Evidence-Based Lessons on Living a Good Life

— Robert Waldinger, MD, on the important and surprising finding from the longest study on happiness


"The Doctor's Art" is a weekly podcast that explores what makes medicine meaningful, featuring profiles and stories from clinicians, patients, educators, leaders, and others working in healthcare. Listen and subscribe/follow on Apple, Spotify, Amazon, Google, Stitcher, and Podchaser.

Since 1938, the Harvard Study of Adult Development has followed the lives of hundreds, and eventually thousands, of American adults, with the goal of discovering what enables people to live healthier, more meaningful lives.

Joining Henry Bair and Tyler Johnson, MD, in this episode is Robert Waldinger, MD, a professor of psychiatry at Harvard Medical School and the current director of the study. He is also the author of the book The Good Life: Lessons from the World's Longest Scientific Study on Happiness.

Over the course of their conversation, they explore the origins and evolution of the study, what adult development actually means, whether happiness is a choice, how social media shapes our relationships, Waldinger's interests in Zen Buddhism, and the key to leading a fulfilling life.

In this episode, you will hear about:

  • 1:53 What drew Waldinger to the field of psychiatry
  • 3:31 Waldinger's reflections on the work and daily practice of a psychiatrist
  • 6:54 An overview of the Harvard Study of Adult Development, the longest running scientific study on happiness
  • 9:49 The medical and psychosocial concepts of "adult development"
  • 16:20 The most important and surprising findings of the Study of Adult Development
  • 23:07 Why relationships are critical to health and happiness
  • 29:37 How social media distorts reality and why it can be quite harmful to mental health
  • 34:48 Whether happiness is a choice
  • 43:55 The impact of Zen Buddhism on Waldinger's life and work
  • 50:02 Waldinger's advice to clinicians on leading fulfilling careers

The following is a partial transcript (note errors are possible):

Bair: To kick us off, can you tell us what first drew you to a medical career?

Waldinger: I didn't expect to have a career in medicine. And in fact, I thought I wanted to be a lawyer because my dad was a lawyer. And then I realized I didn't know anything about law. I didn't like it. And I really liked biology and science. And particularly I studied history of science as an undergrad and really got into it and then decided, okay, that's probably not what I want to do for my profession, but working with people in a way that uses science seemed like a good move. And then I got into psychiatry and really loved that. And the rest is history.

Johnson: Can you talk a little bit about what -- you mentioned it so quickly there -- but how did you get into psychiatry or what drew you in that direction?

Waldinger: It was just my gut. I just found it the most interesting thing in medicine. Like I realized that a lot of medical illnesses I didn't care that much about, like we learned about all the different types of thyroid tumors. But unless somebody I knew had that thyroid tumor, I didn't really care very much. Whereas when I was reading about psychiatry, when I was talking with patients, it was awesome. I just, I kept wanting to read more. I kept wanting to see more patients and I thought that was a really good sign about what would keep me interested through my career. So today I have three patients later this afternoon. I still love seeing patients.

Johnson: Can I ask you, this might sound like a funny question, but, you know, I think that when most of us, when we're young, we have this kind of archetype of what a doctor is, that I think is set by maybe if you have, you know, strep throat or something. Strep throat is great, right? Because you go to the doctor, there's a very clearly defined test that's either positive or negative. And then if it's positive, then we have a very clearly defined treatment, which is this, you know, whatever, 10-day course of antibiotics. And then you take the antibiotics and then you get better and then you're done. Right?

And so I think a lot of us think that that's how medicine is supposed to work. And in some cases, you know, though, it becomes more complex, and in some cases much more difficult. There are still vestiges of that even in more complicated medicine, right? If you have a blocked coronary artery, you can get a stent or you can get a coronary artery bypass graft or, you know, if you break your arm, you can have an orthopedist fix it or whatever.

Then there are other areas of medicine where both the process of diagnosis and the process of therapy become significantly more complicated. And then you have psychiatry where at least to a non-psychiatrist, it often feels like both the attempt to give someone a diagnosis and the attempt to help them get better from the diagnosis are almost never straightforward, right?

I mean, at least to a non-psychiatrist, the DSM-5 feels very, you know, "you need to have some of these and some of these, but it could be this or it could be that." And then how to help someone get better. It could be this medicine, but if it doesn't work, try this other medicine. Or maybe you don't even need a medicine. Maybe you need something, you know? So, I guess, can you talk a little bit about if it's very much not just you have this infection and here's your antibiotic, like how do you think about what you do as a psychiatrist? What is the work of a psychiatrist and how do you think about that in your daily practice?

Waldinger: Well, think about it as suffering and helping relieve suffering, right? And so certainly psychiatric conditions, mental disorders, cause an enormous amount of suffering. And we have so much that we can do to relieve that suffering, in fact, more in many cases than many other medical conditions. But what's different is that mental disorders don't fit neatly into the medical model where these defined symptoms make up this condition. And there are these treatments that often diagnoses overlap, that treatments overlap, that a treatment that works for one condition is often applicable for a certain person who has a different condition.

And so what it means is tolerance for blurred boundaries, tolerance for ambiguity, and a willingness to try and see what works. Now there's more of that in regular medicine than most of us acknowledge. But it's all over psychiatry. That said, psychiatry has a hugely positive track record in terms of actually being able to help relieve the conditions that it sets out to treat.

Bair: Thank you for sharing how you think about treating your patients. Of course, you are now most known for leading the Harvard Study of Adult Development, the longest running scientific study on happiness. So let's talk about that. Can you briefly walk us through the history and the mission of the study?

Waldinger: So, the study was radical for its time. It actually was two studies, and I'll explain. But both of those studies were studies of well-being. They were studies of normal development. And most research that gets done and certainly the research done before 1938 when these studies were founded, most research is about what goes wrong in development because we want to be able to help. And these studies were radical because they said, let's study what goes right.

So there were two studies, 1938, one Harvard University Student Health Service. They picked a group of sophomores, 19-year-olds who were thought by their deans to be fine, upstanding young men. And these were meant to be studies of normal development from adolescence into young adulthood. So, of course, you know, now we chuckle at this because if you want to study normal development, you study all white men from Harvard, like, no, we don't do that. And we're constantly having to explain to NIH why they should continue to fund us. But at that time, that's what they wanted to do. That's what the the investigators at Harvard Student Health Service wanted to study.

In addition, at Harvard Law School, they began a study of juvenile delinquency and they got a group of boys from Boston's poorest neighborhoods, but not just poorest neighborhoods, but most troubled families. So these were families known on average to five social service agencies for domestic violence, for parental illness, and substance abuse. And there was a delinquent group of boys who had already gotten into trouble by, say, middle school, and there was a non-delinquent group. And the question was, how does this non-delinquent group of boys, boys born with so many strikes against them, how do those kids manage to stay out of trouble and stay on good developmental paths?

So, that was our study. What we followed. Eventually, we took that non-delinquent group, combined it with the Harvard College undergraduate group and ended up with 724 original participants. And then we brought in their wives. And since then, we've brought in all their children, more than half of whom are female. And now we have 724 families, over 2,000 people.

For the full transcript, visit The Doctor's Art.

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