The Futurist; Washington
A doctor's prescription for what ails you
For a longer, healthier life, physicians may increasingly
prescribe "responsible pleasures" such as artistry,
sexuality, and satisfying work.
and caring physicians have always tried to supplement their classic
medical (pharmacological) prescriptions with sensible advice for
living. Recently however, empirical advice has advanced this common
practice to a new level of scientifically based advice, or "behavioral
prescriptions." For example, behavioral prescriptions that
I offer my patients include participating in the arts (such as
dancing, playing an instrument, or singing), enjoying nature,
doing work that is meaningful and gratifying, engaging in responsible
sexuality, and encouraging specific stressreleasing physiological
behaviors such as crying and laughing.
medicine is a growing trend. About one-half of premature U.S.
mortalities are directly related to individually chosen health
behaviors, according to the U.S. Centers for Disease Control and
Prevention. Among the common behaviors that doctors routinely
warn against are the abuse of tobacco, illicit drugs, and alcohol;
doctors also advise patients to balance their diets, avoid excess
animal fat, take in fewer calories overall, and exercise more.
But much of this advice has come in the form of finger-wagging
admonitions from a domineering physician/ father figure, so it
is often ignored.
a new relationship is emerging between doctor and patient. As
patients demand a larger role in defining good health and deciding
on treatment, they want doctors who will dictate less and educate
more. Fortunately, doctors are now better able-and increasingly
more willing-to advise patients on what to do, not just what to
avoid. In this process, they often give their patients explicit
"permission" and encouragement to embrace and enjoy
life in new ways, to experience pleasure, and to have fun.
is healthful because it is a form of stress relief. Modern medicine
is gradually beginning to accept the full value of "stress-releasing
techniques" such as crying (the weep response), laughing
(the mirth response), hitting or kicking exercises (the strike
response), and the arts (the creativity response). I have been
"prescribing" these responses to my patients since the
patient of mine, an executive we'll call "Roy," illustrates
the benefits of one such prescription for stress relief. Roy was
taught from a very early age that "big boys never cry"
and that to do so was a sure sign of weakness, embarrassment,
and shame. During the several months preceding my encounter with
Roy, his mother had died, his wife was diagnosed with breast cancer,
his son was suspended from high school for stealing school supplies,
and it was announced that the company division he headed was being
reported that over the previous month he had been having daily
chest pain. A previously energetic and positive man, Roy was,
I sensed, overwhelmed, somewhat depressed, and in need of significant
psychological and possible medical intervention. During the interview,
it became obvious that he wanted to share more with me, and tears
began to well up in his flushed face. While I do not generally
prescribe crying at the workplace, I told him that it was okay
for him to cry in the medical department setting. This precipitated
a 10-minute weeping episode.
course, crying in itself did not solve all Roy's problems, but
it surely gave him some temporary relief from his tension; it
also built increasing trust, added one more coping skill to his
approach to stress management, and possibly increased his energy
to carry on.
Psychology of Health
trend contributing to the rise of behavioral medicine is what
I call "the democratization of psychiatry." Examples
include growing acceptance of behavioral medicine as approved
treatments for addictions to alcohol, tobacco, and (more recently)
food-related compulsions. Cardiologists, rheumatologists, and
other traditional medical specialists are also now applying behavioral
Ornish, considered by some to be one of the leading experts in
cardiovascular disease prevention and management, promotes the
medical value of not only diet, but also meditation, social bonding,
and group support. [Ed. note: See "Dean Omish's Way to a
Healthy Heart" by Clement Bezold in THE FUTURIST April 1999,
behavior and enhancing lifestyle quality are also central tenets
of the wellness movement, and the major pharmaceutical companies
are expressing a growing interest in using behavioral change as
a supplement to pharmacological interventions, thus embracing
a holistic or biopsychosocial model.
Psychiatric principles are even being applied in the field of
physical fitness. Many personal trainers and athletic coaches
now offer support and counseling that borders on psychotherapy.
the number of behavioralmedicine techniques now being widely used
in many health venues demonstrates the enormous contributions
that modern psychiatry has made to the redefinition of health
itself. It is time to formally recognize and integrate modern
professional psychiatric principles into all healthcare endeavors
and to provide appropriate training of doctors.
New Medical Paradigm: Optimism, Not Fear
behavioral change is likely to occur among individuals only after
fundamental attitudinal shifts about oneself and personal growth
have taken place. Thus, selfesteem, self-discovery, and personal
growth also become extremely important. A fundamental shift needs
to take place personally and culturally in regard to what I call
"the paradigm of medical optimism."
this paradigm is based on love of life, self-determination, and
responsibility. By contrast, the traditional predominant medical
paradigm of pathology and paternalism is based on a fear of death
and a clinging to dependency and victimhood.
paradigm of medical optimism views human beings as fundamentally
good and recognizes that pleasure is not inherently "wrong"
or "harmful." On the contrary, given basic emotional
balance, human beings can-and should-engage in responsible pleasures
that do not harm others or society. One new role of the physician
is to give patients permission and encouragement to enjoy the
bounties and beauties of life without guilt. Doctors must not
fear writing these behavioral prescriptions, for they are very
much a part of the emerging new role of health-care providers
as educators, coaches, and counselors.
paradigm of medical optimism requires including pleasureand its
first cousin, creativity-into life as a prescription for total
are blessed with an abundance of responsible pleasures, including
touching, hugging, giving and receiving love and friendship, sleeping,
engaging in responsible sexual activity, experiencing the beauty
of nature and the arts, savoring wonderful smells and tastes,
eating, participating in athletics, dancing, bathing and swimming,
dreaming and daydreaming, experiencing the joy of childbirth,
meditating and praying, engaging in intellectual pleasures, reading,
being creative, solving problems, playing games, gardening, being
appreciated, appreciating others, and many more that you could
think of. I don't think any single one of these is harmful to
you or to others unless it is engaged in excessively, and most
of these cost very little money. Let's focus on just four specific
responsible pleasures: laughter, the arts, sexuality, and work.
Laughter: A Dose Of Daffiness?
or what some call the mirth response, was popularized in the 1970s
by a nonphysician, the late journalist Norman Cousins, author
of Anatomy of an Illness. The book described his experience using
laughter as an analgesic for ankylosing spondylitis.
to Cousins and a very few others who study the physiology of human
laughter, we now have some data to cite. Most notable among the
serious researchers in this field is Stanford University psychiatrist
William Fry, who has studied the physiology of laughter, including
its impact on blood pressure, neuroendocrine response, and respiratory
effects. Other studies have looked at stress hormone changes during
mirthful laughter and at the possibility of a positive relationship
between humor appreciation and longevity. The recent Robin Williams
film Patch Adams showed the positive impacts of a doctor literally
clowning with his patients.
suggest that the medical profession take laughter very seriously
and that doctors not hesitate to prescribe its appropriate frequent
use by their patients. Doctors could teach patients techniques
that stimulate laughter, induce full-blown mirth responses, and
measure the impact of laughter on health and longevity.
Arts: Creativity and Enjoyment
second responsible pleasure that I would like to address is the
female patient of mine, "Bonnie," was an overworked
manager who was juggling the daunting challenges of a full-time
corporate position requiring extensive travel with raising young
children. During our medical interview, Bonnie said she had wanted
to learn to play the cello-a lifelong dream. But she worried that
this activity would represent yet another obligation to an already
busy schedule rather than help her reduce stress. After reviewing
her obligations to her work and her family, I felt that this activity
would represent something she could do for herself and that engaging
in the arts would be a relaxing and useful stress-management tool.
a year of lessons and practice, Bonnie reported that her "cello
time" had become a "lifesaver" to which she looked
forward at least twice a week. When she chose to transfer to another
company, her colleagues raised money for a "new cello"
fund because they observed how much playing the cello meant to
her and noticed her improved well-being since she began.
persistent clinicians and basic researchers in the creative-artstherapy
movement have been exploring the arts' therapeutic capacity pioneering
what some have now begun to call arts-medicine. Do aesthetic stimuli-sound,
melody, rhythm, light, color, form, dance, words-have an impact
on human physiology or longevity? Certainly, we all intuitively
believe that engaging in the arts (either actively or passively)
has an impact on the quality of life. Science is now validating
our long-held beliefs.
some studies are being conducted in all of the arts, the most
mature of these sciences is musicmedicine. In more than 22 years
of research at the International Society for Music in Medicine,
studies of over 80,000 surgical patients have unequivocally demonstrated
music's capacity to reduce anxiety and pain.
arts-medicine studies have explored such issues as immune functions
and stress among musicians, the impact of music on weight gain
of premature infants, improving patients' convalescence by enhancing
the visual environment of healthcare facilities (the "room
with a view" study), using creative writing to relieve the
pain of upsetting personal events, and using dance or movement
therapy for patients with cystic fibrosis.
little research has yet been done on the effect of the creative
process or the arts on longevity. Needless to say, this new field
of arts-medicine represents enormous opportunities to study the
impact of aesthetic stimuli and artistic activities on human health
Sex: Ecstasy vs. Agony
third responsible pleasure that I would like to discuss is sexuality,
especially the experience of orgasm-undoubtedly one of the most
pleasurable experiences in human existence. This is not surprising
from an evolutionary perspective, given that the fundamental biological
purpose for sex is to perpetuate the species. There is also evidence
that sex is beneficial to our general health.
another executive patient of mine, was highly energetic, successful,
and motivated; he reported that his tennis game had improved significantly
since he started letting out a grunt each time he hit the ball-a
behavior observed among highly successful tennis professionals
such as Monica Seles and Andre Agassi.
congratulating him, I moved the discussion toward Victor's sexual
satisfaction, which he reported had been less than ideal due to
his own and his wife's fear that the four children in the house
would detect the noises of lovemaking. Since the last of the four
children had just gone off to college, I asked Victor to consider
transferring his successful grunting techniques in tennis to lovemaking,
in keeping with the natural desire to express great pleasure.
Victor reported several months later that he felt more full of
life and was eternally grateful for this very practical advice.
no one has studied specifically the benefits of noisemaking during
sex, a study published in the prestigious British Medical Journal
in late 1997 found that men who had sex twice a week or more (i.e.,
"high orgasmic frequency") had a 50% lower mortality
rate than men who had sex less than once a month.
Thanks to such courageous research pioneers as Alfred Kinsey,
William Masters, Virginia Johnson, and others, human sexuality
is now accepted as a subject of serious scientific inquiry capable
of being mainstreamed into modern medical practice. The physiology
of arousal, orgasm, and post-orgasm as it affects blood pressure,
peripheral vasculature, heart and respiratory rate, endocrine
response, and skeletal muscles is now well understood.
women, for example, it has been found that those who have at least
weekly sexual behavior have estrogen levels about twice as high
as their less sexually active contemporaries. Perimenopausal women
(average age 49) with "weekly sexual behavior" were
found to have fewer "hot flashes" and tended to age
more slowly. And studies of arthritis and migraine headaches have
demonstrated hours of pain relief after the relaxation and release
associated with sexual activity and orgasm.
the bounds of responsible behavior, including an emphasis on a
loving, monogamous relationship, if possible, I believe that many
more physicians should be counseling and encouraging their patients
to engage in more-frequent, responsible sexual behaviors. I am
convinced of its health-giving properties.
Work: A Meaningful Life
final and probably most important responsible pleasure is work.
Some people might find that to be an unusual choice for pleasure
since many think of work as drudgery. As an occupational physician,
however, I have found that those who are fortunate enough to achieve
gratifying and meaningful work are probably experiencing a major
health and longevity benefit. We already know the opposite-that
acute and chronic work stress can negatively impact health, such
as contributing to heart disease.
classic American Psychological Association study that examined
social factors in predicting life expectancy found that work satisfaction
had the highest correlation with longevity. Based on my 22 years'
experience in occupational medicine, I am convinced that those
individuals who have achieved job satisfaction and meaning in
their daily working lives and long-term careers fare significantly
better from a health perspective than those who view work as mindless
drudgery to be endured as a means to an income only.
is incumbent upon all doctors to better understand issues relating
to work satisfaction, then help people to redesign their individual
and institutional lives. This could also ensure a healthier and
more-productive future work force.
Life Worth Living
the now widely recognized profound impact of behaviors and attitudes
on health outcomes, the future of behavioral medicine appears
bright. Already, we are seeing creative changes in medical advice,
such as taking "news holidays"-i.e., not watching the
news-prescribed by noted alternative-medicine expert Andrew Weil.
the central role of incorporating responsible pleasures into our
lives will finally receive the recognition and further study it
deserves. And we can all look forward to an exciting new era in
health care in which a prescription of pleasure is as common,
safe, and effective as a prescription for a bottle of pills.