News from “Happiness” Research

The International Day of Happiness is celebrated on March 20, every year to acknowledge how important and desirable “happiness” is to people everywhere. It is now no longer an individual effort alone as policy makers are waking up and incorporating happiness as an essential factor into public policy.

This day is celebrated by various organizations such as Action for Happiness (Happinessday.org) and the United Nations.

Research and Ranking Happiness across the world.

World Happiness Report is published annually by the United Nations Sustainable Development Solutions Network. In its 2022 report published last week, it has scored 146 countries and mapped the world according to their happiness levels.

Finland has been ranked first, followed by Denmark Switzerland, Iceland and other Scandinavian countries. USA is around 19^th, and India has been placed in 136^th position. Afghanistan has been at the bottom of the list this year. This report was published before the Ukraine Russia war.

Criteria used for assessing Happiness

Some of the indices measured by the Gallup poll while surveying populations are GDP per capita, social support, life expectancy, freedom to make choices, generosity, and perception of corruption.

What makes the Scandinavian countries so happy?

Apart from the fact that these countries have low crime rates and feel safe to live in, their citizen seem to have very little to worry about. School education, healthcare, social security, are provided by the state. Parents do not have to be drive their children to compete to perform and beat one another. If one does not have a job, the government doles out enough to allow a comfortable living. Also the gap between “haves” and “have-nots” (disparity) is small.

Where is the Happiness Research Institute located?

An International academic institute devoted to studying and researching Happiness across the world, is located in Denmark, in the town of Drager just outside the Danish capital Copenhagen.

The scientists ask and try to answer questions such as “Can Happiness be learnt?”, “What are the effects of Happiness and sadness on our health and life expectancy?” and many such.

What can you do to be Happy (or somewhat less stressed) in India?

Try to smile and laugh more. Studies have shown that smiling causes release of certain neurohormones called endorphins. These are stress and anger busters and protect the brain and body from ravages of “stress hormones” such as catecholamines and cortico-steroids. Laughing also increases the levels of the neuro-hormone serotonin in the brain, depletion of which is linked with depression.

Meditation, music and yoga works well, as is the mental trick of switching off the “worry loop”.

Standing in front of the mirror, ironing out the furrows on your forehead, and generating a smile few times a day could be a simple method to beat stress and take a step towards “happiness”.

Happy International Happiness Day!

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Understanding our Minds and Moods: Cognitive Processing

Many of us keep falling short of being truly happy and relaxed in life, often due to the invisible baggage of negative thoughts at the back of our minds that anchor our moods and feelings.

Some of the common conditions such as excessive anger, anxiety, depression, guilt, hopelessness and sleep disturbances could stem from “traumatic” experiences of the past that our minds are “stuck” at that sometimes keep transmitting “negative” pulses.

A simple example could be a child being brought up to believe that the world is full of kind and trustworthy people, till one day he sees a soft-spoken elderly male relative whom he loved, ruthlessly beat a helpless dog on the street to death. This could constitute a trauma as his past belief about elderly relatives and the present cruel spectacle are difficult to reconcile. This “shock” could prevent him from “trusting” elderly soft-spoken people, and in fact cause him to feel helpless, angry and anxious whenever confronted by situations that conjure fragments of the old experience now lying buried in some part of the mind.

A new approach to identify “trauma” and resolve it could settle much of our miseries, suggests Professor of Psychiatry Patricia Resick, PhD, who has come up with a new approach called Cognitive Processing Therapy (CPT).

According to her hypothesis, once freed from the shackles, a person can see enhancement in self-esteem, intimacy, trust, safety and behavior.

While there is a plethora of counselling techniques to resolve the “past” problems, almost all psychologists and mind-therapists of different genres agree on one common denominator, that unpleasant traumatic experiences of life, sometimes perhaps in early childhood, could be casting long shadows and shaping our thoughts and feelings of our present days, and making us partly what we are.

The controversy seems to be in the approach to tackle it.

Cognitive Behavior therapy (CBT) is presently in fashion. In this method the counsellor or guide helps you identify how and what “triggers” your thoughts and emotional responses, how these in turn affect your body responses, and then your behavior. CPT is one of its parts, specifically targeting past “traumas” such as the helplessness and trauma you felt when an elderly relative contracted COVID and died without getting access to ICU care, helping you get unstuck from its persistent impact.

Most of you may not need or go on to seek therapy, but this post could help you understand how your mind, thoughts, emotions and behavior are shaped, with past “trauma” sometimes being an important factor. Leaving the past behind is easier said than done.

And if a “negative” feeling is not letting you enjoy life to its full, you may try monitoring your thoughts and their triggers.

The Second wave of COVID and Post-Traumatic Stress Disorder (PTSD)

The pandemic, especially the recent second wave, has shaken us all up so badly that even when it recedes and goes, life may not be the same gain.

Some have gone through the fever, cough and fear of death. Many saw the trauma happening to others, and shared the feeling of uncertainty and helplessness of getting a hospital bed, oxygen or medications, or the fear or grief of loss of life.

This kind of trauma affecting a large section of society, does not go away easily. It leaves behind its shadow on our moods, attitudes, relationships and goals.

Post-traumatic stress disorder (PTSD), now more specifically adapted to the pandemic as Post-Covid Stress Disorder (PCSD) is characterized by inability to return to “normal” after experiencing a terrifying event. It may last for months or years and may include flashbacks or depressing thoughts, avoidance of situations that bring back the trauma, anxiety, anger, depressed mood, inability to concentrate, and poor motivation at work.

Many people feel detached, start wondering about the purpose of achieving targets or working, stop enjoying things they once liked doing, constantly feel fearful, and fail to have fun with relatives or friends.

The three roots of the present surge in PCSD are fear, loss, and grief.

Fear has affected almost all of us: from catching the infection, to falling ill, to developing a serious or critical disease, to finding a hospital bed or oxygen, or of dying.

Loss has been common: there is hardly anyone who has not lost a relative or neighbor or colleague. And when the person has been a “not too old” or in apparent good health, it has brought the additional unexpected distressing “it could have been me” feeling.

Grief has followed loss, and made many go through several stages: from denial (“it can’t be happening to me”), to anger (“the hospital that could not provide a ventilator should be destroyed or sued”), to bargaining (“my elderly mother died but at least the children are alive”), guilt (I wish I had taken her to hospital earlier), depression, and finally acceptance.

It is estimated that one of every three of us might suffer from PCSD.

Let us not forget that a large brunt of the trauma has been borne by front line workers: apart from over 600 doctors who have died during the second wave alone, they have had to live through the nightmarish three months of attending to dying patients or breaking bad news to shattered relatives all every day.

If life has to return to normal again, PCDS needs tackling.

A simple first step is to talk, vent and unburden one’s traumatic experience and feelings to a relative or friend.

Professional counsellors are in short supply, but helplines such as those of NIMHANS, Bangalore, are super busy. They often guide and train patients to CBT (Cognitive Behavior Therapy), training them to identify the trigger thoughts, which in turn generate intense negative feelings…which then are modifying behavior).

A short course of medications for stress often helps many to recover faster. And Yoga and meditation can help calm and strengthen the disturbed mind.

Managing PCDS is being feared to emerge as the major health challenge in times to come!

HEALTY DISTRACTIONS A SURVIVAL TOOL

What does one do when the reality around gets as frightening and shocking by the day? Relatives or friends with fever, cough or breathlessness ringing up desperately seeking help to find a hospital bed, oxygen cylinders or an ICU. Or you waking up and noticing your spouse coughing? How do you live through and cope with this helpless feeling for nights and days along with the fear that it could be your turn tomorrow?

“Emotional fatigue” and “burnout” are emerging as new terms in this crisis. Several frontline healthcare workers attending to critical and dying patients every day are exhausting their stores of emotional energy. One young doctor who was continuously on COVID duty for a month, hanged himself recently, leaving behind a pregnant wife.  How do we deal with this type of frustration?

In these times, DISTRACTION, the ‘bad’ word that kept us from concentrating on studies or work, is reappearing with in a new ‘avatar’, this time with a new prefix as “HEALTHY DISTRACTION”.

There is a real story behind today’s post. Last evening a 45 year old niece called and said that she was planning to spend the evening doing “riyaz”, a local term for singing and practicing notes! I did make a “how can you, when “Rome is burning”? kind of snide remark, but soon remembered that she had recently braved her 80-year old mother’s COVID trauma and her husband’s surgery for cancer. Her tool kit for survival was certainly better than mine!

HEALTHY DISTRACTION is now emerging as a necessity to maintain our sanity. Constant “thinking” of what is going around us or wondering what might happen next, is not changing things. Nor are our feelings of fear and sadness at the devastation and deprivation of our neighbors making them go away. Sure, we must do what we can, but learn to take our “minds” off and distract ourselves for short periods to reduce the impact of continuous negative thinking.

People are using distraction to deal with pandemic isolation, anxiety and burnout. Our devices such as cellphones often come handy, as do watching TV. Music, reading, DIYs, videogames, puzzles, gardening, painting or even fantasizing could help provide that much needed “escape” in a positive way when the emotional grind gets overbearing. And we need to resort to them from time to time without feeling guilty.

Mind fullness is a very valuable technique. It requires to engage with the PRESENT: the “now and here” state rather than the fear of future or grief of the past. As does “meditation”. Both these are techniques of mind control that are helping people cope.

To survive the coming days:

1. Think about what you do when you need distraction.
2. Assess whether it is a HEALTHY distraction
3. Try something new to distract yourself that gives you a POSITIVE ESCAPE.
4. Build positive distraction habits. It is like giving the exhausted car engine of your mind a break in order to make it run longer.

Stress: Can you Perceive it in Yourself?

Many may not be knowing whether or how much stressed they are. This is often the case when family, friends or the doctor may see it in your face, behavior or clinical symptoms and suspect it, while you may not be able to recognize it and go on denying it.

We are familiar with only one of the stages of stress: the fright-flight-fight response.. If a loss of job or death of a near one seems possible or imminent, a person with average insight is usually able to recognize the animal called stress stirring, growling or whining somewhere inside you.

The second stage of stress, that of “resistance” or coping, is when one struggles and fights on, sometimes for long periods, often not realizing that a battle is still raging on. It may becomes a habit for years. This stage is often overlooked

This is when heart rate, blood pressure, headaches, bowel symptom, irregular periods or sleep disturbances could take center stage, with several rounds of visits to doctors, tests and medicines.

The third stage is one of exhaustion…as might be expected to occur after any prolonged battle that drains you.

Psychologists, led by Dr Cohen, therefore came up with a Perceived Stress Scale (PSC) to help people make a self-assessment and take control of their own stress levels before they cause problems. It can be taken on-line  www.bemindfulonline.com/test-yc.

The key questions posed are 10, but the short form with 4 key questions that you need to answer are below.

Looking back at the last month:

1. How often have you felt that you were unable to control the important things in your life?
2. How often have you felt difficulties were piling up so high that you could not overcome them?
3. How often have you felt that things were going your way?
4. How often have you felt confident that you can handle your personal problems?

You would notice that questions 1 and 2 assess negative emotions while 3 and 4 your positive coping ones, hence the way they are scored are different.

Recognizing or perceiving stress is not an admission of weakness as many fear, but an opportunity to take control of it before it causes harm and spoils your quality of life (QOL). I think every person should introspect and explore it  in today’s day and age.

Sports and our Health

With the Asian games scheduled in Delhi next year, it is time we looked at how the crowded schedule of matches and leagues are impacting our lives and health.

The involvement that most urban Indians have with sports today is to watch it on television or to read it in the papers. We love watching cricket on TV, sometimes bunking office or college to catch it live.  Many who were not veteran cricket watchers have taken to it so as not to be left out of party or coffee shop conversation. Watching games together with friends is even more thrilling, as passions rise higher with exchange of expert observations and comments. And  chips, pizzas, samosas  or nuts to munch during the matches adds that extra dash of fun that make these sessions so interesting, while making us couch potatoes.

In urban India, the focus has shifted from “playing it” to “following it”, Boria Mazumdar style. Amongst youngsters, the question is no longer “What games you play?” but “What is your favourite game?”, the one for which you might rattle figures and show off your GK.  You are expected to know  how many centuries Sachin has scored in a 50-50, even if you never held a cricket bat.  For school kids, palying computer cricket is another way of relishing the game.

It is hardly surprising then that over 10% of urban school children in Lucknow are overweight. In a study undertaken by HOPE Initiative (www.hope.org.in) obesity was rampant in elite Lucknow urban schools, and correlated well with time spent before the TV screen. It is hardly surprising then that India is becoming the diabetic capital of the world, as obese children grow up and develop this disease. Contrast this with rural schools where none of the 20,000 children surveyed were overweight and where children play their own versions of bat and ball in open fields.

The reasons for not playing are many. Duration of school hours has shotened, and the limited time available is considered to be  “better “ utilized for studies. After all, what are schools primarily meant for? Within the class too, there is a division of studious guys who get marks, and the “sports type” who get the runs in interschool meets but do not  make to the IITs. Homes are no longer homes with fields around. Gathering a group at a remote field to play cricket is not easy; traffic and security hurdles have to be crossed first. And coaching classes take up the evenings anyway – after all engineer ban na hai na?

Is participation in sports dwindling then? The answer is NO. More youngsters are playing games, but not for fun or to remain healthy, but as a career option making it very competitive.  But the overwhelming majority of our urban Indians are content  following it in the media.  Our national obsession for games has not translated into making most of our urban youngsters actaually play them. Let us welcome the Asian games!

Local Heroes make a difference on World Hepatitis Day

Mr Pradeep Kumar Srivastava, a common looking man, is no longer a common man. He has climbed roles from a devasted patient of Hepatitis B for eight years to a hero who has cleared the infection and now to an activist guiding others to prevent and treat this deadly infection. And who can be more convincing than him to tell what it entails being a patient?

The ground under his feet had shaken eight years ago when he, along with his friends, had gone for a screening blood examination in 2004 and tested positive for Hepatitis B. Although he worked in a laboratory as a technician, he did not remember any accidental exposure to blood or blood products. He had never had jaundice, and had felt perfectly fine till this test had robbed his bliss. In disbelief, he got the test repeated from three labs. All were unfortunately positive!

Advice kept pouring freely in. Some wondered how he was still alive, others said that there was no treatment and he was doomed to die, while many suggested going for alternative medicines. He was worried about his wife and small children and wondered how much time he had with them.

He however decided not to give in but to fight back. He took the long crowded road to SGPGI and after 5 hours of wait in the claustrophobic OPD hall, confronted me with the question “Is it treatable?”

Further tests revealed that his infection was not a mild one; the Hepatitis B virus was actively multiplying in his liver, and the viral load in the blood was in millions. Considearble damage had already occured, and elevated levels of the liver enzymes SGOT and SGPT indicated that liver cells were still dying.

Having understood that the treatment had to be long, he started with oral anti-viral medications. The response was impressive; within six months, his liver functions had normalized and the viral load had come down significantly.

He attended our liver clinic with determined regularity. We watched his tests improve with each six monthly visit. His envelope antigen, a marker for viral multiplication, turned negative in three years, his liver functions improved to normal levels and he started getting the feeling that he may not die soon afterall.

He learnt much about Hepatitis B, attending all our seminars and film shows regularly. Convinced that he was indeed getting better, he joined the HOPE team in our yearly World Hepatitis Day functions on July 28 over the last few years, voluntarily lending his hands in the free screening camps, rallies and road shows.

God was probably watching. This year he greeted me with a grin when his HBsAg, the last marker of infection also turned negative. “Am I now cured for life?” he asked with baited breath. He was honored this year as a champion and a hero who had fought and overcome this infection with grit and perseverance.

Intermittent Fasting

Intermittent Fasting (IF): Fad to Fact

If you are wondering how to get over that state of sluggishness, plumpness, high blood sugar and pressure, and want to get your body’s metabolism into good gear, you may consider trying Intermittent Fasting as your New Year resolution.

Abstaining from food for 16 to 18 hours a day helps restore your disordered metabolism, and aid you live longer, reveals a study published recently in a prestigious medical journal (New England Journal of Medicine, Dec 26, 2019).

The findings validate what has till now been considered an eating fad appearing in the social media, and might encourage many of the 500 million Indians suffering from diabetes, hypertension or obesity to transform their fat-stuffed sloppy bodies into robust sprightly energetic ones.

What is Intermittent Fasting (IF)?

IF requires you to abstain from food for 16 to 18 hours a day, and eat only during the slim window period of 6 to 8 hours.  This is referred to as the 16:8 diet regimes.

Another form is to eat “normally” for 5 days a week, and “fast” for two days, consuming no more than 500 Kcal/day during those 48 hours

How does IF work?

During the period of “fasting”, scientists have discovered that the body’s metabolism “switches” from burning of glucose for energy, to burning of fats and ketones. Weight loss, which is also achieved, is done not so much by restriction of total calories, but by burning excess fat during fating periods.

What health benefits does IF achieve?

This periodic deprivation of calories not only helps reduce weight, it restores insulin sensitivity and improves diabetes as well. In fact several overweight patients with diabetes ( Type 2) have been able to come off medications and insulin injections by changing the way they eat!

The benefits of IF extend to lowering of elevated blood pressure, improved brain function, lower incidence of cancers and increase life span.

Dr. Mattson, a neuroscientist and one of the authors of the study, also noted enhanced brain function in the form of improved verbal memory, as well as improved resistance to stress.

How did the idea come?

It seems to have come from observing residents of the island Okinawa of Japan, who are famed for living healthy long lives; they eat sparsely and in lengthy intervals, and consume mainly nuts, fruits and legumes.

This observation led to several studies in experimental animals and humans that have validated the benefits of this eating regime.

What are the challenges and hazards?

The main challenge seems to be to beat the hunger during the fasting phases; it takes around 2 weeks to overcome. The other is “psychosocial”. We are culturally so tuned to the idea of daily three meals and interval snacks, that the “new diet” shakes our conventional habits quite a bit!

Diabetics on insulin or medications should be careful and consult their doctors to avoid precipitous fall in blood sugar levels.

Tailpiece: Intermittent or periodic fasting has been a practice in most cultures and faith, and now science is beginning to understand why!

Wish you a healthy and happy 2020.

Depression

Public attitude towards mental disorders, especially depression, has seen a sharp turnaround from sympathy for the sufferer to one of anger, since the recent German wings airline crash in the Alps, in which the co-pilot, suspected to be suffering from depression is alleged to have intentionally crashed the plane killing 150 innocent people on board.

The topic has become a sensitive one as the suffering of a patient from an incapacitating disease like depression, evokes natural understanding, but grieving relatives of the victims of the fateful flight are justifiably full of anger and accusation for Lubiz Atrea, the 27 year old German co-pilot whom they hold responsible for what they call mass-murder.

Depression, a mental disorder estimated to affect 350 million people worldwide is indeed common and occurs in up to 20% of us. It is characterized by low mood, feelings of sadness, lack of enthusiasm and negativity. The traditional attitude of medical personnel as well as civil society has been to allow privacy to sufferers, and try and integrate them into the mainstream of life, ensuring they are not discriminated against.

And when depression kills, as it sometimes does in the form of suicide, society reacts with sympathy and concern, often blaming itself for not having been proactive and supportive enough to the victims.

Events such as the recent airlines tragedy, and the mindless killing of innocent school children in USA and Norway by depressed men are however raising uncomfortable questions on how we should respond to individuals with depression.

Permitting secrecy of their condition and treatment details to some to enable them to avoid social stigma may be one thing, but the recent outrage calling for full disclosures of medical history of personnel in sensitive jobs have their equally vocal proponents.

Depression unfortunately does not have a biomarker, such as a blood test or an MRI scan, the diagnosis being made almost entirely by self-reporting of symptoms by the patient during an interview with the psychiatrist. It is therefore quite subjective, one counselors ‘depression’ being another’s ‘normal’.

It is therefore extremely easy for prospective candidates undergoing psychological health checks to conceal their feelings and present themselves as “normal” as their disclosure may affect their employment and promotion. Further, history of having taken mood-elevators is also so common that branding anyone who has required an anti-depressant during a difficult phase of life may not justify a permanent branding.

But when lives are at stake, organizations such as airlines or defense forces are likely to come under intense pressure to screen their employees with imperfect tools.

Hopefully this should spurn scientists to look for a reliable bio-marker, such as a functional MR spectroscopy that can measure the levels of neuro-transmitters in the brain, and make a more objective bio-medical diagnosis.

Blame Transfer and Scapegoating. STOP POINTING

When Rahul Saxena (name changed) died recently of liver cirrhosis due to excessive drinking for 20 years, the family blamed the doctors and the hospital for his death. His parents did not blame themselves or their son for drinking away his health. A fleeting mention of his wife for not doing enough to stop him earlier, or his friends who gave him company every evening for booze, paled in the face of the hospital and the doctors who they considered responsible for the tragic outcome. That Rahul was brought to hospital in a critical state having vomited two litres of blood did not mitigate their fury. The 10 minutes delay in the doctor’s attending to Rahul and the one hour time lag for procuring blood for transfusion, they were convinced, caused Rahul’s death and all their problems!

In blame transfer or scapegoating, feelings of guilt, blame and suffering are transferred away from a person or group so as to fulfill an unconscious drive to resolve or avoid bad feelings. This is done by the displacement of responsibility and blame to another who serves as a target for blame both for the scapegoater and his supporters.

In this case, Rahul’s family, by shifting the entire onus of his death on to the doctor and hospital, unconsciously shifted their own sense of blame and helplessness on to others. Also, in the process, by identifying one external scapegoat, the family members found a way of remaining united emotionally.Scapegoating therefore can be seen as the perpetrator’s defense mechanism against unacceptable emotions such as shame and guilt.

Blame transfer or scapegoating is something we do almost everyday without quite realizing. When a smoker develops lung cancer after years of heavy smoking, it is the tobacco lobby at fault. If the cancer, when detected is at an advanced stage, the fault is of the first doctor who ignored that nagging cough and did not ask for a bronchoscopy. If somebody finally succumbs to his disease, then the cancer specialist and hospital are guilty for not being able to provide a cure. Everyone is guilty, except the smoker himself or his family, the people who really allowed all this to happen.

Studies have shown that scapegoating increases as the importance of religion or faith declines in our lives. It is no longer God’s will or destiny. Happiness has become our right and if we are prevented from achieving it, someone must be responsible. And as often happens in matters of health and life, doctors are the favoured scapegoats. It is a lot easier at parties to blame someone rather than ourselves, if something has gone awfully wrong in our lives or our families.

Doctors need to understand this unique need of desperately distressed patients and their relatives to want to paradoxically blame them instead of thanking them for their efforts. It is not logic but compassion that these blamers seek. And doctors need to be generous to them.