In addition to all the fear and chaos it has wreaked, COVID-19 has changed the way we think about our health. Thanks to the psychological, and even physical, impact of protracted quarantines and shutdowns, many of us have come to realize that feeling healthy is more than the absence of disease. We feel our healthiest when experiencing positive emotions, when we feel calm and at peace, when we are connecting with others, and when we are taking in beauty with a sense of wonder.
Would it be too much to ask that our health care system explicitly prescribe a dose of what we all are finding to be true? Could clinicians shift the dominant paradigm on health just as dramatically as we are bringing vaccines to millions? Could we as patients expect more than pharmaceuticals from those who provide our health care?
A few of my colleagues and I are trying to do this now. Although I am in awe when we dramatically change the course of diseases in the hospital with technological fixes, I also feel frustrated that my patients can leave the hospital believing that health is derived from pills and procedures. With the help of the Greater Good Science Center, I and a few colleagues at Sutter Health in the Bay Area have started giving “old school” paper prescriptions to do things that we all understand are good for us and for which there is sound scientific evidence.
Here is the checklist of activities on these prescriptions—and the rationale for their use.
1. Take a few deep breaths. We all know that a deep breath helps us relax. No surprise then that decades of research have demonstrated that by taking slow deep breaths, we calm the body and mind by activating the parasympathetic nervous system; when this happens, stress markers, heart rate, and blood pressure all decrease. That’s why taking deep breaths throughout the day can help keep us calmer and more balanced.
2. Call an old friend. Groundbreaking work by Julianne Holt-Lunstad suggests that social connection’s impact on mortality is on par with blood pressure, cholesterol, and obesity. The benefits likely come from the immediate activation of prosocial emotions and the long-term benefits of social support. This might be particularly helpful for my patients who are facing challenges with their physical health.
3. Give someone a hug. Hugging releases oxytocin that helps build social bonds and lowers the levels of the stress hormone cortisol. When hugging, we also release endorphins that lead to a sense of well-being and relaxation. But does anyone really need a scientist to tell us that hugs are good?
4. Help a friend in need. Helping others allows us to meet some important psychological needs, such as developing our senses of agency and competence as we strengthen social relationships. When we act on our values by being a good friend and helping those in need, we foster a sense of purpose, which is foundational to a meaningful life. In fact, research by Stephanie Brown suggest that those providing help may get more benefits than those receiving it.
5. Write a thank-you note. Many studies over the last two decades have found that people who express gratitude are happier and less depressed. While one thank-you note is not the kind of gratitude practice that leads to lasting, positive cognitive change, I tell my patients that their notes should be the beginning of a habit of counting their blessings in writing.
6. Sing in the shower…or anywhere. Making music, and in particular singing, just makes us feel better. And this happens through several mechanisms. We release endorphins when we sing; given this, it is not surprising that singing reduces pain. Stress hormone levels fall, leading to improved immune function. We make meaning as we embody the lyrics. I often add that people should join a choir, as singing surrounded by others greatly magnifies the benefits of singing.
7. Dance to your favorite song. We all know that moving our bodies improves our health, but moving to music has additional benefits. The mood boost from dancing lasts much longer than from exercise alone. And dancing often has social benefits. There is even data suggesting dancing prevents cognitive impairment in the elderly.
8. Go for a walk in a beautiful place. We all feel better after getting in nature, yet we underestimate the healing power of these experiences. Unfortunately, many of those I take care of have mobility issues and social circumstances that make this really hard to do. I always recommend “awe walks” for those who can do them or speak to patients and their family about finding some way to get to a place where nature can have its healing effects.
9. Forgive someone. Forgiveness doesn’t mean denying we were wronged; it means we let go of our anger and other unhealthy cognitive processes. Forgiveness requires some hard work, but the benefits are profound: Those who have learned to forgive live longer. This occurs from less stress, depression, and better sleep and relationships.
10. Talk to yourself in a kinder voice. We are often our own worst critic and when our health goes bad, we can cast an unhealthy amount of blame upon ourselves. Self-compassion helps us heal ourselves rather than hurt ourselves. Talking to ourselves in a kinder voice is the key to this practice!
As I make my rounds and prepare people for discharge, I may prescribe “Sing in the shower,” “Call an old friend,” or “Go for a walk in a beautiful place.” The exact nature of each Happiness Prescription is tailored to match what I believe to be the patient’s values and passions. And I always add “Spread the Love” on these prescriptions. I tell my patients at the end of the day, there is no better medicine than love. The more we love, the better and longer we live. I encourage them to keep this idea and love in their hearts. For the more curious, I recommend practicing a loving-kindness meditation; research suggests it can help us feel more love.
Inevitably, these prescriptions are met with surprise, and often with joy. In 25 years of practicing medicine, I cannot recall any of my pharmaceutical prescriptions having been met with such enthusiasm. My prescriptions for a cholesterol-lowering drug have never ended up on an Instagram post, as my Happiness Prescriptions have been known to!
Sometimes, these prescriptions are met with tears. Ms. S.—a tall, elegant, 69-year-old woman who is battling cancer—was recently was admitted to the hospital with a urinary tract infection and weakness. During my visits, her sadness permeated the room. Depression appeared to be her biggest challenge at the moment.
“Dr. Hass, I have lost my way,” she said, after describing to me her wavering faith. I handed her a prescription to “Join your church’s Zoom Bible study.”
Tears welled up and she said, “Bless you, I do need more than chemo to make it through. Ooh! Do I need this prescription!”
The deprivations of the pandemic have led many of us to envision the selves we want to be. These prescriptions can help us clarify this idea. And they are an action plan that can offers ideas beyond what we originally might have considered. Sometimes, they just remind us of things we already knew, but had forgotten in our pain and distress. Research suggests when we act on a plan with intentionality, we change our cognitive architecture in ways that make the experiences felt more intensely.
There will be lasting social changes resulting from the COVID pandemic. Health care providers can reinforce what people learned from COVID about well-being and health—so, perhaps, a new paradigm can become one of lasting benefits of the pandemic. These Happiness Prescriptions explicitly state that such happiness-promoting activities can be as valuable to our health as the medicines we traditionally prescribe.