean to be alive in the world? And I find that that infuses my practice a lot. I mean, you know, like I said to you guys, you know, all those buildings we see that are named after people, like most of them, we don't know who they were. Right. And that's very Zen. That's very much about what's going to matter a thousand years from now. Right. What does it mean to be alive right now? And what do I do with that time? And so that infuses my work as a clinician. It even infuses what I ask about in my research.
Tyler Johnson: [00:46:58] Yeah, you know, I have only the most superficial understanding of Zen or Buddhism, either one. But I think that one really beautiful common thread- You know, Henry and I don't really have a I don't know agenda in terms of who we invite on the program except for people who we see, say, or write interesting things. Then we invite them on or people who even just have a reputation as really skilled clinicians that other people learn from. But one really fascinating thread that has become clear from many of the people that we have interviewed, especially those who choose to pay close attention to their metaphysical, spiritual, whatever you want to call them, lives as part of their their being a clinician is this idea that in a sense the thing that matters to, to use your your framing from a moment ago is the person who is suffering and sitting in front of you right now. And it is their humanity and your opportunity to help them to heal, whatever that means. And and this has spanned a spectrum from, you know, one person who we talked to who takes care of patients in an intensive care unit to another person we talked to who was a pediatric oncologist and then a and now a pediatric palliative care doctor to you who works as a psychiatrist. Right. I mean, those those three practice settings could not possibly be more different, right? From chemotherapy to vent settings to sitting across the you know, with somebody on the couch in the psychiatrist office. Those settings could not be more different. And yet the thing that that unifies the beating heart of all of those practices is the presence to fully be there with the suffering person in front of you. And I think that that gem of an idea, I think is clearly one of the things that has come out of more of a year, more than a year of these conversations as being central to returning a more profound sense of meaning to what we do as health care practitioners.
Robert Waldinger: [00:49:18] It certainly does for me. Right. That if if my patients and I are talking about what really matters to them in their lives, I'm so much more engaged. If people don't want to go there, that's okay. That's their prerogative. But I find it so, so engaging and I think many of my patients do too, that somebody is interested in how they look at their life and what matters to them the most and even how they think about death. That all of that is something that we have the privilege of doing as doctors that most people don't get to talk about.
Henry Bair: [00:50:02] Bob, you've been so generous with your time. As a closing question, I'd like to ask, what advice do you have for clinicians based on your work on the study, on adult development? What practical tips do you have for us about how we can lead more fulfilling careers and better help our patients?
Robert Waldinger: [00:50:20] Well, I would say the first thing is to heal ourselves. So we're really bad at taking care of ourselves. I would say that for us as clinicians, we should invest in relationships and that does not mean some Herculean effort. That means tiny, tiny investments every day, every week. So it could be making sure you stay in touch with the few people who you absolutely have to keep up to date with and want to keep in your life. Maybe reach out to somebody. Even if you have a commute, call people on the phone while you're driving. You know, make sure you go for a walk with somebody or have coffee or do something so that you don't let much time go by without contact with the people who are most important to you. So the first step is to heal ourselves. And then I think it would be to ask our patients, okay, who's in your life? Are you are you as connected as you want to be right now, or are you feeling lonely? Asking about loneliness is a really important way in to what's going on in somebody's emotional life that undoubtedly impacts health. So I'd say both prongs are important.
Henry Bair: [00:51:40] Well, with that, we thank you again for taking the time to join us. This conversation has been really enlightening for us.
Robert Waldinger: [00:51:46] Well, this was a pleasure.
Tyler Johnson: [00:51:48] We appreciate it so much. Bob, thank you so much for joining us.
Robert Waldinger: [00:51:51] Yeah, it was great to be with you guys.
Henry Bair: [00:51:56] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program notes and transcripts of all episodes at www.thedoctorsart.com. If you enjoyed the episode, please subscribe rate and review our show available for free on Spotify, Apple Podcasts or wherever you get your podcasts.
Tyler Johnson: [00:52:14] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:52:28] I'm Henry Bair.
Tyler Johnson: [00:52:29] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.