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

Is Virtue It’s Own Reward? A “good” (generous & caring) life is usually happier, healthier, and even a little longer? A “good” (generous & caring) life is usually happier, healthier, and even a little longer? Lincoln’s religion: “When I do good, I feel good; when I do bad, I feel bad.” Lincoln’s religion: “When I do good, I feel good; when I do bad, I feel bad.” Thoreau, “Goodness is the only investment that never fails.” Thoreau, “Goodness is the only investment that never fails.”

True? Emerson, “no man can sincerely help another without helping himself” Emerson, “no man can sincerely help another without helping himself” “Those who enrich others will be enriched.” (Proverbs 11:25) “Those who enrich others will be enriched.” (Proverbs 11:25)

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

Better Than….A Hostile Heart Redford B. Williams, MD, Duke Redford B. Williams, MD, Duke 27 Questions From the MMPI 27 Questions From the MMPI Looked at those who took MMPI in 1950 at age 25 Looked at those who took MMPI in 1950 at age 25 20% of high hostility quartile dead by age 50; 2% of low quartile 20% of high hostility quartile dead by age 50; 2% of low quartile “acid on metal” over time “acid on metal” over time

The Hostile Heart 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), ). 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), ).

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

The Power of Compassion Positive emotions, especially empathy and compassion, allow people to overcome vengefulness and hostility. Positive emotions, especially empathy and compassion, allow people to overcome vengefulness and hostility. (ME McCullough, et al., J of Per and Social Psychology, 73, )

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

The Road to Milesberg Exit 58 on Route 80

I. GIFT-LOVE AND HAPPINESS Self-reported happiness slightly down since 1936 Self-reported happiness slightly down since 1936 Depression and anxiety up tenfold since 1960 Depression and anxiety up tenfold since 1960 The 20th-century Hindu sage J. Krishnamurti wrote, “It is no measure of health to be well-adjusted to a profoundly sick society.” The 20th-century Hindu sage J. Krishnamurti wrote, “It is no measure of health to be well-adjusted to a profoundly sick society.” Harvard Veritas Lecture

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” 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”

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) 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)

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

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) “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)

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 Harvard Business School. 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 Harvard Business School.

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

Happiness, Resilience, & Giving Jim Jim Sister Leola McNair Sister Leola McNair Dan Gottleib Dan Gottleib

Activity and Emotion

II. 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) 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 “Moral Treatment” 1820s “Clubhouse Movement” 1960s “Clubhouse Movement” 1960s

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) 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)

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

MS Patients MS patients trained to provide compassionate love 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) 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)

III. 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) 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)

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) 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)

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

Emotions and Longevity: The Nun Study School Sisters of Notre Dame 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. 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.

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) 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)

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) 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)

IV. Message: “Pay It Forward” A disposition to benefit others, so long as not overwhelmed, seems to contribute to happiness, health and even longevity A disposition to benefit others, so long as not overwhelmed, seems to contribute to happiness, health and even longevity Evolution, neurology, social science, biomedicine, game theory, spirituality and human development converge A message in families, schools, hospitals, prisons, businesses, professions, etc. A message in families, schools, hospitals, prisons, businesses, professions, etc.

A Research Goal 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?

V. A “Good” Doctor or Nurse It does not take a lot to offer each patient some compassionate words, even in brief encounters, and this practice is fulfilling It does not take a lot to offer each patient some compassionate words, even in brief encounters, and this practice is fulfilling For professionals who are regularly confronted with suffering, “empathy over arousal” (EOA) has risks, so step away to replenish For professionals who are regularly confronted with suffering, “empathy over arousal” (EOA) has risks, so step away to replenish Meanings matter (Dame Cicely Saunders) Meanings matter (Dame Cicely Saunders)

Mass General Hospital Foyer “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

Virtues & Quandaries Often quandaries (a feeding PEG? forced C-section? Janet Atkins?) do not allow much objectivity Virtues tend to be more objective (doctors, e.g., compassion, equanimity, diligence, loyalty, integrity, etc.)

Affirmations “What lies behind us and what lies before us are tiny matters compared to what lies within us.” Oliver Wendell Holmes

Affirmations Sooner or later, all the people’s of the world will have to discover a way to live together in peace …The foundation of such a method is love. Martin Luther King. Jr. The unifying characteristic of the qualities I have described as ‘spiritual’ may be said to be some level of concern for others’ well-being. The Dalai Lama

Affirmations We make a living by what we get, we make a life by what we give. Winston Churchill We can do no great things – only small things with great love. Mother Teresa

Rx = Visualize in the morning early to focus on what is really important in the day Visualize in the morning early to focus on what is really important in the day Consistency Consistency Be a good receiver (high givers often are not) Be a good receiver (high givers often are not)

Warning! Don’t Believe Bad Science or Bad Philosophy Ardrey vs deWaal Ardrey vs deWaal Freud vs Erikson Freud vs Erikson Dawkins vs Darwin Dawkins vs Darwin Sartre vs Marcel Sartre vs Marcel

Altruism & Health: Perspectives From Empirical Research, Ed. S.G. Post (Oxford U Press 2007)

Endorsements Dr. Tim Johnson, Medical Editor, ABC News: “As someone who has long believed that giving is essential to good health….I would suggest reading this book before ever dismissing the idea that giving is good medicine.” Dr. Tim Johnson, Medical Editor, ABC News: “As someone who has long believed that giving is essential to good health….I would suggest reading this book before ever dismissing the idea that giving is good medicine.”

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

Examples of the Ways of Love Celebration – Dr. Frat Celebration – Dr. Frat Mirth & Humor – Bob Hope Mirth & Humor – Bob Hope Compassion – Dame Cicely Saunders Compassion – Dame Cicely Saunders Attentive Listening – Dan Gottleib Attentive Listening – Dan Gottleib Creativity – Sister Leola McNair Creativity – Sister Leola McNair Generativity – Jean Vanier Generativity – Jean Vanier

More Examples & Ways Forgiveness - The Amish, Aaron Lazare, MD, On Apology (2005) Forgiveness - The Amish, Aaron Lazare, MD, On Apology (2005) Carefrontation – M. Scott Peck, MD Carefrontation – M. Scott Peck, MD Respect – Mr. Fred Rogers Respect – Mr. Fred Rogers Tom Smith – loyalty (“Don’t ever throw away a whole life just because it’s a little banged up” Seabiscuit) Tom Smith – loyalty (“Don’t ever throw away a whole life just because it’s a little banged up” Seabiscuit)

Attitude of Gratitude Sir John – Thanks for that fax! Sir John – Thanks for that fax!