Get religion (or some kind of community): Believe it or not, studies have suggested causal links between engagement in a religious community and happiness and life satisfaction, as well as improved mental and physical health, meaning and purpose, close social relationships, and other aspects of a flourishing life. Of particular interest to me as a psychiatrist is the finding that regular religious service attendance lowers the incidence of depression by 30% and reduces the odds of suicide five-fold. Regardless of your views on organized religion, it’s pretty clear that religious community engagement offers many benefits.
It sometimes feels like it is so hard to avoid feeling down or depressed these days. Between the sad news coming from world headlines, the impact of the ongoing raging pandemic, and the constant negative messages popping up on social and traditional media, it sometimes feels like the entire world is pulling you down. What do you do to feel happiness and joy during these troubled and turbulent times? In this interview series called “Finding Happiness and Joy During Turbulent Times” we are talking to experts, authors, and mental health professionals who share lessons from their research or experience about “How To Find Happiness and Joy During Troubled & Turbulent Times”.
As a part of this series, I had the pleasure of interviewing Dr. Margaret Chisolm.
Dr. Chisolm is Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University where she directs the Paul McHugh Program for Human Flourishing, which fosters a humanistic clinical approach to patient care. Board-certified in general psychiatry and addiction medicine, she has 3 decades of clinical experience in those fields and has published extensively on psychiatric disorders and humanistic medical practice. Her latest book –for patients and families — is titled From Survive to Thrive: Living Your Best Life with Mental Illness (10/21, Johns Hopkins University Press).
Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?
I grew up in the 1960s and ’70s in a typical middle-class family. My father was a high school science teacher who went on to work in the aerospace industry and my mother was primarily a homemaker. I had two brothers — one 3 years my junior and one 12 years younger than I. I went to public schools for my entire education, in Ohio — where I was born -, Florida, and Maryland.
What or who inspired you to pursue your career? We’d love to hear the story.
I went to college thinking I was going to study science, but fell in love with film history. I eventually graduated with a degree in visual arts — with a concentration in film — from the University of Maryland Baltimore County (UMBC), which is where I met my husband, who is a cinematographer. From college, I was accepted into the prestigious cinema studies graduate program at New York University (NYU).
As a film student, I read several books by the British art critic, John Berger, including one featuring the photographs of Jean Mohr called “A Fortunate Man: The Story of a Country Doctor.” That book — about the life and work of a country doctor in the UK in the late 1960s — pulled me away from film and into the world of medicine. The protagonist was a general practitioner who performed surgeries, delivered babies, and visited patients who were lonely and dying in their homes.
No one in my family had ever gone to medical school and we didn’t have any close family friends who were doctors — or even nurses. But — because of that one book — I decided to give it a shot and signed up for chemistry and physics classes and so started my journey to medicine. I was drawn to the challenge and meaning of a career serving others, and thought I wanted to be an obstetrician. Psychiatry was a field that held no appeal to me whatsoever. But the interactions I had with my patients as a medical student on the psychiatry unit won me over. From there, I went on to do a psychiatry residency at Johns Hopkins, and here I am.
None of us can achieve success without some help along the way. Was there a particular person who you feel gave you the most help or encouragement to be who you are today? Can you share a story about that?
When I was a medical student assigned to the psychiatry unit, I met a patient with schizophrenia, severely disfigured from burns, who had spent most of her life in a state psychiatric hospital. One day, I sat down next to her to chat. I didn’t know much as a medical student, it was just us — as two people — talking. After a half an hour, one of my clinical teachers walked by and motioned for me to come over to him. I was worried I’d done something wrong, so imagine my relief when he whispered in my ear: “Don’t ever change.”
I actually think that his three words — “Don’t ever change” — have made the biggest impact on me. I was perhaps more naïve than most, but like all students who start medical school, I was idealistic and wanted to be like the doctor in “A Fortunate Man” and connect with my patients on a personal level. However, most students actually lose their empathy for others during medical school — it gets worn down by the rigors of training. So, I think the reminder to never change, to never lose my ability to connect with my patients as people, really made me into the doctor I am today.
Can you share the funniest or most interesting mistake that occurred to you in the course of your career? What lesson or take away did you learn from that?
The funniest thing that ever happened to me was probably not very funny to the patient at the time. In those days, when a hospitalized patient needed a lab test, it was the medical students who drew the blood (now they have phlebotomy teams — not medical students — who do that). As a medical student, I first practiced drawing “blood” on an orange, then on a classmate, and then on patients. I’d done it many, many times; and I happened to be quite good at it. So it was no big deal when I was asked to go and draw the blood of a patient. This particular patient happened to be in the VIP suite of the hospital — the hospital equivalent of the Presidential suite at a hotel. I knew he must be important, and I guess I must have been a little nervous, because — instead of releasing the tourniquet prior to removing the needle — I removed the needle while the tourniquet was still on. This resulted in a geyser of blood shooting up from the patient’s arm. I was mortified and apologetic, saying “This has never happened…..I’m so sorry….” But this patient was amazingly gracious and understanding. He didn’t get angry or disparage me or make me feel any worse than I already did, despite his presumably powerful position. He could have easily complained, but he didn’t. My takeaway from that experience was, regardless of your position and the situation, you can always be kind and treat everyone with respect.
What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?
So, it’s come full circle for me from college studying film to what I’m working on now as a Professor at the School of Medicine. In 2019, I was fortunate to be selected — along with 11 other health professions educators from around the world — to participate in a year-long fellowship at Harvard, based at the Museum of Fine Arts. There I learned how to use the art museum as an educational space for medical students. This field of art museum-based medical education is relatively new, but is part of a larger movement to re-integrate the arts and humanities into medical education.
I see the practice of medicine as having two sides: a scientific/technical side and a human caring side. But given all the advances in science and technology, an imbalance has occurred. Medical schools have increasingly focused their teaching on the acquisition of scientific knowledge and technical skills, and away from that human caring side. Also, with the rise of the electronic medical record, medical students and practitioners have moved further away from the bedside, become more specialized and isolated, and are experiencing unprecedented rates of burnout.
The integration of the arts and humanities — historically seen as fundamental to the practice of medicine — into medical education has been conceptualized as a solution to these problems. I believe the arts and humanities show us how to live as human beings, and that our encounters with art help us to be better doctors, and give us insights that will help our patients lead meaningful and purposeful lives. But little research has been done in this area, and — without research showing these benefits — the medical school curriculum will not change.
I’m particularly interested in the role of the visual arts in medical education, but most of the research to-date has only focused on medical students’ observational skills. Little is known about the impact of visual arts programs on more complex aspects of learner development. I’ve been leading research to explore how integrative visual arts programs may benefit learners’ professional identity formation (the process of becoming a physician) by offering visual arts-based programs to learners across the continuum of medical education — from pre-med students to medical students to residents to practicing physicians — and studying their impact.
Although I’ve been doing all of our courses online since the pandemic, hopefully in the spring I’ll be able to get back to doing what I love: teaching in the art museum! For the past two years, I’ve been working with a group of medical and museum educators to develop a four-week course for fourth-year medical students at Hopkins, which we’re hoping to launch in February 2022. The course is focused on using the art museum to explore the big questions in medicine: what it means to be human, to be a physician, and to lead a good life (for ourselves and our patients). Its goal? Transformation. Just as I was transformed by the art museum-based fellowship at Harvard, I’m hoping the students will be transformed by the art museum-based course at Hopkins. My hope is that they’ll enter their residency training with a renewed sense of the meaning and purpose of medicine, and with a deepening of their professional identity formation as humanistic physicians.
You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?
On my desk, I have a simple “message board” on which I’ve placed three words: Courage, Vision, and Generosity. I learned the importance of these three values by watching my past mentors embody them. And I display these as a reminder of the values I aspire to model for those whom I mentor.
Courage: It takes courage to think for yourself, but thinking for oneself is the essence of freedom. Steve Jobs said, “Don’t be trapped by dogma — which is living with the results of other people’s thinking.”
When I joined the full-time faculty as an assistant Professor, I was told by one of my mentors, “You will never be promoted to Professor as an educator” at Hopkins and so I started out on a path as a scientific investigator. But it gradually became clear that — despite numerous scientific successes — what I really loved and was being called to was the path of an educator. So, I stopped living my mentor’s life, and started living my own. And within 12 years, I became the third female physician in the over 100 years of my department ever to be promoted to Professor (and the only one promoted as a clinician educator), and I love my work.
It also takes courage to be a person of a traditional faith in academia. I underwent a conversion to Roman Catholicism several years ago, and many medical learners have sought guidance from me about how to remain true to their commitments and values while navigating the secular world of medicine. This is becoming increasingly challenging for many of our learners and practitioners in medicine, a reflection of our increasingly polarized world in which ideas about which reasonable people used to be able to disagree are no longer acceptable to speak aloud without fear of ostracism.
These experiences have informed the way I mentor others. Not only do I want to help them discover their own strengths, talents, virtues, and callings but I want them to summon the courage to act on and speak these truths so as to thrive in freedom as well.
Mentorship requires generosity of knowledge and skills, but mostly it requires generosity of time. While at Hopkins, I’ve provided mentorship to all levels of medical learners, as well as junior faculty in psychiatry, internal medicine, and other fields locally, nationally, and internationally. I left private practice nearly 15 years ago to make a bigger impact in the field of psychiatry. I thought that impact would primarily be through scientific research, but it’s really been through mentorship. As both of my parents passed away in their early 60s, which is now my age, I sometimes ‘hear the owl calling my name.’ In the rest of my career, I’m committed to remaining generous and inspiring others to carry the same torch and so animate the lives of many generations of mentees to come. “For it is in giving that we receive.” (Saint Francis of Assisi)
As part of a leadership course at Hopkins, I recently took the Clifton Strengths assessment and discovered that one of my top 5 strengths is “Futuristic,” a relatively rare strength for someone in medicine. (Another of mine was “Learner,” also telling.) “Futuristic” means I have a vision for and am inspired by future possibilities, and explains a lot about me and my career. In 2011, I became interested in the then-emerging field of social media in medicine. I was a pioneer in this field, defining the cutting edge of innovation in applying digital technology — particularly social media — to medical education and humanistic care for all patients, especially our most vulnerable populations. I participated in national and international symposia, workshops, talks, journals, and books on social media in medicine. Since 2019, I’ve turned my focus to the now-emerging field of art museum-based medical education. This is the story of my life, and it does keeps things interesting. I have developed many innovative ideas, and I have had to learn a lot. These activities are energizing but the sheer number and scope of the ideas can later make the implementation stage a bit of a challenge!
For the benefit of our readers, can you briefly let us know why you are an authority about the topic of finding joy?
I have both professional and personal lived experience with the topic of finding joy. Professionally, s a practicing psychiatrist for over 30 years, I’ve seen hundreds of patients for a range and multiplicity of problems. I’ve also taught hundreds of psychiatrists-in-training about how to help their patients find joy. People generally come to see a psychiatrist because their lives aren’t where they expected them to be and they are hoping for a brighter future. Sometimes they aren’t experiencing joy because of a disease process that has interrupted their life trajectory. But more often than not it’s a combination of who they are as a person and how they’re making meaning of life experiences. My job is not only to remedy any disease they might have, but to help them get their life back on track, or set a new course, with the express goal of finding joy. I’ve seen patients (plural) who were using IV drugs and prostituting, who have ended up graduating with professional degrees and even joining the faculty of prestigious universities. Hope abounds for everyone to achieve joy and fulfillment in life.
Personally, I’m no different than anyone else. Doctors aren’t immune from finding their lives derailed by psychiatric diseases or by other life events. I have experienced severe depressive episodes twice in my life (and attempted suicide with the first episode), and lost my brother and a first cousin to suicide. Despite all of this suffering — or perhaps because of it — I’ve gone on to find joy, which I define as more than just happiness and life satisfaction, but also mental health, close social relationships, and a deep sense of meaning and purpose.
Ok, thank you for all of that. Let’s now shift to the main focus of our interview about finding joy. Even before the pandemic hit, the United States was ranked at #19 in the World Happiness Report. Can you share a few reasons why you think the ranking is so low, despite all of the privileges and opportunities that we have in the US?
Many sources of authority exist that can shed wisdom on the pathways to joy, notably: tradition, witness, expert, and science. Although for Millenia philosophers have been interested in what it means to lead a good life, and many faith traditions have provided guidance on this, I’m going to comment on the more recent scientific thoughts on this topic. Tyler VanderWeele is an epidemiologist at Harvard University who specializes in drawing cause and effect links from large, decades-long research studies that follow groups of people over decades of their lives. Based on these large epidemiologic studies, he’s developed a model for flourishing with the generally accepted domains of happiness and life satisfaction, mental and physical health, character and virtue, meaning and purpose, close social relationships, and financial stability. What he found was that four pathways lead to joy: family, work, education, and community (specifically religious community, as that is the type of community most commonly asked about in these studies). So, it’s in some ways not surprising that — despite all of our privileges and opportunities — we Americans are not ranking highly in joy, as many of these pathways abound with obstacles. For instance, although the vast majority of us (in the United States, 80 percent of adults age twenty-five or older) get married, this institution is increasingly being challenged, and divorce is associated with less joy for adults and children alike. In addition, we have rising job insecurity, our educational system is in crisis, and many more people do not identify with a faith or other community. Although one can find joy in any of these circumstances, it makes it more challenging without the supports these institutions offer.
What are the main myths or misconceptions you’d like to dispel about finding joy and happiness? Can you please share some stories or examples?
There’s a myth that joy and happiness can sometimes be outside our control. I describe in my new book, “From Survive to Thrive: Living Your Best Life with Mental Illness,” one young patient who was diagnosed with schizophrenia, one of the most severe of psychiatric diseases. This disease is something he “had,” that came upon him unbidden. His parents feared the worst, that he would never find joy or happiness. However, after getting his acute symptoms under control with medication — and despite knowing that no medication is available to rid him of the chronic symptoms of this illness — he was able — with lots of support from his family — to make a family of his own, to find meaningful work, to complete his education, and to participate in joy-filled community service activities. It took a long time, but this man is now experiencing more joy than many people who are living free of any psychiatric disease.
In a related, but slightly different question, what are the main mistakes you have seen people make when they try to find happiness? Can you please share some stories or examples?
No one likes to think that they are unhappy because of who they are, what they’re doing and/or the stories they’re telling themselves. Most people prefer to think that they’re not finding joy because of something entirely outside of their control that’s come upon them, whether it be a disease or some other random act of tragedy. And certainly, diseases and other random acts of tragedy happen, but whether they lead to lifelong suffering or to joy is up to us and how we deal with them, for the most part. One can make something positive out of the most brutal of circumstances. Viktor Frankl taught us that in his memoir “Man’s Search for Meaning” about how his spirit survived the hardship of being interred in a Nazi concentration camp.
I’ve seen this firsthand — as in the story about the patients I’ve described with IV drug use or with schizophrenia. The people I’ve seen who haven’t achieved joy, are those who are unwilling or unable to see that they have a role to play in finding joy. It takes work to make the non-trivial choice to give up drugs or to alter one’s expectations and enroll in community college instead of going back to MIT. It takes work to accept that you are someone who has an extra two scoops of feelings and so tend to overreact to certain of life’s provocations. It takes work to reframe your tale of woe from being a victim to being a survivor. I’ve only had a few patients leave my care before they’d found joy, and almost all have done so because they weren’t ready to take responsibility for the role they were playing in their own unhappiness. Since they are so few, I can’t share their stories here without jeopardizing their confidentiality. Suffice it to say — in order to achieve joy, you’ve got to be ready to accept responsibility and take an active role in “finding” it. Unlike tragedy and suffering, it doesn’t just appear.
Fantastic. Here is the main question of our discussion. Can you please share with our readers your “5 things you need to live with more Joie De Vivre, more joy and happiness in life, particularly during turbulent times?” (Please share a story or an example for each.)
To live with more Joie De Vivre, I recommend:
- Strengthen family ties
Even if you have never met your biological parents, the vast majority of us grow up in some type of family context, and most of us get married and create a family of our own. If you want to achieve joy, it will be important to connect with or create some kind of family ties. Whether it’s with the family you have or one that you create, strengthening and/or developing these bonds will bring you more joy. I have a patient who was estranged from his mother for decades. Now that he and his mother are both older, they have taken time during the pandemic to reconnect via telephone, Zoom, and email. This rekindling of their relationship has brought them added support during these turbulent times, as well as the joy that comes with forgiveness.
2. Get a job
People who have a job are happier than those who do not have a job. Working also increases your odds of marrying and of having other close social relationships. If full-time, paid employment is not for you, you might consider a part-time job, including — during the pandemic — one in which you can work from home. Or you could consider a volunteer job. I had a patient with anxiety whose experience training her own therapy dog led her to do volunteer work with animals, which led to a paying career. Or you may find an important service role within your family, such as taking care of older parents or siblings.
3. Go to school
It might surprise you to learn that higher levels of education lead to more joy. Maybe it’s because more education leads to better pay and thus more financial stability, or maybe it’s because more education leads to a job that brings more meaning or purpose. Or maybe it’s because more education means more close social relationships, as well as a better chance of marrying and less chance of divorcing. Or maybe it’s because of none of those things! Education in itself nurtures our curiosity and sense of wonder, and learning has inherent value. So, regardless of the why, consider going back to school to get a GED, undergraduate degree, or certification in a technical skill. Or take non-credit adult learning courses. Or just visit your local public library or museum. Lifelong learning means you’re always growing mentally, despite your physical condition. This weekend alone I learned about the public water and reservoir system in Maryland, which included lots of local and US history lessons as well as personal stories of the impact of policy on people and their land, all from one great library book (to the annoyance of my family and friends who didn’t seem as interested in the topic!).
4. Get religion (or some kind of community)
Believe it or not, studies have suggested causal links between engagement in a religious community and happiness and life satisfaction, as well as improved mental and physical health, meaning and purpose, close social relationships, and other aspects of a flourishing life. Of particular interest to me as a psychiatrist is the finding that regular religious service attendance lowers the incidence of depression by 30% and reduces the odds of suicide five-fold. Regardless of your views on organized religion, it’s pretty clear that religious community engagement offers many benefits.
It’s interesting to note that the benefits of religious affiliation are found in group worship as opposed to those solitary spiritual practice. It is possible what we’re gathering for — worship — may matter less than the simple act of gathering. Many of my patients are not actively engaged in a faith community. But, in order to find joy in life and thrive, most have become part of other communities, including AA or NA, that have provided similar benefits. My patients found friendships and supportive connections in these groups that developed around a shared sense of meaning and purpose to be invaluable to their recovery and ultimate fulfillment. So, if you’re looking for joy, consider connecting or reconnecting with a faith community — or another community based around shared experiences and needs.
5. Be thankful.
We all go through challenging experiences. But how often do we express gratitude for these? Many experts recommend practicing gratitude as a strategy for finding joy, and I’ve not only recommended it to my patients but practice it myself. Most recently, I had an unfortunate encounter as a patient with a less than clinically stellar doctor. As knowledgeable and technically skilled as the physician was, her human caring skills left something to be desired. She displayed no curiosity about me as a person; asked me no questions about work, family, community, and did not even chat about the weather. Leaving the visit, I felt frustrated and demoralized, feelings that grew after I read her version of the visit in my chart. She called me “noncompliant’ because I hadn’t been able to get a prescription refilled, documented a one-lecture at me as an ‘extensive discussion,’ and made mistakes when chronicling my history. To make meaning out of this difficult experience, I decided to think of this physician as a teacher, someone who was teaching me how not to be as a doctor. I always learn a lot from my patients, but it’s not every day that I have an opportunity to learn from another physician. This shift in perspective allowed me to feel gratitude for this difficult encounter, helped me grow stronger as a person, and also validated my mission with the Paul McHugh Program for Human Flourishing, to foster a more humanistic approach to patient care.
What can concerned friends, colleagues, and life partners do to effectively help support someone they care about who is feeling down or depressed?
It’s natural for family, friends, and colleagues to be concerned when they notice that someone they love is feeling down. Sometimes those feelings can be a symptom of major depression, a common and potentially fatal illness. The first step in supporting someone who is feeling down is to learn about the signs and symptoms of major depression and, if any of these are present, to refer your loved one to an experienced healthcare professional for a comprehensive evaluation and diagnosis, as they could have untreated depression — which is the primary cause of suicide. The clinical syndrome of major depression looks different in different people and can include sadness, irritability or anxiety. Someone may have lost interest or not enjoy activities they used to enjoy. Other symptoms of depression include feelings of worthlessness or guilt or more physical symptoms like insomnia or excessive sleeping, changes in appetite/weight, fatigue, decreased motivation, problems concentrating, and feeling slowed down or agitated. And, if your loved one is thinking a lot about death or having thoughts of suicide, you need to get them help immediately.
Ok, we are nearly done. You are a person of great influence. If you could inspire a movement that would bring the most amount of good for the greatest number of people, what would that be? You never know what your idea can trigger.
My vision is for all human beings to be treated with the respect and dignity. This aspiration has been the foundation of my professional career, from deciding to go to medical school to choosing to be a psychiatrist, serving the marginalized and forgotten. It informed my decision to become certified in addiction medicine and, as I developed as a medical educator, it informed my mission to explore the big questions — what it means to be human, to be a physician, and to lead a good life — with medical learners from pre-medical students through practicing physicians. I’ve found that the arts and humanities, in particular visual art, allows people to reflect openly and deeply on these questions, and to appreciate the perspectives of others, even in a polarized world. Medicine is a moral enterprise and I hope I’m inspiring a movement to integrate the arts and humanities into medical education to help learners understand the importance of the human caring side of medicine, and ultimately help all patients be treated as embodied selves of inherent worth, not just bodies.
We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US, whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we both tag them 🙂
I’d love to share a meal with Michael Bloomberg. We have shared interests in the arts, education, and justice. As the former Chair of the Johns Hopkins University Board of Trustees, Mr. Bloomberg knows that medicine is — at its heart — a moral enterprise in which one human being cares for another. However, even at the best hospitals, patients experience disparities in their care on the basis of race, gender, class, health condition, etc. I would love to get his ideas on how to advance human caring and justice within the healthcare system. At Johns Hopkins, the Center for Innovative Medicine — with which I’m affiliated through its Miller Coulson Academy of Clinical Excellence — has proposed launching an Institute at Johns Hopkins University dedicated to humanizing medicine globally, for the good of our patients, our profession, and ourselves. Perhaps that’s an initiative I could discuss with Mr. Bloomberg over tea!
How can our readers further follow your work online?
Follow me on Twitter and Instagram @whole_patients
My website is www.margaretchisolmmd.com
Thank you for these really excellent insights, and we greatly appreciate the time you spent with this. We wish you continued success and good health!