Do Good and Be Well
Tibetans doctors, old timers in mind-body medicine, offer us provocative advice: less self-concern may be healthy. For 1500 years or so, their viewpoint has been that a strong identification with self gives rise to unhealthy or impure states of mind. These in turn cause energy imbalances that manifest as physical and mental illness. The Tibetan medical model, in addition to using more conventional treatments such as herbs and lifestyle modification, endorses the development of selflessness through spiritual practices.
Most of us rove in the middle range of self-identification, with an indulgent but generally people-friendly narcissism. A rare few fall in the polar extremes of malevolent sociopathy or true universal compassion. If we take a spiritual viewpoint we see that, thankfully, it is possible to upgrade. Spiritual practices and life experience can help us gradually redefine and soften our concept of self. By embracing greater parts of the world around us, we may progress to a heightened state of selflessness with more feelings of connection, generosity and compassion toward all beings.
At first glance, a position espousing a spiritual orientation to all disease seems hopelessly at odds with Western medicine. The modern Western perspective is that the self-identification device of ego is generally not a health risk. Our reigning medical paradigm is the poster child of Cartesian dualism, with a Grand-Canyon-size mind/body split. Modern medicine holds that genes, germs and bad habits are the harbingers of disease, not mental or spiritual factors.
Yet if we look at behaviors that may reflect a lower degree of self-focus-such as community involvement, spiritual orientation, volunteering, making fewer conversational self-references-the available medical research suggests that selfless actions may have positive health effects.
Feelings of isolation and lack of community interaction have repeatedly been associated with early mortality and worse medical outcomes. Many of these findings have been attributed to the impact of less social support. Some research suggests, however, that the effects of aging are attenuated not by how much people receive from their community but by how much they contribute to it. The more selfless actions individuals reported, such as giving love and support to others, the more the individuals benefited. Some prominent physicians such as Dr. Dean Ornish (who demonstrated that coronary artery blockage could be reversed through lifestyle modification) consider social connection to be one of the most powerful factors affecting health.
Many studies demonstrate that people who consider themselves spiritual, have feelings of devotion and maintain regular religious practices are considerably more likely to be healthy. These health benefits are only partly accounted for by the effects of social support and religious proscriptions regarding alcohol and tobacco use. It’s generally accepted that the unexplained health effects are most likely due to improved mental health. Most spiritual traditions encourage acts of generosity, charity and compassion, and these actions generally give rise to positive mental states through a greater sense of connection to those around us. Such reduction in self-focus may account for some of the health effects of spirituality.
Research shows that volunteering promotes increased physical and psychological well-being (particularly in elderly persons), benefits that again are only partly explained by differences in health habits or physical disability. During and after volunteering, 95% of people reported feelings of warmth and well-being similar to those who report highs after prolonged exercise. This “helper’s high” may be the result of endorphins released in the brain and could be health-promoting.
Interestingly, males who regularly donate blood have reduced incidence of heart attacks. A controversial medical debate revolves around whether or not they are benefiting from a reduced iron load, which other research has shown to be associated with a reduced risk of heart attacks. An alternative interpretation, yet unexplored, is that the routine acts of generosity themselves may be contributing to the health benefits.
Hard-driving, time-pressured Type A personalities are more likely to have reactively higher blood pressures if they make more self-references in interviews: I, me, my, mine. In analyzing recorded interviews of research subjects in the MR. FIT trial (taped well before the subjects had any evidence of heart disease), researchers found that increased self-references were associated later with coronary artery disease and also increased the chance of death due to a heart attack. This occurred regardless of smoking status, cholesterol levels or sedentary lifestyle.
So are we getting fringe health benefits as a result of altruism, volunteerism and less self-obsession? It’s important to note that in the studies mentioned in this article researchers were not directly investigating the issue of selflessness, so from a scientific perspective this is largely speculation. Therefore the answers are, “We don’t really know yet,” and more importantly, “That’s not why we were acting selflessly in the first place.” Ultimately the truth and beauty of selfless acts resides in the fact that regardless of what future research shows about health effects, others benefit from our generosity and compassion right now.
In Tibetan society, the deep enmeshing of Buddhist spiritual values in daily life allows for a natural integration of the concept of selflessness into medicine. Western physicians face a challenge if they choose to encourage volunteering and charitable acts in the same manner that they encourage exercise or smoking cessation. Envision people striding out of the doctor’s office clutching a prescription that says (if they could read it): “Forget yourself and do good three times a day, preferably before meals.”
Doctors will have to address the paradox of patients intentionally looking for self-benefit through selfless action, or “being well by doing good”. This may not deliver the same health effects as heartfelt altruism. The key may be in selecting patients who naturally understand that “in giving, you receive”-as long as you don’t actually expect anything in return. It’s also possible that taking further small steps in generosity may lead people to have positive transformational experiences that will eventually foster a more truly selfless attitude.
It’s tantalizing to think that the central malady identified by an ancient medical system inseparably blended with spiritual philosophy could come to be recognized in mainstream medicine as a radical new definition of “self-inflicted harm.” The eventual response of society and the medical community to the growing trend in body/mind research may be one of seeing beyond our current limited scope of disease causation to an increased appreciation of the role of holism and spirituality in health. Thoughts, feelings, beliefs and behavior all contribute to the well-being of an individual-in addition to genes and germs. Those who embrace a more expanded view of health realize that the world’s sacred traditions have been telling us that for millennia.
Chris Stewart-Patterson, M.D., is assistant professor of medicine at the University of British Columbia and works as an emergency department physician at an inner city hospital in Vancouver.
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