Key Benefits

• Parity for mental health and substance abuse services. As it is now, when you see a mental health provider, your insurance company will probably pay him or her less for your visit than they would pay your GP or specialist for a similar service. They might require a higher copay from you for a mental health service than a GP visit. They might limit your total annual or lifetime benefits for mental health services. For instance, I have many chronic depression clients who need year-round supportive therapy, but their annual benefits run out in August or September. Most patients have to pay me a $30 or $40 copay from their own pockets, rather than the $10 or $15 that their GP charges.

  With a reform bill, private insurers would have to end these practices. That will make it much more possible for patients to receive the care they need without added expense. It will also make it possible for patients who need medication to see a specialist, and not have to rely on the family doctor to prescribe medications he’s not really expert at. Eventually, it may lead to more practitioners entering mental health, a real benefit because credentialed providers are in short supply.

• No discrimination based on pre-existing conditions. The fact that insurers currently can, and do, refuse to insure you for pre-existing conditions is one of the major factors that keeps consumers tied to their jobs. It also forces them to contort themselves anxiously through COBRA plans and sensitive negotiations with their employers to stay on their old plan. And of course the old plan currently is still free to let you go, cap your benefits, or charge you a higher rate for those pre-existing conditions.

  This doesn’t hurt only mental health consumers, of course, but also those with cancer, heart disease, diabetes, or any other chronic or recurring illness. The current policy thus causes a great deal of stress for many, many consumers, which hopefully will be greatly eased by the new legislation.

• No rate changes based on health status. With reform, insurers will no longer be able to raise your rates because you develop a chronic or expensive condition. All subscribers in the same age group will pay the same rate.
• Greater availability of insurance, at lower cost. Though the details haven’t been worked out yet, a major goal of all the bills is greater availability of individual insurance plans to people who can’t afford health care now. Many people with mental health disorders such as long-term depression are not able to sustain themselves in challenging or stressful jobs, resulting in poverty or underemployment. The current economic collapse and the fact that insurance rates keep rising more than twice as much as the general cost of living has put health insurance out of reach for many. Reform is meant to make insurance much more available.
• Expansion of Medicaid. Medicaid is the government-run health care plan available to the poor. It’s a program that works well, and though there are some problems they are nothing like the problems with private insurance. The bill would basically expand the definition of the poor to include more working-class, low-income families. The fact that so many households have parents working two or three part-time jobs, none of them providing private insurance, means that Medicaid expansion and the greater availability of low-cost private plans will take a tremendous worry off of working people’s backs.

These are all great steps forward, especially for everyone who sees a therapist or takes an antidepressant or other psychiatric medication—or needs to. However, the devil is always in the details.

In this article, we’ll discuss three specific skills to practice to raise your happiness level: reducing unnecessary misery by learning mindfulness, experiencing more joy, and finding greater life satisfaction through strategic goal setting.

Learn to be More Mindful

Much unnecessary misery comes from mindlessness: the frantic, hypervigilant frame of mind that has us always rushing to cross to-dos off our lists, in a hurry, not listening, not concentrating, distracted, not fully present. Greater mindfulness will reduce that misery. There are two components to mindfulness. First of all, there is mindful living, which means deliberately cultivating a new attitude toward your thoughts, feelings, and experience — an attitude of openness, compassion, and objectivity; a deliberate effort not to be guided by old habits of thinking and behaving but to see each experience in its uniqueness. Then there is mindfulness meditation, which is a specific kind of meditation practice, used both as a means of achieving mindful living and for other benefits.

Mindful living helps you see that all the thoughts and feelings in your mind are to some extent just a passing parade, which you can observe from a little distance, without getting caught up in. You develop a part of your mind that doesn’t get swept away by the urgency, that hangs back and keeps the larger picture of yourself, your goals and values, in mind. As you grow more and more mindful, you’ll find that the burden of unnecessary misery in your life is greatly reduced. You will have an easier time not acting on impulse or being tricked by your brain, so you don’t get as angry, hurt, or depressed as you used to. Your analytical skills will be much more effective because you’re no longer judging automatically and seeing the world as only a series of stereotypes. You get better at looking underneath the surface and seeing things as they truly are. You start to make decisions that are based on your rational thinking and your intuition. These are wiser decisions, that will help you stay out of trouble and lead to greater self-esteem, better relationships, and more happiness.

Mindfulness is developed through practice. When you feel yourself rushed, slow down; when you feel anxious, take a minute to calm down; when you’re about to say or do something impulsively, just stop, take a few deep breaths, and do something else. It sounds like inane advice — it sounds so easy to say, but it’s difficult to do. That’s why you have to practice, because each time you practice, you’re breaking an old link between nerve cells in your brain and building a new one. You will get discouraged, you will feel like you’re not getting anywhere. But I guarantee that if you give this an honest effort every day for three months, just like the jugglers you will change your brain so that staying mindful will be easier.

For those who can take mindfulness a step further and practice regular meditation, the news about mindfulness potentially goes far beyond the obvious benefits of clear thinking, wise decision-making, and emotional centeredness. New research is showing that mindfulness meditation practice actually rewires our brains and builds new neural pathways. It promises to heal the damage of stress so that we are able to experience a greater degree of pleasure. Mindful meditation practice affects how the brain deals with emotions, leading to an increase in activity in the area where the brain processes positive feelings and controls negative feelings, an increase that lasts even when we’re not meditating. It seems that the more we practice this effect, the easier it gets; we learn to control disturbing emotions like we learn to ride a bike; after a while we don’t have to think about it, it just happens.

Pay Attention to Joy

Joy, the immediate and spontaneous experience of pleasure, requires special attention because there is so much going on in today’s world that interferes with our ability to be attentive to how we feel right now — and if you can’t do that, you miss a lot of happiness.

The simplest, but most important, message about happiness is this: WAKE UP! There is spectacular beauty all around you. Miracles are happening right under your nose. Compared to our ancestors and most of the people in the world today, we live a very comfortable, pleasant existence with great freedom and many opportunities. Don’t let it all slip by unnoticed.

One reason why we miss out on so much possible joy is that we rely too much on short-cut thinking, an inevitable result of today’s hurry-up world, especially for doctors who are trained to make quick decisions. Whenever we see a familiar object, like a flower, there are actually two processes going on in the mind at the same time. Our eyes perceive an object of a certain color, size, and shape, and transmit that information to the brain, where the higher cortical layers get busy trying to identify the object. We know what a flower looks like from all of our previous experiences with flowers. The higher layers send a message down to the senses saying essentially I got it. This is a flower. You don’t have to pay attention any more.

That’s fine if we’re weeding the garden; our minds can skip over all the details of the flowers because our purpose is to find weeds. But if you want to experience more joy, you have to break that habit and pay attention to the glorious detail of our experience. The problem is that 21st century life has us so busy that we’re always in weeding mode. Got to rush through the garden like every other task we have. We have to slow down and pay some attention to the sensory part of the brain—Look at that flower! What colors! What beautiful complexity inside! Smell it, touch it, taste it!

When we’re stuck in an overstressed state, all we’re likely to see of life are those shortcuts — including those of our children, our lovers, our bosses. Instead of seeing complex individuals with all their own feelings, we see only our stereotypes of them. Instead of appreciating the senses, we dismiss them as nuisances. Wonderful things in life zip by like cars on the Interstate. We have to learn to relax and slow down so that we are able to see beyond categories into the true novelty of our child on this day, at this age, with this expression on his face, with this concern.

We dismiss things as small or everyday when, if we focused, we might find ourselves in a state of intense pleasure. One good friend of mine puts sitting in the sun with her dog in her top ten pleasures in life. Another likes a really good grilled cheese sandwich. Why don’t you make a list of the top ten things that make you feel really good?, and then spend more time at them, savoring the experience.

Set Realistic, Achievable Goals

Having realistic, concrete, and achievable goals that still challenge us to do our best may be the single best avenue toward greater life satisfaction. Research shows us that the mere act of setting reasonable and concrete goals seems to improve both our experience and our performance.

For instance, if you have a major project to do, you’ll do much better if you can break it down into pieces and organize a timetable. You’ll feel much better as you attain those little goals than if you just work on this piece or that when you feel like it. Making a commitment focuses our attention on the target and helps us think more intently about how to get there. There is a lot of research to suggest that we feel happier as we are progressing toward our goals; we have a sense of purposeful involvement, we give ourselves mental pats on the back for being so good and industrious, our self-esteem is enhanced. And being such adaptable creatures as humans are, we can even fail to meet a goal and still benefit greatly from having pursued it, and get over our disappointment rather quickly.

Having goals frees us to enjoy the here and now. If we set out on a journey without purpose or direction, every fork in the road becomes another decision to make, another point where our ambivalence and anxiety can overtake us. Will the scenery be better this way, or that way? Have we gone too far? What if there are no motel rooms? Should we stop at this battlefield, or that old cavern, or the antique center? But if we know where we’re going, our minds are saved all this hassle and we sit back and enjoy the ride. Same thing if you have a major project at work, or are writing or creating, or are learning something. Many of your daily decisions are taken care of because you know what your priorities are.

People who make realistic plans, who save for the future, who pursue tangible and concrete goals, who use practical methods for attaining their goals, who build productive and supportive relationships, are obviously at an advantage compared to those who are pursuing impossible dreams or following the whims of the moment. Their lives will turn out better, and they’ll be happier. They’ll also grow in feelings of autonomy and mastery. You’ll be more successful, on your own terms, and you’ll keep growing in competence and self-esteem.

Richard O’Connor, MSW, Ph.D., is a psychotherapist in private practice in Connecticut and Manhattan and is the author of four books, the latest just published. Entitled Happy at Last: The Thinking Person’s Guide to Finding Joy (St. Martin’s), the book reviews why it is so difficult to find happiness despite material wealth, and guides the reader with a clear roadmap toward solutions for these problems, grounded in the latest scientific research.

Time magazine tells us that 44 percent of physicians say they are “very happy,” a significant difference from the 67 percent of clergy who say they are happy. Doctors are right down there with lawyers, accountants, and dentists. But I have a hard time believing that 44 percent anyway. I’m a psychologist, and I know a lot of doctors, many of whom are making plans to leave the profession ASAP.

Some of this is a reflection of world-wide trends. Though physicians generally make a decent income, in the last few years there’s been an increasing recognition — and good research evidence — that advances in personal prosperity may actually lead to unhappiness. In fact, in the United States and Europe, over the fifty years since scientists started measuring personal happiness reliably, people report that they are less and less happy every year, although personal wealth continues to increase. As other nations become more Westernized, and prosperity spreads around the globe, happiness declines as well. At the same time, psychology has for the first time begun to look into what really does make us happy. Unfortunately for physicians, the news is not all good. There’s a lot that accompanies the medical profession that science can now prove will add unnecessary misery; but now we’re beginning to understand what we can do about that.

You have to start with the recognition that happiness isn’t normal — humans aren’t naturally wired for it. We can get happy when good things happen, but it’s very difficult to maintain that feeling. Humans are wired to be able to feel good when good things happen, but the feeling never lasts. That process is in our brains where our genetic heritage put it. The cavemen who liked to linger contentedly around the fire were more likely to get eaten by the bears, and thus were not available to be our ancestors. Instead, those who survived to be our ancestors were alert, competitive, never satisfied, always on the move — and we’ve got their genes.

Bottom line: Your brain really doesn’t care whether you’re happy or not, as long as you survive. Doctors tend to have a surfeit of those competitive, hard-driving, perfectionistic genes, and that places them at a special disadvantage.

The Hedonic Treadmill

Then there’s what some call the Hedonic Treadmill. The greatest myth of human life is the belief that I’ll be happy if I just get what I want. All the research shows that as soon as we get what we want, we’ll just want something else — but we seem doomed to keep forgetting this. This is another evolutionary gotcha; our brains trick us into doing what’s good for species survival by making us believe it will make us happy. The things we crave — money, power, success, beauty — in the old days would have put us in a better position to pass on our genes; in fact, they still do a little. They don’t make us any happier, but we have real trouble learning that, because our genetic heritage, expressed in the unconscious, is so powerful. How do you manage to stay happy with a brain like this?

Staying happy is also more of a problem these days because our society has broken up our most of our means of security — meaningful work, close-knit families, a supportive community, a sense of religious belonging. It’s replaced them with more of the same fruitless values we just discussed (money, power, etc.) but at the same time made those things harder to reach. Despite the growth in overall wealth, most Americans today are working 25 percent more hours than they were 25 years ago simply to stay in place economically. Hard to be happy if you’re only treading water with no land in sight.

Vulnerabilities to Happiness

Doctors may have gone into the profession with higher values — to be of service, to be part of a respected community — but medical school debt and the need to squeeze in eight or ten patients an hour will erode those values pretty quickly. Your idealism has no place to go, and you become kind of cynical. You begin to feel that you’re working for Big Insurance while being manipulated by Big Pharma and scrutinized by Big Brother, and you lose the autonomy that used to go with the practice of medicine.

Doctors have other vulnerabilities to unhappiness. They tend to be pessimists — they’re trained to look for every little thing that might go wrong with patients — while happy people tend to be optimists. Optimists tend to believe that people are basically good, while doctors come in contact daily with some of mankind’s least attractive qualities.

Happy people get by on some protective illusions. In one experiment where subjects were told to play a video game (but their game controller did not actually affect the action on tte screen), optimistic people went on playing happily for some time, while pessimists would soon turn to the experimenter and complain that the joystick is broken. It’s a more realistic, but less happy, way of life.

Doctors are trained in critical and objective thinking. Happy people tend to overrate their own performance in virtually anything they try, while doctors turn all that critical thinking on themselves. Doctors tend to be perfectionists, a major obstacle to happiness.

There’s also the overwork and isolation that goes with the profession. Managed care has made it so that you have to zip through your patients so that you only have a little time to spend with them. You don’t get to interact with them as people, and perhaps the quality of your work suffers. We know that autonomy, control, and pride in your work are essential to satisfaction in any career — and doctors are losing the battle on all three fronts. You get used to making snap judgments — and if you carry that tendency over to your family and friends you’ll be missing out on the richness of life.

Yet there is good news for physicians in the latest research about happiness: We can change our own brains. You may be constitutionally a pessimist and your professional experience may have made you isolated and cold, but you can change. The new neuroscience is teaching us very concrete methods we can use to overcome our genetic heritage and the bad mental habits we’ve developed. We can do a great deal to make us more receptive to happiness, but it takes longer than we want it to.

Some researchers recently taught a group of college students to juggle and, using the latest high-tech neuroimaging equipment, observed their brains as they learned. After three months of daily practice the researchers could identify measurable growth in gray matter in certain areas of their subjects’ brains; after three months of no practice the growth disappeared. Life experience changes the structure of the brain itself. Just like juggling, happiness is a set of skills you can learn; and, just like juggling, learning to be happy is work that requires dedication and practice.

We know now that the ways of acting, thinking, feeling, and relating that lead to lasting happiness do not come naturally to most people. It takes conscious, sustained effort to overcome the habits that keep us unhappy and learn new habits to replace them. But after you’ve done that work, actually being happy is not much work at all. Once you’ve learned to ride a bicycle, or type, or juggle, or acquired some of the happiness skills we’re going to talk about, it doesn’t take much conscious effort to maintain your ability. If you practice regularly, your brain will incorporate your new skills so that it gets to be easier and easier to be happy. Three months is longer than we want to stick to any reform plan; but if you appreciate that your brain is changing a little every day, it may be easier to maintain your commitment.

In Part 2, we’ll review three specific skills to practice to raise your happiness level: reducing unnecessary misery by learning mindfulness, experiencing more joy, and finding greater life satisfaction through strategic goal setting.

Richard O’Connor, MSW, Ph.D., is a psychotherapist in private practice in Connecticut and Manhattan and is the author of four books, the latest just published. Entitled Happy at Last: The Thinking Person’s Guide to Finding Joy (St. Martin’s), the book reviews why it is so difficult to find happiness despite material wealth, and guides the reader with a clear roadmap toward solutions for these problems, grounded in the latest scientific research.