Healthy Minds With Dr. Jeffrey Borenstein

- [Jeff] Welcome to "Healthy Minds".

I'm Dr. Jeff Borenstein.

Everyone is touched by psychiatric conditions, either themselves or a loved one.

Do not suffer in silence.

With help, there is hope.

(soft piano music) Today on "Healthy Minds".

- As you know, I was born and raised in India.

And like many Eastern cultures, the older people are respected and they're thought to be wiser.

And I really didn't think much of it until decades later when I became a geriatric psychiatrist.

The one question was, "What happens with aging?"

Of course, we all know that physical health declines with aging.

And that's why there is a concept that aging is all doom and gloom.

That is why successful aging is defined, not based on physical health, but on mental wellbeing.

- [Jeff] That's today on "Healthy Minds".

This program is brought to you in part by The American Psychiatric Association Foundation and the John and Polly Sparks Foundation.

(gentle piano music) Welcome to "Healthy Minds".

I'm Dr. Jeff Borenstein.

What is wisdom and how can we develop wisdom in order to age in a healthy way?

Today I speak with leading expert, Dr. Dilip Jeste about wisdom.

Dr. Jeste is the author of the book, "The Scientific Roots of Wisdom, Compassion, and What Makes Us Good".

Today we explore wisdom with Dr. Jeste.

(gentle piano music) Dilip, thank you for joining us today.

- Thank you Jeff.

Thank you for having me on this show.

- I want to jump right in and ask you about wisdom.

What is wisdom?

- Wisdom has been an entity in the language since antiquities.

Practically all the religions and all the philosophies in the world talk about wisdom.

However, wisdom in scientific research has been a recent phenomenon.

Empirical research in wisdom started in the 1970s at the Max Planck Institute in Berlin and University of Southern California in Los Angeles.

And we started getting into this research about 15, 20 years ago.

And one of the first things we wanted to do was try to define it and then how we can measure it.

- So what's the definition?

- Wisdom is a personality trait.

It is a characteristic pattern of behavior.

Just like we talk about resilience, optimism, introversion, extroversion, wisdom is a trait.

However, it has several different components.

A very important component is empathy and compassion.

The things that we do for others rather than do selfishly for ourselves.

Second component is emotional regulation with positivity.

That is having control over emotions but being happy.

The third one is self-reflection, which means looking inwards.

Trying to understand ourselves.

If something goes wrong, instead of blaming others or the surrounding, we think about whether I did something wrong which I can do better next time.

And the fourth component is acceptance of diverse perspectives.

We may have strong values, but we can appreciate the fact that other people may have different values.

That doesn't mean that one of us is evil or dumb.

We don't have to agree with them, but we can accept the fact of different value system.

So those are the main components of wisdom.

There are some additional components such as sense of humor, curiosity, decisiveness, even spirituality, although that is somewhat controversial as a component of wisdom.

- We think of wisdom in sort of in public thought about wisdom as being associated with older people with aging.

And I'd like you to speak about that.

- So as you know, I was born and raised in India and like many Eastern cultures that the older people are respected and they're thought to be wiser.

And I really didn't think much of it until decades later when I became a geriatric psychiatrist.

And the one question was, what happens with aging?

Of course, we all know that physical health declines with aging.

And that's why there is a concept that aging is all doom and gloom.

And that is not my personal experience.

Because I saw number of older people who were doing very well, they were contributing to the society in a meaningful way.

And the question is, are they becoming wiser?

So as a scientist, I thought the task was to find out empirically if wisdom increases with aging.

There are no longitudinal studies done over a period of decades using scale for wisdom.

However, there are numerous cross-sectional studies done all over the world that show that older people tend to have higher levels of empathy and compassion.

Higher levels of emotional regulation with positivity.

Higher levels of self-reflection.

Higher levels of accepting diversity perspective.

So it does look like wisdom increases with aging.

However, there are two caveats I should mention.

One is that this does not apply to every person who is aging.

We all know some older people who are very unwise and some young people who are very wise.

Nonetheless, generally wisdom seems to increase with aging.

The other caveat is that this increase continues up to a certain point in age.

When we reach a certain age, and that varies from person to person.

80, 85, 90, whatever it is, at that age, the neurodegeneration takes over and then dementia sets in.

And of course after that it is hard for wisdom to increase.

But in many people, wisdom tends to increase with aging up to or much later age.

- So even if a person may have some mild changes such as difficulty remembering a name or misplacing an object when they are putting their keys somewhere and they don't remember where it is.

Even if they have some of those typical age associated changes, they still could be developing a greater amount of wisdom during that timeframe.

- Yes.

I think wisdom is not entirely related to, say, intelligence.

Clearly as we get older there is decline in some forms of cognition.

So things that we learned recently our ability to learn new things.

That does go down with aging.

On the other hand, the things that we learn long back, or long term memories, they stay intact.

Things like, again, emotional regulations, compassion, empathy, self-reflection, those things don't go down with aging.

As a matter of fact, they tend to increase with aging.

Because part of the wisdom comes with experience, and experience of course comes with aging.

- What steps can a person take to increase their wisdom, to develop their wisdom sooner rather than later?

- Yes, we can develop and increase wisdom at any age.

We don't have to wait to be old to become wise.

If there's a need to increase empathy and compassion, there are strategies for doing that.

We published a meta-analysis of randomized control trials of interventions to increase specific components of wisdom such as empathy and compassion, emotional regulation, spirituality.

So there is good scientific evidence to show that components of wisdom can be increased.

So what can we do in daily life to do that?

So for improving empathy and compassion.. For a long time people used something called "A Gratitude Diary".

That is at the end of the day, before falling asleep, write something that made you feel grateful.

Because somebody helped you.

And you do that every day.

Very nice idea.

But it was found that people got tired of doing that and they stopped doing it after a few days.

So now what is recommended is something called, "Three Good Things".

Think about and talk about or write whatever you want to do, three good things during the last 24 hours.

And this may be because somebody helped you or it is because you helped somebody and you feel good about that.

If we do that regularly, then what happens is that we get up in the morning and thinking about what am I going to talk about or write by the end of the day.

So it becomes our second nature to help others and appreciate the help that we receive from others.

So that is one thing that is the "Three Good Things" as they call it.

Second is volunteering.

In addition to the job we do, if we can volunteer.

We are all busy, but we can take some time maybe a couple of hours on the weekend when we go and help people in nursing homes.

People with dementia or children with disabilities.

Children with, say, Autism Spectrum Disorder.

Doing those kinds of things outside the job is quite helpful.

Another is meeting with people who are different from us.

And again, we don't have to agree with people with different perspectives, but we can try to understand where they are coming from.

So these are the things that we can do to improve empathy, compassion.

For self-reflection, I call wisdom exercise.

You know, most of us follow healthy lifestyle.

We do physical exercise five days a week.

Do it at home, walk on the street, or go to a gym.

Why can't we set aside, say half to one hour, couple of times a week when we just self-reflect.

Think about the things we have done, things that happened to us in the last three, four days.

What are the things that made us feel happy?

What are the things that made us feel stressed out?

If we do that regularly, some common pattern will emerge.

We'll understand ourselves better, and that'll help us correct ourself going into the future.

So these are ways in which we can improve components of wisdom depending on what we need to do.

- So just as people do physical exercise to help their body, there are exercises, steps that we can take, really to help our brain, to help our mind to really expand the level of wisdom that we have over time.

- That's exactly right.

We do physical exercise to improve our muscles in the body.

If we self-reflect, then we can increase the strength of the muscle in our brain.

I'm getting off course, but there are studies that have shown that not just physical activity, but also cognitive mental and social activity improves neuroplasticity.

- Define neuroplasticity because that's an important point you're making.

What does that mean?

- If we stay active, the number of synapses increases even the number of neurons increases in some specific subcortical region.

Not all over the brain but in the gyrus of the hippocampus or periventricular area.

This has been shown in numerous animal species and also in humans.

So this is the neuroplasticity of aging.

The brain can continue to improve not only functionally but even structurally if we keep ourselves active physically, mentally, cognitively, and socially.

- I want to emphasize this point because when you and I went to medical school, we were taught that old brains do not grow new cells, do not have cells make new connections.

And old was after the age of two.

And we now know that really older brains, even brains that are the age of you and of me, our brains continue to grow new cells, make new connections.

And these important activities, exercise social involvement, cognitive types of focus, all can help with that process.

And that is obviously a part of healthy aging for the brain and the body.

- That's exactly right.

I remember when I went to medical school, I learned that the only thing that happens to brain with aging is it shrinks.

And research in the last 25, 30 years has clearly shown that that is not the case if we keep ourselves active.

- One of the challenges for people as they age is to maintain social connections.

People may pass away who they were friends with, families, members, et cetera.

Talk about the importance of social connectedness and what people can do to maintain that as they get older.

- Social connection is a very important thing in life.

Studies have shown that the single most important social determinant of health is social connection.

Meta-analysis have shown that social connections have greater impact on health and longevity than the traditional factor that we study in medicine such as hypertension, smoking, drinking, obesity.

The social connections.

And it is not the number of social connections, it's a quality of social connection that is important.

And as you said, Jeff, I agree that with aging that is one of the problems that we lose friends, we lose family.

Sometimes there is only a couple living together and then the spouse or the partner dies.

Clearly it creates a problem.

However people can improve the quality of relationships that they have.

So a younger person may have a thousand Facebook friends and an older person may have only two people that he or she works with, and yet those social connections may be stronger and more meaningful than the thousand Facebook friends.

And so older people do face a problem of losing their near and dear ones.

On the other hand, their other traits can help them improve the quality of the existing relationships.

- I want to ask you a little bit about the development of wisdom and healthy aging in people who have over their life experienced psychiatric illness.

And how do those two issues come together?

- Yes, that's an important question.

As you know, I have been studying schizophrenia for many years.

And as a geriatric psychiatrist, I've been focusing on schizophrenia in older people.

When I initially started doing this work, some of my colleagues said this will be so depressing to study schizophrenia in older age.

Because schizophrenia is an illness which for which we have no cure and things only go down.

People with schizophrenia die young, which is true.

However, what we found was that as people with schizophrenia got older, their symptoms improved.

Their psychopathology improved.

They became more adherent to the treatment.

And of course the physical illness has increased, but if they're hospitalized, it was not because of the psychiatric problems or because of the physical illness.

And that was a surprise.

How can psychotic symptoms and negative symptoms improve with age in people with schizophrenia?

Back in the movie "A Beautiful Mind", I think many of you have seen the movie or read the book.

It's a true story of a Nobel Laureate who was diagnosed with schizophrenia in his early twenties.

And he was hospitalized multiple times, got ECT, insulin coma, psychotherapy, medications, everything.

But didn't do Beta until about 50.

At 50 he started doing Beta.

At 60 he wrote a paper for the first time in 30 years.

And we are very proud to invite John Nash to be a keynote speaker at the American Psychiatric Association meeting some years ago.

So just think about a person with schizophrenia being a keynote speaker at the American Psychiatric Association.

Of course, he was also a Nobel Laureate.

And there are other examples of people such as Elyn Saks at the University of Southern California who has written her autobiography called, "The Center Cannot Hold".

There are examples of people who have schizophrenia and as they age, they start getting better.

Again, this doesn't happen to everybody.

Clearly there are some people who suffer from serious physical illnesses and die from them at a younger age.

But I do think that we can improve the prognosis in schizophrenia.

If as a society we help people with schizophrenia by providing better access to treatment.

Not only access to treatment, but also access to healthy lifestyle.

How can we help them live a healthy lifestyle?

Physical activity, nutritious diet, better sleep.

They're ready to do that if we help them.

And I think really that the society should focus on helping, of course everybody with schizophrenia, but especially older people who can benefit from it.

- I think the parallel between your study of people with schizophrenia getting older and doing better over time and potentially people without schizophrenia, without a a different diagnosis, having a similar improvement over time.

In many ways experience really leads to growth when people can take advantage of what they learn from that experience.

- You know, that's exactly right.

What happens is that younger people with schizophrenia, they often stop medication for variety of reasons including the side effects of medication.

Or they don't feel the medication is helping or they become more paranoid about the medication.

They stop the medication, they have a relapse they become suicidal or become aggressive and they're hospitalized.

After this has happened four or five times and people are older, they realize actually that they should not stop medication because it makes their condition worse.

So the medication adherence improves with age in many people with schizophrenia.

Similarly the smoking and drinking also go down with age.

Again, this doesn't happen in every person with schizophrenia.

But it does happen in a significant minority at least of patients with schizophrenia.

And those numbers will grow if we help them.

So I think it is really our responsibility as a society to help older people with schizophrenia.

You know, sometimes we think about schizophrenia as a cancer of the mind and think there isn't anything we can do.

That's not true.

There can be a light at the end of the tunnel.

So we should always have a positive attitude that we can help people with serious mental illnesses and they will get better.

Again, won't happen in every case, but it'll happen in many more cases than what we see today.

- Yeah, I think that that is such an important piece of advice for people who have schizophrenia, for their family members as well, and other conditions also.

Not just schizophrenia.

I want to shift back to the broader issue of healthy aging.

If somebody's watching in our audience at different ages in their twenties, forties, sixties, what do you say to people at those age levels about healthy aging?

- That's an excellent question.

Some years ago we did a study called "Successful Aging Evaluation Study".

We took about 2,500 people randomly selected from age 20 to 100.

This was the local community and these were people who had different physical illnesses, mental illnesses or nothing.

But this was a randomly selected population and we have been following them for a number of years.

What we find is that physical health declines with aging.

This is as we expect, right?

20s and 30s, Fountain of Youth, the best physical health.

After that slowly starts declining and the decline accelerates after 60, 70 and so on.

What about mental health?

Mental health goes in exactly the opposite direction.

That's what I call the paradox of aging.

You know, 20s and 30s that's when the physical health is the best.

Unfortunately, the mental health is at its worst.

There is considerable anxiety, depression, stress.

And most of us who can look back at our teenage years and twenties we will agree that that was a period of great stress.

We had to make a lot of important decisions.

We were very unsure if you're making the right decision.

A lot of peer pressure.

And whatever we decided, we felt that we were not doing the right thing.

That we are doing worse than most of our other peers.

The good news is that things start getting better as we get older.

It's not that the stresses go down, they don't.

But we know how to handle the stresses better.

We become less affected by the severity because we have been there, done that, things have happened.

That is why successful aging is defined not based on physical health, but on mental wellbeing.

You know, who can tell me if I'm aging successfully?

Only I can say that, right?

Others can't tell me whether I'm aging successfully or not.

If I am happy, that's all that matters to me, right?

So an 80-year-old person in a wheelchair can be happier than a 20-year-old or perfectly healthy person who is severely depressed, right?

So age is associated with improvement in wellbeing.

And to me that is successful aging.

And the things to do to help that is keep yourself active physically, mentally, cognitively, socially.

And as you mentioned, Jeff, earlier, social connections.

Have good quality social connections that you can count on.

- Dilip, the guidance you give is so important.

The work that you're doing really has an impact.

And I want to thank you for all that work that you've done and continue to do.

And thank you for joining us today.

- Thank you, Jeff, for having me.

It was my pleasure (gentle piano music) - At all ages, our brain continues to develop with new brain cells, new connections between cells.

It's so important to remain as active as possible both physically and mentally, and to maintain and build social connections at all ages.

Remember, with those social connections, there is tremendous opportunity to continue to enjoy one's life.

(gentle piano music) (peaceful music) Do not suffer in silence.

With help, there is hope.

(gentle piano music) This program is brought to you in part by The American Psychiatric Association Foundation and the John and Polly Sparks Foundation.

(peaceful music) (peaceful music continues)