Sriram Shamasunder You know, what we’ve experienced here with COVID I think a lot of the world lives in that space, where both life and death are very kind of immediate and not, you know, it’s not guaranteed. And so there’s a fragility that is at the center of many people’s lives and a precariousness that I think that we are only starting to understand.
You know, there’s places in India where you’ll see the mom not name their child for three months because they don’t want to get super attached to that kid because there’s a possibility or even a probability that that child might not survive. And so, I think that there’s a centering of the fragility of existence.
I had a professor named June Jordan and there’s a prompt that she would give us that was Martin Luther King prompt that said, “Only when it’s dark enough can you see the stars.” There’s a lot of truth to that, that, you know, in the midst of burnout and overwhelm and seeing a lot of suffering, you know, compassion is a flipped side of that. Otherwise, I think you can be enveloped by the darkness. So the practice of cherishing and drawing out the pieces of our lives that we’re grateful for, I think is such a crucial practice because it helps us anchor in possibility and hope in imagining a new world for ourselves and, you know, the communities that we’re serving.
Dacher Keltner One of the paradoxes and enduring truths about life is that with suffering and loss come a reverence and gratitude for the things we have.
I’m Dacher Keltner, welcome to The Science of Happiness.
Our guest today is a California doctor who spends half the year working in underserved communities around the world.
Sriram Shamasunder is an Associate Professor of Medicine at UC San Francisco, and the co-founder and faculty director of the HEAL Initiative, a group training health workers to serve in Navajo Nation and under-resourced countries around the world.
Sri joins us after keeping a daily journal where he reflects on what he has to be grateful for in his life.
Later in the show we hear what practicing gratitude can do for your mental health, and your heart health as well.
Sri, I want to thank you for joining us.
Sriram Shamasunder Thanks so much for having me.
Dacher Keltner I know there are a lot of different reasons that people are drawn to medicine. You know, the kind of the wonders of healing, the science, the clinical practice. What drew you to take your career to these underserved realms of the world?
Sriram Shamasunder I think some of it comes back to, where can you have the most meaning and purpose in your life? And, you know, sometimes I think about being in San Francisco and one floor in the hospital has more doctors and nurses than some of the communities in East Africa, the entire country that I would work in. And so, you really think of like, how do you make your life meaningful and useful? And I think it drew me to some of these places to serve. And then, I think it also, as I’ve gone along, I think one of the beautiful parts of medicine is really being a witness to really crucial moments in people’s lives, including threshold moments of birth and death and really understanding the human experience at a deeper level. And so I find myself really cherishing those moments that are difficult and profound and surprising at the end of people’s lives or sometimes the beginning.
Dacher Keltner So for our show, you chose to try a daily journaling practice where you write about what you’re thankful for, a gratitude journal. Sri, tell us what you did.
Sriram Shamasunder Sure. So, I got out a new journal, I cracked a new journal. And so trying to be at the same time every day I would just write for about five or ten minutes. Sometimes it would be throughout the day because, you know, I was on service in the hospital, I would take quick notes here and there, I was trying to just keep the practice probably once a day and for about five or ten minutes and really noting some of the things that would come kind of naturally to mind and being grateful. So not necessarily spending a whole lot of time racking my mind, but just everyday occurrences that were powerful or meaningful or just simple and beautiful that I noted down or jotted down.
Dacher Keltner You know, you did this gratitude journaling every day for the last couple of weeks. What were some of the specific things that you wrote about?
Sriram Shamasunder I got vaccinated on a Sunday. And so I wrote about just the health workers that were working on a Sunday. There’s one entry that I wrote that says for the workers who worked on a Sunday for the unseen hands, who created a vaccine in record speed, for the patients who never made it to the vaccine, for the county and public health officials pushing for equity and the vulnerable to have access to this vaccine. And I just mentioned the COVID risk to myself and how much death I was seeing, like I wasn’t, like, totally sure that I would make it to a vaccine moment. And so and then there’s everything from the evening light, magical and orange and blue, the settling of the city when everyone and everything seems to embody itself perfectly, and that was like an evening entry.
Dacher Keltner Nice.
Sriram Shamasunder And and even like the tree outside my house is a guest and is a great refuge for the many birds and the ants in the squirrels as it stretches into the sky. So just like, even like the noticing of things that I, you know, I know are in the background, but noticing just the other beings that exist with us on this planet and where they’re taking refuge in this moment.
Dacher Keltner Wow.
We know these practices of gratitude. You know, they elevate vagal tone. They make me feel more optimistic. You handle stress better. But, I’m really curious, as you did this over time, like, what arose in your mind and how did those images and associations build over time?
Sriram Shamasunder I think the most profound thing that came out of it was that the act of writing kind of carried and the act of naming the gratitudes carried into the next day and the next, where I became more aware of things in my life that I should cherish in the moment, or I need to cherish, where I became aware that, you know, when my kid is laughing like how precious that is or, you know, just walking around the block paying attention to things. And so, it was almost like a muscle was growing in terms of all the things that I kind of passively am grateful for in my life, it became more of an active thing where throughout the day when something happened, I would take it in with much more awareness. And I think that was the, almost like a coach who’s unveiling or holding up a mirror to your life. And in a way that, you know, you have these already inside of you. But the act of writing kind of drew it out more and more.
Dacher Keltner You know, William James, one of our great founding psychologists in the U.S. wrote about consciousness as a lens, you know, and I just feel so much of the happiness practices that we talk about is like you get this lens and then it starts to sharpen and you see things that come into a little bit more focus.
Sriram Shamasunder Yeah.
Dacher Keltner You know, one of the things that happens when you practice savoring and gratitude, in particular, is you, you kind of walk through the day and you interact with people a little bit differently. Did you sense any shifts in interacting with your kids or your patients?
Sriram Shamasunder Yeah, I think that was kind of a side effect that I didn’t expect, which was, you know, even in the some of the moments, you know, all of us that have young kids, my kids are now five and two it’s funny with our team, there are a lot of single people are like craving for connection. And a lot of the people with young kids are craving for some solitude.
So everybody has their challenges. And so I think like for me, you know, when my, my son or daughter was requesting my attention, you know, it’s just a slight reframe of, even though this is difficult and you want to be a little bit, have more solitude, this. It was just this sense of this moment is fleeting, so there is this awareness that all of us know. But it’s just such a practice to be like if they weren’t there, how miserable my life would be or you know, the gratitude that you have for their presence requires you to also lean into the boredom and the mundane.
Dacher Keltner Oh yeah.
Sriram Shamasunder You know, the annoying.
Dacher Keltner The sleep deprivation.
Sriram Shamasunder Yeah.
Dacher Keltner You know when I think about your medical work with HEAL and being in the places that you’ve done this work, you’re really looking at some of the hardest living conditions that humans face. And it seems counterintuitive in a sense that you would choose to do a gratitude practice in the context of that work. So what got you to gratitude coming out of this work?
Sriram Shamasunder Yeah, I think some of the oncologists or the palliative care doctors are some of the most joyful people that I know because they’re very much grounded. They’re not in, you know, an amusement park or Disneyland, of like, imagining that life isn’t deeply connected to death. And with that urgency, I think, comes a certain blessing of your own life.
I mean, one of my greatest privileges of my life and being a clinician and a doctor is to be around entire generations of health professionals, doctors, nurses, community health workers that just teach you not only about taking care and what does it mean to, like, really love a community or a patient or, you know, kind of go to great lengths to take care of underserved populations.
If we think about inequity across the United States, Navajo Nation is twenty-seven thousand square miles across New Mexico and Arizona and Utah. And it’s the size of New England or West Virginia. And, you know, to give you some statistics, it’s you know, there’s 13 grocery stores in Navajo Nation and there’s 162 in West Virginia. And so there’s a certain amount of resource, what we call it, like a resource-poor setting, but in terms of the family structure, in terms of the level of compassion and care for one another, the lineage that really ancestral commitment to their elders, it’s walking in a different way and seeing the world in a different way where you’re tied to the land and your family and your ancestors.
Dacher Keltner Yeah.
Sriram Shamasunder One of the things that’s so striking about where I’ve all the places I’ve worked oftentimes is if a mom has to go to do some work and in their home village, they will hand their child off to that’s that’s sick to the next patient over. And the community will take care of the patient. And there’s so many people at the bedside and a lot of these communities in Haiti and India and oftentimes in the US even before COVID, where there’s patient restrictions or visitor restrictions, there’s oftentimes, you know, people are dying in isolation. And so, I think that’s a profound difference, that social network and connection and the depth of not feeling lonely is massively a well-being parameter. It shapes your entire life if you have a lot of riches, financial riches, but don’t have a deep sense of social connection.
Dacher Keltner It is striking how scarcity and fragility are related to gratitude and reverence that we lose sight of that sometimes.
Sriram Shamasunder Yeah, I would agree with that.
Dacher Keltner So Sri, you’ve given us this powerful awareness of how when we journal and we write things down, it kind of shifts our thinking and shifts how we approach the world. Were there any other shifts that the gratitude journaling brought about for you?
Sriram Shamasunder I think it recedes some of the things that are not as important and elevates other things that are more important. So I would say that it prioritizes some of the things that, just by habit, that we get. We get external accolades for that actually don’t make our life any more rich or nourishing. I think it recentered that somewhat for me. And then it also slowed me down because in order to take in gratitude, I think that the pace of your life also has to come down a bit. And so I would say those two things.
Dacher Keltner What do you think is your biggest takeaway that you get from journaling about gratitude for a couple of weeks?
Sriram Shamasunder I think the act of journaling just draws to the forefront like the many blessings of my life, I think that in some ways where, you know, just being programmed in terms of evolutionarily like towards some things that make us fearful or negative sometimes in our mind, like the critical or the negative kind of arise as a point of focus. And so I think the act of journaling is a slow shift away from that habit pattern, because so much of what we can focus on, you know, whatever we focus on grows. And I think that’s very true, that the more you focus on gratitude, the more you focus on the practice of gratitude in a very active way, as opposed to, you know, in a very passive way, that muscle grows. And I think that that’s the start of what I’m seeing in my own life.
Dacher Keltner Well Sriram Shamasunder, thank you so much for being on our show, and thank you for the work you’re doing right now.
Sriram Shamasunder Thanks for having me.
Dacher Keltner How does gratitude improve health?
Laura Redwine Will that reduce our stress levels? Will it allow us to rest more and allow our hearts to rest, particularly in people who have a lot of heart disease?
Dacher Keltner More, up next.
Laura Redwine We notice the negative things in life. It wards off danger and allows us to plan ahead to avoid negative outcomes and stuff like that. So it’s kind of part of our psyche. But when people get caught up or it becomes part of their psychological framework, it can prevent us from noticing and appreciating positive things.
Dacher Keltner Laura Redwine is an associate professor in the college of nursing at the University of South Florida.
Laura and her colleagues wanted to see if having a more grateful mindset could not only improve mental health but be good for heart health as well.
They did an experiment with about 200 people who were recently diagnosed with heart disease.
Laura Redwine Either they’ve had a heart attack, they have valvular disease, or they have untreated hypertension. These can lead to a very bad outcome of heart failure.
Dacher Keltner Heart failure happens when the heart isn’t getting enough blood. In the U.S., half the people who have it die within five years of diagnosis.
Laura Redwine So we were focusing on this group because it’s a therapeutic window, perhaps, to stopping the progression to a worse disease.
Dacher Keltner Laura’s team first measured how grateful these people were.
Laura Redwine So we wanted to know whether people who naturally have a lot of gratitude, what they look like, what is their psychological profile, what behaviors are they doing? How is their sleep? What are their biological stress hormones.
Dacher Keltner They also looked at people’s depression levels, mood, and sleep.
Laura Redwine What we found was that gratitude was actually related to better sleep. They actually did have less depressed mood, less fatigue, even their behaviors for self-care, healthy behaviors were better.
Dacher Keltner And they had lower inflammation, an indicator of a healthier heart.
Laura next set out to see if she could direct people to become more grateful over time, and if that would lead to similar results.
Laura Redwine Will it allow us to rest more and allow our hearts to rest, particularly in people who have a lot of heart disease?
Dacher Keltner They asked those questions in a subsequent study.
Laura Redwine So half of the subjects were assigned to do eight weeks of gratitude journaling, where they had to write most days of the week things that they were grateful for between three and four items.
Dacher Keltner The other half of the group didn’t do any journaling. Laura’s team measured everybody’s gratitude levels before, during and after the experiment.
Laura Redwine We also were measuring their heart rate and how it might change. And then we were also measuring their inflammation. Since both of these things seem to be related to cardiovascular disease.
Dacher Keltner The people who didn’t keep a gratitude journal showed no signs of a healthier heart. But those who did had lower inflammation levels, better sleep, and less depression and fatigue.
Laura Redwine Even when people are sick or have heart disease, If they can change their perspective and look at those things, what are they grateful for? Or who are they grateful for? It’s good to call attention to those things rather than ruminating or thinking about negative things that could happen and never do or thinking about the past. I mean, gratitude also brings us, I think, into the present moment. And that’s a good thing.
Dacher Keltner I’m Dacher Keltner, thanks for joining us on The Science of Happiness.
You can try the Gratitude Journal practice or other exercises like it on our Greater Good In Action website at GGIA.berkeley.edu.
We’re launching a new initiative to explore how practices like the gratitude journal can support the well-being of nurses in particular. Learn more at gratitudefornurses.org that’s gratitudefornurses.org.
Share your stories with us by emailing firstname.lastname@example.org or using the hashtag #happinesspod.
The Science of Happiness is a co-production of UC Berkeley’s Greater Good Science Center and PRX. Our Senior Producer is Shuka Kalantari. Sound design by Jennie Cataldo and Ben Manilla of BMP Audio. Our Associate Producer is Haley Gray. Our Executive Producer is Jane Park. Our Editor-in-Chief is Jason Marsh. I’m Dacher Keltner, thanks for joining us.