The Modern Epidemic of Loneliness: Using Wisdom as Behavioral Vaccine with Dilip Jeste

The Modern Epidemic of Loneliness: Using Wisdom as Behavioral Vaccine with Dilip Jeste


(electronic jingle) – [Narrator] The Sam and Rose Stein Institute for Research on Aging is committed to advancing lifelong health and wellbeing through research, professional training, patient
care, and community service. As a non-profit organization at the University of California
San Diego School of Medicine, our research and educational
outreach activities are made possible by the
generosity of private donors. It is our vision that successful aging will be an achievable goal for everyone. To learn more, please visit
our website at aging.ucsd.edu. (mellow music) – So, I’m going to talk about the modern epidemic of loneliness, using wisdom as a behavioral vaccine. So, this is our team. It includes faculty, staff, trainees. And I’m really fortunate
and blessed by having amazing colleagues who do all the work. I just give talks, so. We have a good division of labor. (audience laughing) So I’m going to begin
with what is an epidemic and what is a behavioral epidemic? You may not even have
heard of this term before. Then I want to focus on loneliness, the risk factors, biology,
and health consequences. Next I will talk about wisdom. And finally, interventions for loneliness. Let me start with epidemics. What is an epidemic? If you open a dictionary, epidemic is defined as rapid spread of an infectious disease
to a large number of people in a given population
within a short time period. And the best examples
or the worst examples of epidemic are plague, cholera, smallpox. There’s a long list of these diseases which kill millions of people from the beginning of
humanity practically. However, with modern medicine, we now have almost eliminated
all of these epidemics thanks to the antibiotics and vaccines
that we have developed. Once the cause was identified
as some infectious agent, we could find something that could take care and remove the cause. And partly as a result of that, the average lifespan has been increasing. The average lifespan in the
US in 1900 was 45 years. Okay? Today, it is 80 years. And in a few decades,
it is going to be 90. So, doubling of the lifespan in 150 years. That’s almost unimaginable. One of the main reasons was
controlling these epidemics, both in kids and in later life. So that’s all good news. That’s that the lifespan
has been increasing, until recently, that is. For the first time since 1950s, the average lifespan in the US dropped. It dropped two years in a row. Why did it drop? Not because of plague, cholera, smallpox. Not HiV, not Zika. Not because of some new cancer. Not because of some new heart disease. It dropped because of things like suicide. Suicide rates in the US have increased by 33% in less than two decades. In 1999, if you look at the rate, the middle line shows the average rate. The line above shows the
suicide rates for men, and the one below shows it for women. Men, of course, have a higher
risk of committing suicide. But you’ll see, there is a marked increase in the rate of suicide in a short period of time, and this is across age groups, especially affecting the youth. The number of suicides in teenagers and people in their 20s
has shot up markedly. You hear about suicide at
age as young as 10 years. I mean, it’s just horrible
to even think about that. So there is something happening. Another thing that we are all aware of is the opioid epidemic. The number of deaths from
opioid has skyrocketed. In 1999, there were about
8000 deaths from opioid use. In 2017, that number had
increased to about 48,000. So, from 8000 to 48,000 in less than two decades. Underlying both the
suicides and the opioid is another epidemic,
and that’s loneliness. Loneliness has been
called a grand challenge. Loneliness and social isolation, they are related, they’re
somewhat different. I will talk about the
differences in a slide shortly. But loneliness and social isolation are called silent killers. Studies have shown that
they’re as dangerous to health, if not more, than smoking and obesity. And this has been reported
by a number of studies, including our former Surgeon
General, Vivek Murthy. And then look at the next statistic. In the US, 162,000 deaths per year are attributable to social isolation. That’s more than the number of deaths due to lung cancer or stroke. Wow. In the UK last year, they established a new
Ministry of Loneliness. And one of the main
reasons was not health, but it was actually business. They found that lonely
workers cost the economy more than two billion pounds
because of their sickness, the performance going down, leaves, and so many other things. So they have established this
new Ministry of Loneliness. And several other countries,
including Australia, New Zealand, Germany, and Canada are in the process of
doing something similar. So, what we are facing today
is not cholera, smallpox, but suicides, opioid
abuse, and loneliness. There is something that is changing and that is in recent years. Gallup does polls all over the world. And Gallup Organization, they
do pretty scientific polls of randomly selected
representative population. So they have been looking at stress, worry, and anger in the US over 10 years. Every year they do the survey. In 2008, and now this is 2018
the last survey was available. The rates of stress, worry, and anger have increased anywhere from 35% to 40%. Just imagine. So what is happening
that the whole society is affected by these
behavioral catastrophes? So why is this happening? One is rapid globalization. Now rapid globalization, the whole world actually
has become much smaller. In many ways, that’s great because we can communicate with people, any part of the planet instantly. Right? So that has provided increased
opportunities for people to travel to other places and help them. But it also means increased competition, which means more stress. Technology. It’s unimaginably fast
growth of technology. Nobody would have imagined, really. I mean, it’s hard to think about a time when we didn’t have
email, let alone Facebook, Twitter, and these have become, and this is true all over the world. In the poorest countries, cellphones are available
more easily than food. So technology has been
helpful in many ways, but also means considerable and stressful information overload. Social media. It is hard to imagine a time when we didn’t have all of this social media. And clearly they have pluses. They have brought together
people from across the world. But the minuses are also becoming obvious. They have so many adverse effects, especially on vulnerable people. Especially the youth. So the result is social anomie
with loss of connectedness. The changes in the last
20 years have been greater than the changes in
the previous 200 years. And our brain is not really equipped to handle this new change. Because the changes are
occurring every day. There is nothing stable now. It’s interesting to note that, actually there is a British
historian named Fay Alberti. She said that the word loneliness did not exist in English
language until 1800. The word that was used was oneliness. So what is oneliness? You are by yourself,
but you are contented. You are happy. You don’t mind being by yourself. That actually gives you
free time to do something. But in 1800, with the beginning
of the industrialization, the things changed and then
that L got added to oneliness. It became loneliness. And what is wrong with loneliness? What is wrong with loneliness
is it is distressing. I talked about loneliness
and social isolation. They are related, but different. Loneliness is subjective. I feel lonely. And what do I mean by that? That means I feel distressed because there is a gap between
the social relationships I want and the social
relationship that I have. For example, if I have five
friends, five close friends, I may be happy because I
have five, it’s plenty. But if I want 10, then I will be unhappy because I’m not having what I want. So, and that causes distress. And then I worry about myself, that maybe I’m not able
to connect with others. That creates fear about contacting others. And so that becomes a vicious circle and the loneliness increases. Social isolation is objective. You can measure it by counting
the number of relationships. Somebody has 10 friends,
five friends, 20 friends. That is social isolation. Say if you are on an island
where there is nobody else, or those who are in solitary confinement, obviously that is social isolation. No question about that. But loneliness and social
isolation are different. You can be lonely in a crowd. Like the students in a dorm, they’re surrounded by hundreds of students and yet they feel lonely. On the other hand, you may
not be lonely in a cave because you are contented with yourself. You don’t need others right? So, that’s the difference, but both loneliness and social isolation carry significant risks to health, and need different types of intervention. So, we have been studying loneliness in one of the senior housing communities, and we interviewed these people. People there and asked
them what does it feel like when you are lonely? And these are the quotes,
these are quotes from them. One said, “It is kind of
gray and incarcerating.” That’s such a powerful word incarcerating. “I would like to cry out for somebody.” Another said, “Just feeling sort of empty “or not really feeling
belonging to someone.” Another said “Oh, ugly. Just ugly. “I’m very silent and would be away “from everybody and everything.” And finally once said that,
“I don’t know what to do. “I’m feeling lost and not having control.” So that’s the problem with loneliness. It makes you feel repressed,
pessimistic, helpless. So, what are the risk
factors for loneliness? There was a good study of
loneliness done in Chicago. It was a part of Chicago Health Aging and Social Relations Study. So, they looked at 225
adults from age 50 to 68. They found that education and income were negatively associated
with loneliness. That is people who are
more highly educated and people who are affluent
did not feel lonely, whereas people who did not have education or who were in poverty felt more lonely. That’s not a shock of course, but they found that
racial ethnic differences, ethnic minorities felt more lonely, but that was not because
of their ethnicity or race. That was because of the association with education and income. So there is no association between race, ethnicity, and loneliness. It is the secondary things like education and income that are affected. Being married and having
positive marital relationships seem to offer the greatest
protection against loneliness. And this is a consistent
finding in the literature. Other risk factors included male gender, although that’s not
clear some studies find that women have more loneliness. Some find no difference. Physical symptoms, chronic
work stress and social stress, small social network and poor
quality social relationships. You may have friends but if
they’re really not good quality, they don’t help. The loneliness among college students. Again they’re surrounded
by other students, and yet they would feel lonely. So, this is an online survey and this is really interesting talking about the parental
relationship and social media. The students who reported more
frequent phone conversations with parents, also reported
more satisfying, intimate, and supportive parental relationship, whereas those students
who contacted the parent through social networking
sites, like Facebook or Twitter, they had higher levels of
loneliness, anxious attachment as was conflict within
the parental relationship. And of course I think here the cause-effect
relationship is both ways. If you are not close to your parents, you wouldn’t call them. You would rather contact
them through Facebook. Good relationship, you will
call them and talk to them, but then it becomes a vicious circle. So, loneliness is like other
traits neurobiologically based. In lonely person, there is less enjoyment from social interactions
and that is associated with less activity in
certain brain regions, such as ventral striatum. So there’s a blue area, where there is less activity
compared to non-lonely people. There have been several
studies of genes associated with loneliness and number of those genes are also associated with brain areas that are involved in emotional
expression and behavior. So these are parts like prefrontal cortex, limbic striatum and interestingly and I will talk about that shortly later, is that these are the same area that are also involved with wisdom, but of course in the opposite direction. There’s a large genetic
study or genomic study of loneliness in UK. Nearly half a million people they studied, and they found that
loneliness is a modestly heritable trait about 50%. Actually what is inherited
is not loneliness per se. It is sensitivity to social pain that is the inherited characteristic, and loneliness is a state
that is affected by that. So that’s why we may be
more lonely at some time. Less lonely at other time but then by and large some
people tend to be lonely, others not and interestingly, the genes associated with loneliness are also associated with heart disease, metabolic diseases like diabetes, obesity, and psychotic disorders like depression, as well as high triglycerides and low HDL, the good cholesterol. So, it is not surprising that loneliness is associated with bunch of physical and cognitive disorders. It is associated with various
cardiovascular diseases, hypertension, heart disease, depression, anxiety disorders. It would affect behavior, sleep, use of substances like alcohol, which also increase the
risk of those diseases. So, loneliness can cause diseases because of the genetic association, but also because lonely
people are less likely to have a healthy lifestyle. If you’re feeling lonely
you feel depressed, you’re not going to do physical
activity or exercise right? There is clear evidence
that loneliness increases risk for depression and dementia. Two very nice studies done in UK, the first one was an Irish
study of 5000-plus people over the age of 50. They followed these people
over a period of time and they found that people
who had greater loneliness and social isolation or social isolation, either of those, they had
a higher risk of developing major depression or
generalized anxiety disorder two years later and the second study, which is even more concerning. So, this was almost 7,000 people, who did not have dementia to start with, they were followed for six years. 220 of them developed dementia, and the risk was related to
greater loneliness at baseline, and universally with the
number of close relationships and being married. So, loneliness is not only associated with depression et cetera, but increases the risk of depression
and dementia later on. This was all bad news right? Now it’s time to think
about some good news, and there is plenty of good news. So we published a paper last year. Ellen Lee, she is an assistant professor, was first author as well
as some of my colleagues who are here like Barton
Palmer and Danielle Glorioso, were co-authors on this paper. This paper received wide publicity. It was on CNN Headline
News to BBC and so on. It was a study of 340 people in San Diego from age 27-101. So, it was almost the
entire adult lifespan, and we used a scale called
UCLA Loneliness Scale, which is perhaps the
most widely used scale for measuring loneliness. 20-item scale. We found that in San Diego
America’s Finest City right, I mean this is heaven. 3/4 adults felt lonely at some point, moderate-to-severe loneliness. And this loneliness, even moderate level, was associated with worse
physical functioning, worse cognitive functioning
as well as other things like depression, anxiety, stress so on. Loneliness and age had a relationship, which was actually weird. That it was present
throughout the lifespan but there were three peaks of loneliness. In late twenties,
mid-fifties, and late-eighties the best fit multiple
regression model identified three factors for loneliness. So, the three factor that went
in the opposite direction. The three factors that reduce loneliness were wisdom, living with
somebody that is opposite to living alone and mental well-being. And the most significant
of these three was wisdom. This is the association
between wisdom and loneliness, I’ll talk about wisdom,
how we measured wisdom. So, we have a rating
scale for measuring wisdom and we had a rating scale
for measuring loneliness. So, this shows loneliness the
higher the score more lonely and this is wisdom score. So, higher the score means wiser you are. So, people who had high scores on wisdom, on loneliness they were very low. So, they didn’t have loneliness. And the correlation was minus 0.53. In behavioral research
correlation of 0.5 is pretty high. Usually you don’t see
that kind of correlation between two different behavioral measures. So, what is wisdom right? Wisdom is a personality trait. It’s a personality trait like resilience, optimism, loneliness, but it is complex and it has different components. One component is self reflection. The ability to look
inside, analyze ourselves, our behavior, compassion, empathy
and compassion for others. Dr. Bill Mobley’s here. He is director of the new
100 million dollar compassion center that UCSD will be having. I mean it’s already started work. I’m just delighted about that. So, compassion is something
obviously very important but compassion is not
just to other people. Compassion is also for self. So, self compassion is a part of that. Emotional regulation, how
do you control your emotion and not throw temper tantrums
or go into road rage. (audience laughing) Spirituality. Spirituality is different
from religiosity. Spirituality is belief in
somebody higher than ourselves. Somebody beyond our thinking that exists which makes us feel humble. An accepting diversity of opinions, diversity of perspectives
where I have some values but I can understand why somebody else may have different values. That doesn’t mean that either of us is either stupid or evil. So, accepting the fact of
having different perspectives for different people. So that is wisdom. So this is a combination of
these traits, that’s wisdom. So, we developed a scale. The paper was published earlier this year. The San Diego Wisdom Scale. This is a 24-item scale and there are four items for
each of the six component that I mentioned previously. And this is well validated. It has already been translated
into several languages and has been used in many studies. Just to give you examples of
the sample, of the question. Now some of the questions are positive, some are inverse questions in the center. Answer is negative. “I avoid situations, where
my help will be needed.” So, this is to test compassion. If you’re compassionate, you’d
want to help others right? So, if you avoid situations
in which your help is needed, that means you are not compassionate. “Others look to me to
help them make choices.” So, that’s a sign of being
useful to the society, giving useful advice. It is important that I understand
the reasons for my action. Self-reflection think about yourself. “I have trouble thinking
clearly when I’m upset.” It’s an indication of
emotional regulation. When you’re very upset if
you can’t think about that, that’s not good. Can you control your emotions? And “I’m okay with others
having morals and values “other than my own.” So, that acceptance of
diversity of perspectives. So, there are 24 items like this. The whole scale takes about
five minutes to complete, but as I said, it is reliable
and valid as we have shown. Like loneliness, wisdom is
also neurobiologically based, and there are specific, again brain is, it’s a very complex computer. So, there is constant interaction
among different areas. So, it is simplistic to say
that these are the areas that affect wisdom. That’s not so. The whole brain is involved. However some areas are
more important than others and those areas are prefrontal cortex, dorsolateral ventromedial anterior cingulate and amygdala. An important question is, does wisdom increase with aging? And there is strong
suggestion that it does, but does wisdom do anything else? So, there is something
called grandmother hypothesis of wisdom, which says that when grandma helps her adult daughter
in raising her children, that adult daughter
lives longer, is happier, and produces more children
than the grandma did. And all three generations, the grandma, adult daughter and the children, they have greater happiness,
health, and longevity. This has been reported
in bottlenose dolphins, killer whales, species of
bird called Seychelles warbler and humans and these are papers published in the highest journal in science, such as Nature and Science. So, this is not some feel-good TC science. It’s actually hardcore science. Why it is important? The value of older people in the society. I mean most of the time
older people are thought of as a burden on the society. Talk about silver tsunami, as if it’s a disaster that
people are getting older. Actually the nature wants
humans to grow older, and that’s why humans live long after they stop being
fertile, unlike other animals. So, Darwin’s law of
survival of the fittest meant that animals would not live after they stopped being fertile. So, for humans the age of
menopause or andropause in men is about 45-50 years. So, if you live to age 90, that means half of your
lifetime there is no fertility. Why do you live that? That is because of things like this, the Grandmother Hypothesis of Wisdom, that we don’t produce children, but we help the younger
generations be happy, healthy and more fertile
than the earlier ones. So, the finding I
reported about correlation between wisdom and loneliness that was in 340-some San Diegons. So, whenever I present
any data from San Diego, people from other parts of the country they say oh they’re San Diego population. That’s California, that doesn’t apply. So we recently did a large study using Amazon’s Mechanical Turk. This had 3,388 people
from across the country. And we used the same scale
for loneliness and wisdom, and look at this. Same correlation minus 0.51. So, even in the general population, we are seeing the same
inverse relationship between loneliness and wisdom. And then we are just
embarking on a new study. Danielle talked about that. This is called CIAO. CIAO stands for Cilento
Initiative on Aging Outcomes. So, this is a wonderful collaboration between UCSD and University of Rome. Dr. David Brenner our Vice Chancellor, is, be on the San Diego side and Dr. Desoma cardiologist
and ER physician in Cilento be on that side and there
are a number of us at UCSD who are involved in the study. So, we began with a small
pilot study of 29 people over the age of 90 in Cilento, and their 51 children aged 51 to 75. We found that those adults over 90 had better mental well-being
than their children although there was physical health. And we did qualitative interviews and this is another paper that caught wide publicity everywhere. So, this study reported that
the Cilento nonagenarians had more positivity, they worked hard, spirituality and religiosity, bond with family, religion and land resilience and stubbornness. That stubbornness
elicited the most interest from the media. People said oh my family,
stubbornness runs in my family and that’s good news for me. So, recently we started
a second study this. And this study now is focusing
on loneliness and wisdom. So, what we did was, we, this two scale that we
have been using here, UCLA-3 Scale and San Diego Wisdom Scale. These were translated into Italian. We had two medical students
from Rome who came here, spent three months of internship with us. They translated these into Italian, back translated into English,
retranslated into Italian. So, it’s a really well done study and this is what we found. So, these are the Cilento people. Younger ones 50 to 65, and then over 90 and this
is a San Diego sample. There are some slight differences but they are not significant. So, this shows the mean
and standard deviation. So, the point here is that in an entirely different culture, and by the way, the Cilento
population is mostly rural. And they’re much less educated
than San Diego population. Only about 10% in that population
has any college education, whereas in San Diego,
our study, SAGE study, Successful Aging Evaluation, about 90% have some college
education even one year. So, the education and
being from rural parts, does make a difference but still the basic concept do not seem to be different supporting that
they’re biologically based. So, that is loneliness, this is wisdom. Again similar thing you’ll find that there is not a significant difference among these groups, but the main finding was again this loneliness versus wisdom. So, these are four group. These are the Cilento 50 to 65, Cilento nonagenarians, San Diego 50 to 65, San Diego nonagenarians. Same thing everywhere. Inverse correlation between
loneliness and wisdom anywhere from minus 0.522 to minus 0.755. That is huge. That is huge for any study, especially for a behavioral study. So, what this means is that
there is something we can do. Wisdom is a potentially modifiable trait, and that’s what makes this
interesting and positive. So, the last part of my talk is then what can we do for loneliness? So, the American Academy of
Social Work and Social Welfare and I give them a lot of credit. Starting in 2015, they started
talking about loneliness, what an epidemic and what
a social disaster it is. So, they have started a
campaign to end loneliness. They’re focusing on older age. However, loneliness is not
restricted to older age. Loneliness is common across
age group including children and adolescents and others. So, the interventions
are of different types. So why are people lonely? Because they have sometimes difficulty in establishing social connection. Sometimes you try something
that doesn’t work out. You go to a party, talk
to a couple of people. You come out and you feel
terrible about yourself. I really didn’t connect with others. There’s something wrong with me, and so that is maladaptive
social cognition, because if you carry that feeling, then it becomes a vicious circle. Then you are less likely
to talk to others right? And then that reinforces
your feeling of being lonely and socially isolated. So, how do we address that? So you have to do something
like cognitive behavior therapy. Actually Dr. Eric Granholm, who is here, he has done pioneering work in this area of cognitive behavior therapy, improving the social
skills and this can be done in different ways. You can teach people, you can have them practice in a group. You can have role models, play-acting, and number of different ways
in which you can do that. Increasing the opportunities
for social interactions. This is important. Right now we are doing several studies with senior housing
communities in San Diego, and the senior housing communities, there are continuing care communities, independent living, assisted
living, and memory care. At many of these independent communities, independent living communities, there are a number of social interactions. They have a common dining room. They have a gym. There may be movie theater. So, there are opportunities
for social interaction but not everybody uses them. So, you need to make sure
that you can talk to people and see that they find those
opportunities useful for them and enhancing social support. Really one cannot
exaggerate the importance of social support. One of the best protectors
against things like depression and dementia is social support, which leads to
intergenerational activities. Peter Whitehouse, who is here,
has done some remarkable work in this area. There is a study that was
done number of years ago that was funded by MacArthur Foundation that’s called Experience Corps. What they did was they
took some older adults over the age of 65, who had retired and they have to agree to
spend at least 15 hours a week in a public elementary school in downtown. So, these are the schools
where most of the kids come from socioeconomically
disadvantaged backgrounds. They don’t have grandparents. Sometimes not even functional parents. Overcrowded classrooms and really not much attention given to them. So, these older people had to
spend at least 15 hours a week working as mentors and tutors to enhance their literacy development, the reading, writing, arithmetic but also behavioral management skills. If a kid didn’t do well in math in one exam, why did you not do well? Maybe you don’t understand
or you don’t tell the teacher that you had some problems. How do you manage that? After one year and actually
they had a control group in the study, which of older adults who did not have these
intergenerational activities. So, in this school these kids’
grades went through the roof. They did very well in their classes. They were also very happy, but importantly the older
people and this is remarkable. Their mental health
improved, not a surprise. Physical health improved. What is interesting is
that biomarkers of stress and biomarkers of aging in
blood and urine improved compared the control group, and the most amazing thing is
the volume of the hippocampus on brain MRI was larger in these people than in the controls. Hippocampus as you know is
the area that is responsible primarily for memory, but one of the most important areas for memory. And that’s something that
is affected in a major way in Alzheimer’s disease
and many other dementia. So, just think about that, this
intergenerational activity, I don’t think it increased
the volume of hippocampus. What it did was it prevented the decline that occurred in the control group, but even that is remarkable. Another intervention would be converting the loneliness into onliness. In the sense that if you are
alone what’s wrong with that? That actually you can allow yourself to check in with yourself because that’s a time that you get for yourself, which it doesn’t happen too often right? It makes you think. You don’t have to do
anything else but think. It helps you enjoy time alone, inspires to get active, pushes you to reach out and opens up your creative side. So, if we could help
people when they’re alone, not to feel distress and not to feel that there is something wrong with them, that if they are alone that means they don’t want to be with
them, that’s not the case. It is their choice to be alone. And then they’re going
to make the best use of the time alone. If you take that perspective, you’ll find that it is much more useful than the distress and
depression and anxiety that go with loneliness. So, wisdom, so how do we use that wisdom for reducing loneliness because they go in the opposite direction. If you’re wise you’re
not likely to be lonely, so the question is how to, can you become wiser? Is wisdom something you are born with and then stay stable? The answer is no. Wisdom is a potentially modifiable trait. Unlike IQ, IQ you can’t change too much. I mean you can change some
through better teaching, better support but you can’t increase it. Wisdom on the other hand,
so actually Ellen Lee and we recently reviewed the
literature on interventions to increase components of wisdom like emotional regulation,
spirituality, compassion and there are randomized control trials that show that you can do that. In real life what we
want is practical wisdom, which means making wise
decisions on a daily basis. You’re not talking about big
decisions that change life. Talking about small decisions, how long do we take to go to work? Then how do we interact with this? If my paper is rejected,
what do I do to deal with it? How do I start people? So, these are the sort of small decisions that don’t change your life,
but they are important. If every one of those decisions
can have self reflection, emotional regulation, with contentedness, empathy and compassion
including self compassion, decisiveness while accepting
diversity of perspectives, and spirituality, if you can
incorporate these elements into almost any decision, you will be much happier. And it seems like too much
work and how can we do that? Well it’s a question of just
making it a habit right? Once it becomes a habit, so every time we become
very annoyed and angry, there’s the time to
think about controlling the emotions for example. So if we practice that things will change. The first step in the
process of becoming wiser is honest self-reflection. I talked about those different
components of wisdom. I don’t think there is anybody or probably there are a few people but most people are not
great in every one of those. For example, my wife is
much more compassionate and impressive than I am. So, on the other hand, I might probably be somewhat more decisive when it is needed. So, I need to find out where
I’m strong and where I’m weak and I need to focus on the
things that I need to increase, but ultimately wisdom is a balance. None of these things in extreme is good. For example if I’m very compassionate, I would give away everything I have, and then I won’t have enough to survive. If I’m too self reflective
I spend all of my time just thinking about myself, then I’m not very productive right? If I’m too accepting of
different perspectives then I will not have my own perspective. That’s not good. If I’m too emotionally regulated, I become like a zombie or a robot right? So, what is required is
balance and we need to find out where we need that balance more, then we focus on those areas. Self-compassion. Again everybody knows
the importance of empathy and compassion, but it’s
interesting that people who are compassionate to others sometimes are overly self-critical. If my friend does something wrong, I said that’s okay everybody does that, but if I do that wrong, I have sleepless nights
and why did I do that? Why didn’t I do something better? And the common situations are interview and you go for a talk, date, party. Let’s say I’m giving this talk. After the talk I’m sure
there will be some questions, and there may be one or two question that I don’t answer well. Then I can go back and just
keep on thinking about that that those questions I
just didn’t answer well. What did I do wrong? Instead of thinking about the overall, actually the whole evening was great, I got to meet with wonderful people, and I had great time. So, how do you do that? So one is self kindness. So, instead of being too
judgmental about self and too critical about self, we need to be just as I
would be kind to my friend. If my friend came and
said that he gave a talk, that he couldn’t answer the question, I’ll say “Don’t worry, who
will remember those questions “and your answers next day?” but I need to tell that to myself right? Another is mindfulness,
in which I say okay I’m feeling somewhat anxious
or sad about something or I didn’t do well, but there’s okay I will get over that. And sense of common humanity. Everybody does it. Tell me a person who hasn’t
made a mistake right? So, I’m one of them. So what is important is
again self compassion, again to some extent. Some people have too
much of self compassion. That becomes a problem. They need to be compassionate
to others right? Emotional regulation, road rage. Common problem in California right? On the highways, you’re
going, you’re late to work, you’re rushing and somebody
just cuts in front of you. You get so mad. How could he do that? And start honking, start cursing him, and shouting, screaming,
and you lose it right? So, what do you do if
something like that happens? I mean it is stressful
somebody cut in front of you because that slows you down. You’re going to be late. One is deliberate effort
to reinterpret the meaning of a distressing event. So, you think about why that
person cut in front of you? It is not because he was
just trying to overtake you. Maybe because there was a child
in the backseat of his car and maybe the child suddenly had a seizure or the child threw up
or the child something seriously happened. If you were the parent,
wouldn’t you do the same thing? You would rush to go to the
emergency room or someplace. So, what is wrong with that? So, that sort of rationalize
the motivation of somebody else right who did that. And there is distraction. Change the focus, don’t
think about the driver, increase the volume of the radio, think about or the music you like, and focus on that or just label. Just say okay I’m feeling angry at that, and that’s absolutely appropriate, because somebody cuts in front of me, but that’s okay, I’ll
get over this emotion. I will move on. This happened. So if we do that once, twice, thrice, then slowly it will
become a second nature. In the last few minutes,
I want to talk about sort of broader implications. I mean I started the
whole talk by discussing these behavioral epidemics, and what’s happening to the society that the level of stress, anxiety, depression is increasing. Suicides are increasing. Opioid abuse is increasing. Social isolation is increasing. And all these are killers. They don’t just make you feel bad. They’re killing people and that’s why the average
lifespan has dropped. It’s unimaginable, that with all the modern medicine we have, it has dropped and that’s
because of this thing. There is something wrong, and this is not just you, I mean this is globally what is happening in the last two decades right? And more so again in the last few years probably 10 years, four years whatever, and we saw that that is what is causing actually these problems and
yet we are not aware of that. And there are reasons, like globalization,
technology, social media. They are not going to go away right? The question is how do they adjust to them and how do we help our brain get used to this rapidly changing
society in the face of anomie? And especially we need to focus on youth, because that’s where the
biggest problems are. As I said the suicides are
increasing in teenagers, and people in their 20s as young as now 10 years. So, what is needed is wise
parenting and grand parenting, and number of studies have shown that actually wise parenting
and grand parenting reduce the incidence of later life psychosocial and health problem, including physical health problems. But of course parents need
to serve as role models. The parent can’t throw a temper tantrum and expect the child not to do that. Family discussions at dinner, and family discussions which
are not to criticize somebody oh yes you did something wrong. Not like that but sort
of how should we function or when something works well, how did it work well? What did we do right that we can do at other times? Clearly working with the
school teachers is important because then the teachers and the parents they’re conveying the
same message, same way, and intergenerational activities. Here I cannot overstress the importance of intergenerational activity. They’re useful for both generation. The kids need that because
they need the wisdom of the older people. The kids there are lot of energy but their concentration is not very high. They’re distracted and when
they see wise person come they can go, he can or she can
help them solve the problem, that’s much better, but for older people also. I mean if you talk only
with other older people, who are complaining about
their physical ailments, and how the society is going down, I mean it looks very depressing. It’s great to have some kids
who have a lot of energy, enthusiasm, excitement. They’re doing something. So, that becomes infectious right? So, we can help each other younger and older generations. And going beyond childhood, workplace, the number of suicides is
increasing in medical students, law students, engineering
students, or in physicians. This has become a major
problem on the medical side. Medical students as well as physicians and one of the reasons for actually, or one of the main parts
of the compassion center that Dr. Mobley is heading
is some well-being training for the medical stores and
not just medical students. I mean this needs to, this applies to undergraduates
and graduates and others too. I think the problem in what
we do today is in schools we focus on three R’s, reading, writing, arithmetic, and professional schools
we focus on hard skills. For example, your teach ’em physician, physician to be, how to be
good at diagnosing illnesses and in treating them? So, we become experts in looking at an MRI and exactly localizing the lesion and then exactly deciding how
much radiation would we need. That’s great, I mean that’s our job and we got to be able to do that. But aren’t soft skills also important? Things like compassion, compassion about the patients, regulating your emotions. Physicians get upset
if the patient did not take the treatment properly, forgot to take his medication. How could you do that? You’re supposed to do that. Again we need to control our emotions. We need to self-reflect because physicians also are
patients at other times. How did we handle that and should we not give the
same courtesy to the patient? So, the soft skills and the soft skills also include self compassion. And medical students again there is, sometimes there is too much self-criticism which becomes a problem that leads to increased risk of suicides. So, the soft skills of
emotional regulation, compassion, self-reflection, spirituality, those are also needed to be transmitted. And where should be done? Professional schools, businesses, and last one, politics I
put a big question mark. (audience laughing) That I can only hope. So, we know that the
traditional infectious epidemics that require antibiotics and vaccines. So the behavioral epidemics
need behavioral vaccines. Behavioral vaccines like resilience, the ability to handle stress, overcome stress, cope with
it and not just cope with it but survive and grow from that right? Post-traumatic growth instead of post-traumatic stress disorder. Social support. Again this value cannot be overstressed. There are something like 150 studies of social engagement and social support that have been published that show that social
support increases longevity with an effect size that is equal to or greater than using statins, stopping smoking, and doing exercise. So, social support is one of
the best medicines we can give. And last but not least,
of course, is wisdom. I mean just think about that. If most people had self-reflection,
emotional regulation, compassion, empathy, accepting,
diverse perspectives, decisiveness, social advising, we would not have these
epidemics of suicide, loneliness, social
isolation, and opioid abuse. So, that’s my last slide. So, what we are trying to do we hope to do at CINE Institute with all of you as partners in that is making the stressed lonely and pessimistic society happier, healthier, and wiser. Thank you for your attention. (audience applauding) (pleasant music)

3 thoughts on “The Modern Epidemic of Loneliness: Using Wisdom as Behavioral Vaccine with Dilip Jeste

  1. People, get a load of this… The academic world as a breeding ground for gurus. Why not introducing a brotherhood in freemason style?
    Pay thousands for degrees in spiritual tyranny and become part of the club. So positive!

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