Synapse: Current Issue

Dr. David Sobel asked his audience in HSW 301 to raise their hands if they were primary care providers. Sparsely scattered throughout the auditorium, arms belonging to nurses, internists, doctors were lifted. “That was actually a trick question,” Sobel said, smiling. “All of you should have raised your hands.”

The seminar was aptly and enticingly named Healthy Pleasures: The Health Benefits of Sensuality, Optimism, and Altruism. As part of the Student Enrichment Series, the message of Sobel’s November 6 talk was one of individual empowerment in the health-care system – empowerment that manifests itself physically, but most importantly, mentally and emotionally.

Patients should not be viewed as passive consumers of health care, Sobel said, citing a statistic that 80 percent of illnesses are self-diagnosed and self cared for without even coming into the professional system. And when patients do seek professional care, their individual mindsets, attitudes, and beliefs can directly impact disease progression and outcome.

This theme of self-care is one that has echoed passionately in Sobel’s medical career, which began at the UCSF School of Medicine.

Now as the Medical Director of Patient Education and Health Promotion for Kaiser Permanente Northern California and the author of several books on the topic, Sobel is the first to point out the irony in his area of interest. The platform of his philosophy on preventative medicine is to educate patients to holistically take charge of their own health and chronic conditions such that they don’t need, well, doctors like him.

Sobel also pointed out some well-intentioned, but deeply engrained faults in the patient-provider relationship: “A lot of what we do is to scare people and tell them about all the bad things that can happen to them.”

Confidence and sense of control, the twins of an individual sense of self-efficacy, have been shown in studies to be the main predictor of improvement of health outcomes and accordingly, happiness.
Sobel asked the audience to rate their overall life satisfaction and happiness on a scale of 1 to 10. He then presented a list of possible life events: a new lover, increased attractiveness, weight loss, a baby, a better job, higher pay. “Here’s the good news and the bad news,” he said as the audience pondered. “None of these things will make you reliably happier.”

In the pie chart in the sky of happiness, Sobel presented, 50 percent comes from a setpoint or heredity, only 10 percent is attributed to circumstances and events, and the remaining 40 percent comes from individual thoughts and actions.

In study after study, the tangible science of intangible happiness confirms that sustained life satisfaction comes from things that are somewhat expected, yet all too limited in the modern lifestyle: vacations, naps, chocolate, sex, intimate touch. The statistics are mortally significant.

Candy eaters—mostly of chocolate— have a 27 percent lower relative risk of death than non-candy eaters. Frequency of ejaculation in men is correlated to a decreased subsequent risk of prostate cancer. (And Sobel was quick to point out that this study, which was published in the Journal of the American Medical Association in 2004, was adjusted for age, social class, smoking, and blood pressure.) Patients undergoing surgery can recover more quickly if their hospital room has a view of a natural scene as opposed to a brick wall. Simply watching a film about the selfless acts of Mother Teresa temporarily boosts immune system function.

Optimism, if it is not innate, can be something that is trained and practiced. A powerful exercise, which was characterized in a UC Davis study, is keeping a gratitude journal: the daily act of writing down three items that provide gratitude or thanksgiving. Study participants experienced a measurable increase in happiness at the end of two weeks.

“It gets you scanning your entire world and life to find these things you are grateful for,” Sobel said. Such a practice caters to the natural, evolutionary needs of human beings as social creatures — we desire what is pleasurable, we seek the companionship of others, we receive more satisfaction from giving than taking.

Lastly, Sobel catered to many in his audience and referred to the delayed gratification treadmill of the health professions, which is populated with constantly moving targets. Happiness always seems to be in the distant future: first in a good medical school, then in a good residency, followed by a good job, and finally, a longing for retirement.

“There is only one time in your life you can be happy,” Sobel said. “And that is right now. You have to populate your everyday experience and awareness with healthy pleasures.”

Synapse is part of the Office of Student Life and Student Academic Affairs.
The University of California, San Francisco, CA 94143. Copyright 2008, The Regents of the University of California. All rights reserved.