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Flourishing in Medicine: From Surviving to Thriving Episode 13 Mindful Healing: Dr. Ellen Langer's Approach to Well-being · Flourishing in Medicine: From Surviving to Thriving

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I think the most important thing for me to leave people with, general, you know, now
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I'm talking to your audience, not as people who work in medicine, but rather as people
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that we all have so much control over our health and well-being that it's time for us
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to, you know, people are sealed and unlive lives and it's time to break the seal and
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start to fully live and to appreciate all the positive effects we can have on each other
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and help spread the word for this.
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My view of what is possible goes far beyond what most people even think.
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Welcome to Flourishing in Medicine From Surviving to Thriving.
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I'm your host, Dr. Mick Krasner, and this podcast is produced by EmPRO, a medical professional
0:55
liability insurance carrier headquartered in New York State.
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This podcast really came about because of EmPRO's commitment and actions to support the
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physicians they protect.
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This commitment includes many wonderful learning opportunities and I hope you explore these
1:12
podcasts and other of their offerings.
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Today I'm really excited to share with you my conversation with Dr. Ellen Langer, a professor
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of psychology at Harvard University and by many considered to be the quote, mother of
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positive psychology and the quote, mother of mindfulness.
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She has too many honors, too many titles and too many awards and too many books published
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to name all of them, so I recommend you look at the show notes for links to those.
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But she has been and still is truly a force of nature in the field of mind-body connection
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and what she calls mind-body unity and it is such an honor and pleasure to have her
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on the podcast.
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In this conversation, Dr. Langer explores the intersection between mindfulness and health
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care, drawing on examples like the counterclockwise study to underscore the potential for psychological
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factors to significantly impact physical health.
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She's an irascible and singularly independent thinker and storyteller who asks us, dare
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I say demands of us in health care that we think outside the box and consider the potential
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that exists for healing inside all of us as both an approach to patient care but as one
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of the ways of finding excitement, meaning, purpose and joy in the profession of medicine.
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And now our conversation with Dr. Langer.
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Welcome today to flourishing in medicine from surviving to thriving Dr. Langer.
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It is such a pleasure and honor to have you here.
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I wanted to start our conversation allowing you to or asking you to share how it is you
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got into studying things that are related to health.
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You know, a lot of our guests are medical practitioners and it's really curious about
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you know what led them to this, their origin story we could call, whether it's early childhood
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experiences or things that happened during their educational journey or encounters with
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wellness or illness.
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And so for you would love to hear how you got here.
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Okay, it's only a guess.
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People can't know how they got to wherever they are.
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It could have been some stranger on a bus that had an overwhelming impact.
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But for me, the most dramatic thing was many years ago, my mother had breast cancer and
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the cancer had metastasized her pancreas.
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And as your listeners know, that's the endgame.
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Because of this, her muscles and her legs weren't exercised, you know, why bother if
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she's going to die soon anyway.
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And then magically, the cancer disappeared.
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And the medical world wanted to write it up as something astounding.
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They couldn't explain it.
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And I think that was for me the beginning of trying to see if I could come up with anything
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that would explain it.
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And so that was the first once I started on the path that hopefully we'll talk about largely,
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not completely, but it's about mind body unity, you know, just as a pause to explain that.
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For me, you have mind body, these are just words.
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And we've given them more meaning importance than I think we could have.
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For argument's sake, you could have had mind, body and elbows.
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And that would lead us to a different conception of people.
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So at first, I, you know, in a shy way said, well, let's for heuristic purposes, put the
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mind and body back together and see how far we can get with this.
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And that was my cover.
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But actually now I mean it quite literally, that mind and body are basically a single
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unit.
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And if so, then wherever you put the mind, you're necessarily putting the body.
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So if we go back to my mother, if her mind was now, you know, I went down there, I was
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in my third early thirties and basically, you know, did rah rah for as long as I could.
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I wouldn't let anybody see her who wasn't uplifting.
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I mean, I did ridiculous things.
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And some of it was ridiculous because at the time I was studying the importance of perceived
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control and without realizing it, I essentially took over her life.
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But needless to say, whatever caused it, the cancer disappeared.
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Then I started to test this idea of mind, body, unity.
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And the first test, I can tell you, make proudly, this is an important popular study because
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it's, if you tune into the Simpsons, go to Havana, they actually talk about the study.
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Okay.
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So this was the quote famous.
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That's what I meant to say, not important study, famous study called the counterclockwise
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study.
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And all we did was retrofit a retreat to 20 years earlier and we had elderly men living
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there as if they were their younger selves.
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So we were putting their minds back in time.
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And the question was what would happen when we took measures from the body.
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They spoke about past events as if they were just unfolding and so on.
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And in a period as short as one week, we found their vision improved, their hearing improved,
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their strength, their memory, and they looked noticeably younger.
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And I don't know about you, but I've never heard without a medical intervention, elderly
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people's hearing improved.
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This was very startling.
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And then we went on and as you know, from reading the mindful body, many, many studies
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to corroborate the idea that if we treat the mind and body as one, the amount of control
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we have over our health is enormous.
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Now one of the things that I think is very important for people to understand something
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that the medical world, your listeners already know, but people in the outside world are
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not quite as aware that none of us really know anything.
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You know that science can only give us probabilities.
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It says that if we were to do the exact same study again, we're likely to get these findings.
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And those are translated in our textbooks by speakers and newspapers and so on as absolutes.
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And if you know something as absolutely true, you accept it that way, then you don't look
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for other alternatives.
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If you see it as well, it's a good guess, maybe then you know, you don't give up in
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quite the same way.
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Yeah.
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Well, first of all, I appreciate the description of this duality, which is really a false duality
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between mind and body.
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And I think it's very true what you're saying.
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I'm so happy that the Simpsons made this so famous.
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The other thing is, you know, when I was in medical training, I'm a physician and I wasn't
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really trained in uncertainties.
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And when I started in practice, I was hit head on in the face with the fact that everything
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I do, all the decisions that I'm involved in, all the illnesses that I face are completely
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uncertain entities and the path I cannot predict what's going forward.
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So I think you have a lot to say about that.
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Before we get there, I wanted to ask you, you know, your work has contributed tremendously
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to our understanding of expectation, attitude, for example, your work on the placebo effect.
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And certainly, you know, of some of the people here in Rochester, Bob Ader and Nick Cohen's,
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their work here on psychoimmunology and the brain and behavior in the immune system.
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So before we get into the challenges facing health professionals, I'd love to hear from
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you about that field, about the placebo effect and the effects that actually are quite applicable
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to the work that we do in medicine.
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My view is that placebo is our strongest medication.
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Now, as you know, placebos have gotten a bad rap in some sense, that in order to bring
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a drug to market, the pharmaceutical companies have to find that whatever drug they're looking
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at can outperform the placebo.
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So every time it doesn't, they lose money.
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And so, you know, it's so people came to say placebos as meaning that you're not really
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sick, you know, that if you can be healed with a placebo, since a placebo is nothing,
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then your, you know, your problem is in your head.
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And all of this has confused things enormously.
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So I look at a placebo and I say, okay, if you take this sugar pill, this pill doesn't
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have to be sugar, but this pill that's inert, which it has to be to be a placebo and you
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heal, clearly it's not the pill that's doing the healing, you're doing it yourself.
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And so to go back to what you originally asked me, my life's work in essence is to try to
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find a way, since you're doing it yourself anyway, to get people to do it.
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You know, there'll always be work for physicians, so they don't have to be threatened by, you
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know, people helping themselves more than they do.
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And I think, you know, if we go back to the medical model, not that long ago, you'll know
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better than I, but I would say just a few decades where they believed that psychology
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was essentially irrelevant.
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I'm sure, you know, being nice, caring people, they want people to be happy.
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But I don't think that, I think that the rule of thumb was if you're going to get a disease,
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it can only be caused by an antigen.
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All right.
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Then things moved along where you had what you know is the bio-social model.
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So now psychology is starting to show its face.
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And then my work is not that they're related, because when you talk about them being related,
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you come into the same mind-body problem, which is how do you get from this fuzzy thing
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called a thought to something material called the body?
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And I think eventually it's going to go all the way to the other end, and one will appreciate
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the importance of psychology in every aspect of our health.
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Yes.
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You know, I think it's actually happening in medicine.
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And luckily, I've been the beneficiary of some of that coming to Rochester for my after
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medical school training, the program heavily influenced by a man named George Engel, who
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coined the term the biopsychosocial model.
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And I think it really is a better way of looking at things.
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And you cannot extract, you're right, the psychological from the body.
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I mean, it's all co-extensive, isn't it?
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So it really is a false dichotomy again.
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And everybody has had experience with the, we'll say, to me, it's mind-body unity, but
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for a moment we can talk about mind-body relationship or connection, what have you.
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But I had this experience when I was very young that spoke volumes to me.
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So I was married before most people even have their first date.
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I was very, very young.
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We went to Paris on our honeymoon and I was now 19 going on 40.
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So it was very important to me.
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I was very sophisticated.
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I had to be sophisticated.
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We go into this restaurant and I order a mixed grill for dinner.
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On the mixed grill was pancreas.
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Now my then husband was more sophisticated than I, and I said to him, Jean, which of
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these is the pancreas?
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He pointed to something on the plate.
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I'm a big eater.
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I ate everything else.
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Now the moment of truth.
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Could I eat the pancreas?
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I had to after all, I was a married woman.
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I start eating it and I literally get sick.
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At which point he starts laughing.
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I say, why are you, it seemed an inappropriate response.
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I'm suffering from being ill.
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He's laughing.
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I said, why are you laughing?
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He said, because that's chicken.
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You ate the pancreas ages ago.
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So I had made myself sick.
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If you're walking down the street and in the fall and a leaf blows in your face, everybody
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is startled.
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Their blood pressure and pulse increase and suddenly their breath changes and so on, physiological
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responses.
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But until they see it's just a leaf, you see somebody regurgitate on the side of the road
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and you start to feel that you're going to throw up.
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So we've all had these experiences.
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And I think that the book, The Mindful Body, for me started as a memoir.
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So there are lots of very personal stories in there.
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And as I started to explore my own experiences that spoke volumes in the way this pancreas
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story did.
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And, you know, let's just say as a side effect now, most people don't have any pancreas stories.
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I've already told you two.
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So I'm already different from most people, for better or worse.
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And I think that there's a larger issue here that I don't tend to talk a lot about on these
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podcasts, and maybe, you know, I think it's a little too complicated, but it's the idea
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that we can't predict.
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Now people think they can predict because they're so good at post-dicting, you know,
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looking back and making a nice story.
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So you and I are at a party and we see Jane and Jack fighting.
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And I say to you, do you think they're going to get divorced?
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You say, yeah, who knows, right?
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People fight.
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But let's say we didn't have that conversation.
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We just see them fighting.
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And two weeks later, we find out they're getting divorced.
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Ah, I knew it.
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You should have seen the way they went with each other at the party.
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So the point is mostly that science and all the training our medical people are getting
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are based on norms.
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We can predict for the group, you know, if we went to a Mercedes dealership, unless
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they're a hundred cars, we know that if we put the key in the ignition, almost all of
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them are going to start.
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But I don't think people would bet their whole life savings that any one car chosen at random
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would necessarily start.
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You know, there's a way we realize sometimes there's a lemon.
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I mean, if I were shooting baskets against Michael Jordan, if we did many, surely he'd
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win.
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But just one foul shot.
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No, I, you know, sometimes get it in and he sometimes misses.
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And something that I just realized the other day that I thought it was interesting to me,
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at least that I do a lot of talking about mind, body unity.
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And I realized people don't even have body unity.
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And what I mean by that is, you know, when you get a diagnosis of some chronic illness,
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all that means is that the medical world doesn't yet have a medical solution.
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It does not mean that there is no solution.
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And if you realize that the body was all one, then you know, that strengthening any part
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should strengthen every part.
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And so there's always something you can do.
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And I was thinking this during COVID, that if you had a couch potato and an Olympic athlete,
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I catch potatoes watching television, eating candy all day long and the Olympic athlete
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is exercising and you expose both of them to COVID first.
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And I have no data on this, but I would think that the Olympic athlete would be less likely
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to get it.
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Let's assume they both get it.
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I don't think the disease would play out the same way.
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I think you're absolutely right on that.
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And it has to do with, you know, how our immune systems are tuned and etc.
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And also maybe some of that is expectation of what we would expect as well.
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You've done this really interesting work on cold virus and that sort of thing.
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But I'm going to move into an area.
16:09
First I wanted to say before I do that, that it's really interesting to hear that that
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mindful body book started out as a memoir because I think you do a wonderful job of
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weaving the personal with the scientific.
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And it makes it really helpful for the reader to say, oh, well actually this stuff isn't
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just abstract.
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It's applicable to one's life.
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So let's move into maybe an area not so expertise, but I think you have a lot of, we'll have
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a lot of interesting insights for our listeners.
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So medical professionals, clinicians, especially physicians, we face many challenges that have
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increased the level of what we call burnout over the years leading up to the pandemic
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and actually continue to be of tremendous concern.
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And I'd really love to hear your reflections on this, especially as it relates to your
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work in mindfulness, positive psychology, and what we call mind body unity.
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Sure.
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And we do have some data.
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Essentially when people think they know, it's very hard to find your work interesting.
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And if you don't find your work interesting and you're in the medical profession, we call
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it burnout.
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If you're in sales, we call it boredom.
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You could also call it burnout.
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And so how do you change that?
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Well, it turns out, and I think we should, it's an opportunity for me to say what I should
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have said at the beginning.
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Mindfulness as I study it has nothing to do with meditation.
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Meditation is fine.
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It's just different.
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All it is, is the process of actively noticing new things.
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And as you actively notice new things, the neurons are firing, which we find in study
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after study is literally and figuratively enlightening.
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Now you don't notice new things when you think you know.
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So when the doctor, nurse, any of the medical people is speaking to Mrs. Jones and they
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think they know Mrs. Jones' diagnosis, prognosis, they are not expecting any changes.
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If you compare meeting somebody new versus somebody who you have no particular affection
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for and you're seeing them for the umpteenth time, surely the former is engaging.
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You don't know you're going to like this person.
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You're going to learn something from them, get something from them, share experiences
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and so on.
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So when the medical people realize they don't know, then Mrs. Jones becomes more interesting
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when they realize not only that even if she hasn't changed from yesterday, yesterday they
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didn't know all of her, but she's changing also.
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And so in a very simple way, if the medical professional dealt with each patient as if
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they were brand new, that would be exciting for the physician.
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The physician then would approach the person differently, which would be good for the patient.
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If we took measurements, I think the health for both parties would improve.
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Years ago when Atul Gawande was about to publish his book on checklists, you know, so I spoke
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to him, but it was sort of too late, but we have, this is a study we have to do.
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So if any of your listeners want to do it with me or instead of me, you know, I welcome
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it.
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So I've done a lot of traveling in my life and years ago they don't do it so often now,
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but you'd be given a checklist and say, you know, so when you're coming back from Mexico,
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they'd ask you bringing back any plans, did you interact with livestock?
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You know, you answer two of these and you know all of them are going to be no.
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So you don't really read them.
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And so same thing with pilots when they're taking off and they do, they go through their
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checklist and they say flaps up, throttle open, anti-ice off.
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Well back in the eighties, a plane crashed because it was going from Florida, one warm
19:52
location to Washington DC, another warm location.
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So the de-icer was mindlessly turned off, but this was an odd time for DC.
20:02
They were experiencing snow with the anti-icer turned off the plane crash.
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People were killed.
20:07
Okay.
20:08
So all checklists ask questions where after a while it's, you know, the answer without
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even looking.
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And so I wanted to do, I haven't done it yet, a checklist that by necessity is mindful.
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So you don't say, does the person have eyes?
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You'd have to say on a scale from one to 10, how open is their eye right now?
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How much liquid or whatever we call it, you know, and so on.
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And to answer those questions, you have to actually look.
20:34
And again, when we think we know we don't look and we're oblivious to it.
20:40
Let me tell you, for example, so if I asked you a question, how much is one plus one?
20:45
Mick, how much is one plus one?
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It's a trick.
20:48
Two.
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That sounds like a trick.
20:50
Of course it's a trick, but you have no other answer right now, but two.
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Now this is the thing we think we know the best.
20:56
So there'd be no reason for you to pay attention to anything.
20:59
Two, and that's it, and you continue on your way.
21:02
But if you were to add one cloud plus one cloud, one plus one is one.
21:06
One pile of laundry plus one pile of laundry, one plus one is one.
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One watt of chewing gum plus one watt of chewing gum.
21:13
So in the real world, one plus one doesn't equal two as or more often as it does.
21:18
Now to make it clearer, imagine we're finished talking and very, very likely somebody says
21:24
to you now, Mick, how much is one plus one?
21:27
You're not going to confidently, mindlessly, with complete certainty, answer two.
21:33
You're going to pay some attention to the context, and then you'll probably say, well,
21:37
it could be two, or you may say it could be one.
21:39
All right?
21:40
And so when we know that our diagnoses are probabilities, when we know that the prognoses
21:48
are probabilities, when they know that any of the medications or treatments we're suggesting
21:54
are based on probabilities, we'd pay a different kind of attention than we do right now.
22:00
Everything is changing.
22:02
Everything looks different from different perspectives.
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So you can't know.
22:06
Nobody knows.
22:07
And the medical people know they don't know.
22:09
And so I'm here to free them.
22:11
It's okay.
22:12
Admit you don't know.
22:13
And that would almost necessarily bring the patient into the process.
22:17
Yes.
22:18
You know, it's a lot of things you've brought up for me.
22:22
One is that absolutely to make it more interesting, to see things new and fresh is a mindset that
22:30
is sometimes difficult to cultivate as experienced medical professionals.
22:34
There's a saying, I think it was a quote by this famous Zen teacher, Suzuki Roshi, who
22:39
says, in the beginner's mind, the possibilities are many.
22:42
In the expert's mind, they are few.
22:44
We tend to narrow that down.
22:45
And I'll give an example, two things.
22:48
One is it's said that I didn't know him.
22:50
I met him, but George Engel, when he would take trainees on rounds and he'd go into an
22:55
exam room and he asked them, what did they notice?
22:57
And among the things he would point out is that look and see how many flowers are in
23:02
this room.
23:03
How many greeting cards are in this room?
23:05
Before you even encounter talking with a patient, you already see a context there.
23:13
The other thing is a wonderful medical educator, Faith Fitzgerald from UC Davis many years
23:18
ago wrote an article about curiosity and she described, you had me remember it and I laughed,
23:24
how they admitted a woman one night, a social admission, so to speak, and it didn't seem
23:29
like there was anything interesting about her.
23:32
And Dr. Fitzgerald was on this mission that every patient is interesting and she brings
23:37
her trainees to the bedside.
23:38
And it turns out she had one medical encounter in her life.
23:41
She had broken an arm and people were like going, you know, shrugging their shoulders.
23:45
Oh, big deal.
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This is in San Francisco.
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It turns out as they began to inquire, she began to inquire more.
23:52
The woman broke her arm because the Titanic lurched and a piece of luggage fell on her
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arm.
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She suddenly became the most interesting thing in the hospital.
24:03
Everyone at TV stations wanted to talk with her, et cetera.
24:06
So yeah, it's interesting.
24:07
I just went to a memorial service and it made me remember all the other memorials.
24:12
You get older, there are too many of these.
24:14
And when you hear people talk about this person you thought you knew, I didn't know that.
24:19
I didn't, you know, and so it's not just patients, but virtually everybody.
24:25
And so it's in a related but different way.
24:29
I wrote this little song for my grandkids.
24:32
I'm not going to sing it, but it's essentially it goes to the tune of the old Sarah Lee commercial.
24:37
Everybody doesn't know something, but everybody knows something else.
24:41
Everybody can do something, but everyone can do something else.
24:44
And that we're too quick to stereotype people.
24:47
And this all came to me.
24:48
I was, we were having an enormous amount of furniture delivered to be stored in the basement.
24:54
So I look at the basement, I look at the truck and there's no way that that's going to fit
24:58
there, right?
24:59
Well, the guy who was there, who was going to organize all of this is the person who
25:05
would see himself, I'm sure as a loser, you know, he's uneducated, he's missing a lot
25:10
of teeth, you know, just, you know, to write him off.
25:13
And he unpacked all of that, or packed it, you know, where everything was accessible,
25:19
everything.
25:20
And it seemed to me, it's just not fair.
25:22
You know, people assume I can do everything.
25:25
He can do nothing.
25:27
And yet he was clearly more skilled than I in this moment.
25:32
And so if we look for what people can do, and we're taught this in schools, you know,
25:37
I was talking to somebody the other day about attention, I don't know, about dyslexia.
25:41
And if you gave somebody a 250 word sheet of paper to read, and they're dyslexic, they'll
25:47
probably miss two words, possibly four, right?
25:50
Not more than that.
25:51
That means they're getting over 95% of it correct.
25:55
You know, why are we defining them by the things that they can't do?
25:59
And so it really is a matter of organizing ourselves differently.
26:03
I played this thing for a health class I was given where there's this young kid, she, this
26:08
is America's Got Talent.
26:10
It's very fun anyway.
26:12
So she's tiny.
26:13
She's about eight years old.
26:14
She just had this medical, a kidney replaced or, you know, given to her, whatever it was.
26:19
And they asked me, and what do you want to do when you just I want to be the next Whitney
26:23
Houston.
26:24
So of course, everybody is signed.
26:25
Yeah, okay, fine.
26:26
And then the kids start singing.
26:28
And she was already better than Whitney Houston.
26:30
And I pay a lot of attention, attention to the times I'm misjudging.
26:36
And you do that often enough, you'll find that you're wrong often enough, and then you
26:40
stop doing it and stop being so judgmental.
26:43
And I think that physicians, you know, we have, you're only looking for certain disorders
26:49
if the person is male or female, if the person is black, if the person is old, young, and
26:55
so on, again, acting as if the data that's leading you to that behavior is more than
27:02
more certain than it actually is.
27:05
Because if somebody presents with something that looks classic, but you just don't get
27:09
it in a young woman, they're not going to do the appropriate tests and so on.
27:15
You're right.
27:16
You know, sometimes we have a joke in medicine, in the practice of medicine, that it would
27:21
be so much easier if the patients would simply read the textbook and present as the textbook,
27:25
because that's what we know.
27:27
You know, but the truth is, and this is a real challenge, because the truth is, is that
27:32
we are so problem-focused in medicine, and that's, you know, by necessity.
27:37
But on the other hand, it actually hamstrings us, and I'll explain why.
27:42
Because when you are actually practicing, working in partnership with your patients,
27:46
you're trying to leverage their strengths and capacities to do whatever it is they can
27:51
do to manage their situation, as you mentioned.
27:56
And I think that's sort of what you're pointing to, is that there are all these capacities
28:00
and successes.
28:01
And my vision of, say, the future medical record should include at least an acknowledgement
28:07
of what those capacities and strengths are, because that's really what we're trying to
28:11
build off of if you're in that healing relationship.
28:14
Can I say something?
28:16
Sure, absolutely.
28:17
I've hinted at a couple of things, and without giving your listeners an example, I think,
28:22
and just go by the by and say, oh, that's interesting.
28:25
So let's go to mind, body, unity.
28:28
That when people have chronic illnesses, they're led to believe that it's uncontrollable.
28:33
Okay, or, you know, that without whatever the particular medication or so on, there's
28:38
really nothing more they can do for it.
28:40
And if you have a sense of the whole body is connected, well, you take care of the rest
28:46
of the body, and you probably are going to do good things for you.
28:50
But for these chronic illnesses, what we found, I told you, I was trying to see if I could
28:55
replace the placebo, give people full control.
28:58
And we came up with this, it's not quite the same, but at least is related.
29:03
This treatment that I call attention to symptom variability, and that's just a fancy word
29:08
for mindfulness, mindfulness is noticing changes, right?
29:11
So when you're diagnosed with a chronic illness, you believe that the symptoms will stay the
29:16
same or they get worse.
29:18
But nothing moves in only one direction.
29:20
It's sort of like if the stock market is going down, it doesn't just go in a straight line
29:24
from whatever it is to zero, it'll go down a little, then go up and go down some more,
29:29
or let's be positive when the stock market is going up, it doesn't go up in a straight
29:33
line.
29:34
So too with these illnesses.
29:35
So what's happening when the symptom is improving and people don't pay attention to it?
29:41
And so what we do is we call people periodically throughout the day, throughout the week and
29:46
say, how is it now?
29:47
Is it better or worse than before?
29:49
In other words, and why?
29:51
And the why is the important question because the why leads to a mindful search for possibilities.
29:57
And I have 40 years of evidence that this mindfulness itself is good for your health.
30:03
We have four studies where people are living longer and so on.
30:07
And okay, so what happens?
30:09
You're, we go through this thing, the first thing you realize, hey, it's not always awful.
30:14
Okay.
30:15
So you feel better.
30:16
Second, by doing the mindful search for why is it better now than before, you become more
30:20
mindful that's good for your health.
30:22
Third, I believe that if you are looking for a solution, you're more likely to find one
30:28
than if you just assume this is, you know, chronic and uncontrollable.
30:33
And finally, and this is very important for medical people to realize how important experiencing
30:39
some control is for people, you know, that so the going through the whole process, even
30:46
if they don't come up with anything is going to make them feel better.
30:50
So we do this and we've gotten incredible results, I think, with, let's say, multiple
30:55
sclerosis, chronic pain, arthritis, stroke, Parkinson's, biggies, you know, and, you know,
31:02
so how can this be like the placebo where you'd give it to yourself, but you can't give
31:06
yourself a placebo because you know that if you believe it, you can't work.
31:11
If you believe placebos can work, then you can treat yourself with placebos, but everybody
31:16
can set their smartphone to ring in two hours.
31:21
And when it rings, you say to yourself, how is it now, whatever the symptom is, and is
31:25
it better or worse than before and why, and then set it to ring two and a half hours,
31:30
three hours, 10 minutes, it doesn't matter.
31:33
And you do this throughout the day over a short period of time seems to result in an
31:38
amelioration of the symptoms.
31:40
I think that attention to symptom variability is really a useful tool.
31:45
And I think that's a really practical thing for our listeners.
31:48
You know, for example, we're managing, helping someone manage diabetes.
31:52
And often we label the patient as noncompliant because it's just not working out.
31:56
But if we were to turn it around and say, tell me about times in which, you know, things
32:00
seem to be under control.
32:01
What were you doing when your blood sugars were much better under control?
32:06
How did you do that?
32:07
And what were the things that you were doing?
32:08
And I think that gives the patient more sense of control.
32:12
This was another one of our mind-body unity studies.
32:15
So people with type 2 diabetes come into the lab, we give them all sorts of tests, then
32:19
we set them down at a computer.
32:21
And the reason for this will become clear in a moment.
32:23
We're going to have them play computer games, but we have a clock next to the computer and
32:29
they're told change the game you're playing every 15 minutes or so.
32:33
And that's to ensure that they'll look at the computer, look at the clock rather.
32:37
Now for a third of the people, the clock is going twice as fast as real time.
32:42
For a third of the people, it's going half as fast as real time, and for a third of the
32:46
people, it's real time.
32:47
And of course, the rig clock, the person is not aware of this, right?
32:50
The question we were asking was, would blood sugar follow real or perceived time, clock
32:56
time?
32:57
And it turns out clock time.
32:59
And we've used this same thing in so many ways.
33:02
We have people in a sleep lab, they wake up, the clock tells them they got two hours more
33:06
sleep than they got, two hours fewer, or the amount of sleep they got, cognitive and
33:11
physiological responses seem to follow perceived time.
33:16
The most recent is kind of fun.
33:18
I love this one where we inflict a wound.
33:20
Now the powers that be wouldn't let us really hurt people, and nor would I want to, but
33:27
it's still, it's a wound.
33:28
And they're in front of a clock.
33:30
And again, the clock is going twice as fast as real time, half as fast as real time or
33:35
real time.
33:36
And here the question we're asking is, does that wound heal based on clock time or real
33:41
time?
33:42
And the answer is clock time.
33:44
Now imagine, you know, as a physician, I'm sure your patients ask you, how long will
33:49
it take for me to heal?
33:51
And the information you give them is crucial.
33:54
It's going to set the expectations for how long it's going to take.
33:58
Amazing, very provocative work.
34:00
And it actually, I'm thinking there's probably 20 studies that can come from that that are
34:05
addressing questions.
34:06
Back to the physicians, many physicians, health professionals find themselves really in very
34:11
complex care delivery areas, high uncertainty, emotional states are intense sometimes, organizational
34:18
administrative demands are significant.
34:20
Time just seems to be compressed and limited in many ways.
34:24
As you know, this is kind of a recipe for learned helplessness.
34:28
And we know that the empirical evidence linking clinician well-being and quality outcomes
34:33
is very robust, very strong.
34:36
So can you help us think about how to apply lessons from some of your research and thinking
34:40
on control, decision making and other areas?
34:43
If you recognize that stress is psychological, and that, you know, events don't cause stress,
34:49
what causes stress are the views we take of events.
34:53
And so the relationship between the physician, the nurse and the patient is not inconsequential.
34:58
It's not just, oh, isn't that nice that they've had a nice conversation that by caring about
35:04
the person, which by noticing them, a person, that's when a person feels cared for, you
35:10
know, go home and tell your wife, you look great today and she'll be happy, but give
35:15
her a specific compliment.
35:17
Wow, you know, your hair is shiny today, something specific.
35:21
So she knows you actually looked at her and it will cement, help cement the relation.
35:26
All right.
35:27
So if physicians recognize that the relationship with the patient is good for the patient's
35:33
health, it's good medicine.
35:35
And when they're administering good medicine, they're going to feel better.
35:39
So it's good for their health.
35:41
There's little to say they shouldn't do it.
35:44
You know, these five minute appointments, I hope quickly become a thing of the past.
35:49
I think you're right.
35:50
And I think most of my colleagues and those that are even most distressed will tell you
35:55
that most of the meaning and satisfaction they get is in that relationship.
36:00
And it's all these other things that are eroding their ability to kind of be in relationship
36:06
with their patients.
36:07
One of the things I noticed in my career in clinical medicine and also my work with mindfulness
36:12
based interventions, I've designed with a colleague here in Rochester, a program called
36:16
mindful practice in medicine for health professionals, mostly physicians, that meaning, meaning is
36:22
really important for these health professionals.
36:25
I love to hear from you about how you think about that kind of in academic terms and how
36:30
you would study that, but also personally, what gives you meaning in your work, in your
36:34
life?
36:35
How do you understand meaning for yourself as well as how do we apply it to health professionals?
36:40
An interesting question that I'm not sure I have a brilliant answer to is I don't, you
36:45
know, I think that when you're actively noticing that's equivalent to making it meaningful,
36:50
you know, that when you don't, you look at a painting and you look at it quickly or whatever,
36:57
it has no meaning for you.
36:59
And then you start to pay attention to the texture and the content, you know, all the
37:04
particulars.
37:05
It's a painting of fruit and there are apples and grapes.
37:08
Why isn't there a pear there?
37:09
And you tell yourself a story and then it becomes meaningful, which is why galleries
37:14
know that paintings need to get be given titles as a way of getting into the painting, which
37:20
means a way of making it meaningful.
37:23
So just being mindful makes everything meaningful.
37:26
And then as far as my studies are concerned, it's interesting because everybody that's
37:30
asked me tends to assume that I have an idea and then I go see if it works rather than
37:36
I have an experience.
37:38
And gee, I wonder are other people having this experience?
37:41
You know, as I said, getting sick from the thought that it was pancreas, something like
37:47
that.
37:48
And so it's noticing my own behavior, seeing how it might or might not be explained, you
37:54
know, come up with a theory then and to see how widespread it is.
37:58
Because I'm different, for better or worse.
38:02
So what is the question?
38:04
Oh, it's really how to do it.
38:07
What gives you meaning and how do you understand it for yourself?
38:10
You do so many things.
38:12
So really, it's all meaningful.
38:15
You know, that when you're mindless, you're acting as if you know, you're letting the
38:19
past dictate who you are and how you are in the present.
38:24
When you have the deep beliefs that I do, everything becomes possible.
38:29
You know, I was at this horse event many, many years ago.
38:32
I've told the story a thousand times.
38:34
And this man asked me to watch his horse because he was going to get his horse a hot dog.
38:38
Well, I'm Harvard Yale all the way through.
38:40
I know horses don't eat me.
38:43
He comes back with the hot dog and the horse ate it.
38:47
And that's when I realized everything I thought I knew could be wrong.
38:50
And for me, that opened up a world of possibility.
38:54
So I've never been turned off of something because, well, no one has done it or most
38:59
people can't do it or, you know, because the fun is in the trying to do it.
39:05
Once you've done it, it's done.
39:06
An example I use for people is you're a little kid and you're trying to reach that elevator
39:10
button and you can't every time you get in the elevator, your father and mother picks
39:13
you up.
39:14
It's very exciting.
39:15
And then finally, you're tall enough.
39:16
You could hit the button.
39:18
How many people do you know get excited when they go into an elevator pressing the button?
39:23
So it's an awareness that it's the not knowing that's exciting, that, you know, trying to
39:29
master not having mastered.
39:31
Yeah.
39:33
Another intriguing thing about your writing and especially in the mindful body is the
39:38
discussion on mindful contagion.
39:40
And let me just ask you something.
39:41
Yeah, I want to ask you something.
39:43
I want you to imagine a health care system in the future because it's certainly not here
39:47
right now, which is truly mindful.
39:49
Yeah, I'm building the mindful hospital.
39:52
Oh, what would it look like?
39:54
Well, I talk about that in the mindful body.
39:57
And if you think about hospitals, except for different equipment, there's really nothing
40:02
different since its inception.
40:04
Right.
40:05
Now, if I'm right about stress, just think about it.
40:08
You have to go to the hospital because you're really sick.
40:11
You walk into this building that, you know, wreaks fear, makes you stressed.
40:17
So before anything good can happen, I think it's going to make matters worse for you.
40:22
And so people can read the book to see the way I suggest making those changes.
40:27
But you asked about the mindful contagion and what if there is this mindful contagion,
40:32
then to make the change in society or just, you know, within one medical facility, you
40:37
don't have to get each and every person on board.
40:41
So it makes it much easier.
40:43
The work is new.
40:44
And I, you know, when I wrote about it, I wanted to make people aware that they shouldn't
40:50
discount all the other things that I'm very confident of because of so much research.
40:55
But turns out, well, let me give you an example of the study and people can make of it what
40:59
they will.
41:00
In this case, we use meditation.
41:02
So we had people meditating in a room and then they left.
41:06
Then the subjects would come in and be given tests versus the room is empty and the participants
41:13
would go in and we give them tests.
41:15
Well, in the form of condition, when they go in a room that was just occupied by people
41:20
meditating, they do better.
41:23
And we have individual studies, you know, that if we have people in a wine tasting experiment,
41:30
these are heavy drinkers and we have the experimenter is either mindful or mindless.
41:35
They're not saying anything different.
41:36
They're just present in a different way.
41:39
And that when they're mindful, people drink less.
41:42
It seems somehow, you know, you know it that you find some people so exciting.
41:47
They haven't even said anything.
41:48
They walk into a room, but it's because they're there.
41:52
And most of us sadly are not.
41:54
I know if I go to the ballet, which I wish I did more frequently, people shouldn't think
41:58
I'm so cultured.
41:59
But in the past, when I would go to the ballet, my eyes would be riveted not to the person
42:05
in the front who is clearly technically the best dancer.
42:08
That's why they're in the position that they're in.
42:10
It would be to somebody on the, you know, on the side and I would ask why.
42:14
And because to me, that person is there.
42:18
And so we recognize and we have expressions like the lights on, but nobody's home.
42:23
So we all recognize that this is true.
42:26
And when you're with somebody who is mindful, this is not so much in the air.
42:31
It's a different kind of contagion, but you feel safe.
42:34
You know, when people are mindful, they're less likely to be judgmental.
42:37
When they're mindful, they're reading their cues from the same environment that you are.
42:42
So for a number of reasons that we get a small group to be mindful, it's just a nicer environment
42:48
to be in.
42:50
You reminded me in this answer and also bringing up the ballet of developing the mindful hospital
42:56
or the mindful healthcare system.
42:58
In ancient Greek times, when you were in need of healing, often you couldn't find it in
43:02
your own community.
43:03
So you traveled to one of these healing temples, the Asclepian healing temples.
43:08
And the healing process begins along the way.
43:11
You meet people who are coming back.
43:13
So there's this hearing stories.
43:15
You enter, you go to the temple.
43:17
And before you even enter the temple, you may take a bath in the public baths.
43:21
You may attend the theater.
43:23
And at that time, a theater was an interactive experience where your personal story became
43:28
part of the larger ethos of the larger tragedies.
43:31
So I think art and medicine.
43:34
When my mother was going through the cancer episode, I was down there with a friend.
43:38
We were both, not so recent, but both PhDs.
43:42
Now it's time for my mother to go on the gurney to go get x-ray, whatever.
43:46
And they wouldn't let me, her daughter, PhD professor at Harvard, wheel the gurney.
43:53
Instead, a 17-year-old kid had to do it because of insurance.
43:58
And so I think we need to rethink a lot of this.
44:01
And when we recognize that everything we do to save time, to prevent the possibility of
44:08
lawsuits and whatever, that dehumanizes the situation is also causing harm.
44:15
And you took an oath, right?
44:17
Cause no harm.
44:18
So a lot of the procedures need to be changed.
44:22
Yeah.
44:23
I think.
44:24
I would agree with you.
44:25
So you are, we're coming to an end and you are a woman with, I can tell, just tremendous
44:30
energy, creativity, drive, tenaciousness, commitment, persistence, confidence, really
44:35
great things.
44:36
Well, don't stop there.
44:37
Yeah.
44:38
I'd like to know, and I have a sense, but I'd like to know what you do for fun.
44:42
You know you have your dog there.
44:43
In Puerto Vallarta, Mexico.
44:45
Yeah.
44:46
Well, everything I do, I make a game.
44:48
Everything.
44:49
Even if I'm flossing my teeth, you know, with a water pick, it's a game.
44:54
Everything is a game.
44:55
So I don't need to take time out for that, but I also am an avid tennis player and I paint
44:59
and I enjoy cooking and dare I say, I'm a very big eater.
45:04
So, but there's no reason why things shouldn't be fun.
45:08
I think.
45:09
You know, when you, once you really understand that outcomes are not in events, they're in
45:15
your head, you know, that's going to greatly reduce stress.
45:19
When you appreciate that everybody has something to offer that makes everybody more interesting
45:25
people to interact with and that life doesn't turn typically on a single success or failure.
45:33
So you don't have to beat yourself up because the car got in an accident or the paper got
45:37
rejected or whatever.
45:40
So yeah, I'm, I mark the edge of the optimism continuum I'm told.
45:45
And of course, to me, I don't see it as being optimistic.
45:48
I'm just being real in the same way the pessimist thinks life is real.
45:52
And again, I think the most important thing for me to leave people with general, you know,
45:57
now I'm talking to your audience, not as people who work in medicine, but rather as people
46:02
that we all have so much control over our health and wellbeing that it's time for us
46:09
to, you know, people are sealed and I'm live lives and it's time to break the seal and
46:14
start to fully live and to appreciate all the positive effects we can have on each other
46:21
and help spread the word for this.
46:23
My view of what is possible goes far beyond what most people even think.
46:29
What a wonderful note to end on human potential and the potential we have in our healing work
46:36
and in our communities.
46:37
So this has been just wonderful and I really appreciate and thank you.
46:41
I wish you continued fun and I hope you stay alive for a lot longer so you can continue
46:47
to contribute this to this wonderful body of knowledge that is really practical and
46:51
very helpful.
46:52
Thank you.
46:53
So thank you again.
46:54
Thank you, Nick.
46:56
Thanks for listening.
46:57
We will include a summary of today's podcast and links about Dr. Langer and other references
47:03
that were discussed in the show notes.
47:05
I conclude today by sharing another practical exercise to help you flourish during your
47:10
work day that you can draw upon to enhance purpose, meaning and wellbeing.
47:16
There was discussion during the podcast about recognizing some of the variations that occur
47:20
in our lived experiences.
47:23
The example in the conversation was about illness and patients, but we can use this
47:29
idea for ourselves, especially at moments when we are feeling frazzled, stressed out
47:34
and overwhelmed.
47:35
So over the next week or two, try to remember at a time of mild, moderate or even significant
47:42
stress or feeling overwhelmed to take a breath and coming even for just a moment into the
47:50
present moment awareness.
47:54
And noticing if that feeling of stress, that intensity of feeling overwhelmed as you are
48:01
sitting in it, in that present moment, has some variability to it, even the smallest
48:08
amount, just a little bit in that moment.
48:15
Noticing how it may be changing, not fixed, not something necessarily to expect that it
48:22
will continue on endlessly.
48:25
And through the noticing, see if that somehow, in some way, and being curious about in what
48:32
way makes the experience just a little bit more manageable.
48:39
That's it.
48:41
You can repeat that practice from time to time if you find it helpful.
48:45
This practice of noticing the variability of the intensity of your feelings, even in
48:50
the midst of feeling mild, moderately or even significantly stressed.
48:56
I hope you found this podcast and this simple exercise useful to you and look forward to
49:00
having you return and join us for the next episode of Flourishing in Medicine From Surviving
49:06
to Thriving.
49:07
If you'd like to learn more about EmPRO, please visit www.myEmPRO.com.
49:11
If you'd like to know more about EmPRO's peer support programs, visit www.myEmPRO.com forward
49:21
slash peer dash support.
49:23
If you're a physician or a medical student and you're in need of urgent support, please
49:28
consider calling the physician support line at 1-888-4909-0141 or visit www.physiciansupportline.com.
49:41
This support line provides a safe place to discuss life stressors with volunteer colleagues
49:47
who are uniquely trained in mental wellness and also have similar shared experiences of
49:54
the medical profession.
49:55
For more information about me and my work, please visit www.MickKrasnermd.com or www.mindfulpracticinmedicine.com.
50:09
Until next time.