Tami Simon: Welcome to Insights at the Edge, produced by Sounds True. My name’s Tami Simon, I’m the founder of Sounds True, and I’d love to take a moment to introduce you to the new Sounds True Foundation. The Sounds True Foundation is dedicated to creating a wiser and kinder world by making transformational education widely available. We want everyone to have access to transformational tools, such as mindfulness, emotional awareness, and self-compassion, regardless of financial, social, or physical challenges. The Sounds True Foundation is a nonprofit dedicated to providing these transformational tools to communities in need, including at-risk youth, prisoners, veterans, and those in developing countries. If you’d like to learn more or feel inspired to become a supporter, please visit soundstruefoundation.org.
You’re listening to Insights at the Edge. Today my guest is Dr. Dilip Jeste. Dilip is the senior associate dean for healthy aging and senior care. He’s a professor of psychiatry and neurosciences and the director of the Center for Healthy Aging at the University of California, San Diego. He’s also a past president of the American Psychiatric Association and someone who is really on the edge of a new field that he calls positive psychiatry. He’s a neuropsychiatrist who specializes in geriatric issues, and he spent the last 20 years studying aspects of healthy aging and the neurobiological roots of wisdom. With Sounds True, Dr. Dilip Jeste has written a new book. It’s called Wiser: The Scientific Roots, Wisdom, Compassion, and What Makes Us Good. What moved me the most about this meeting with Dilip was yes, his sincerity and his humility, and also his all-out commitment to help us evolve more quickly as individuals and into a wise society, something we need so much at this time. Here’s my conversation with Dr. Dilip Jeste:
To begin, Dilip, I would love our listeners to get to know you a little bit. You have a pretty unusual story; born in India, you became a psychiatrist at a young age at a time when that wasn’t very common in India. Tell us a little bit about that, and then your journey to the University of California at San Diego as a professor.
Dilip Jeste: Yes. First of all, thank you, Tami. It’s a pleasure to talk with you. As you said, I born and raised in India. As a teenager, I got fascinated by Freud’s books for lay people—Freud’s book on interpretation of dreams and everyday areas of life. I thought that it was brilliant that Freud could take a behavior like dream, or everyday [inaudible], and interpret it like a detective, or [inaudible]. It was almost like what happened with [inaudible]—it starts with a murder and then ends with finding the people who committed the murder. Here, what he did was really remarkable. And Freud was a neuropsychiatrist—he believed that psychology rode on the back of physiology. So he had brain related explanations for the behaviors. And I thought that was fascinating, how he could study mind and interpret its basis in the brain.
As a result, I decided to become a psychiatrist. I went to medical school in order to become a psychiatrist, which was quite rare at the time. I’m sure several of my friends questioned my sanity that I was choosing psychiatry, but I really found it very interesting. My interest in psychiatry was actually in research, trying to find out how the brain modulated various behaviors. At that time, research in India was quite limited, so I decided to move to US because I’d heard about the National Institutes of Health. That was like the Mecca of research. With that in mind, I migrated to the US. Here, I did my residency in psychiatry, mainly at Cornell. Then I went to NIH, which was my life’s dream. After spending some time there, I moved to San Diego—University of California, San Diego. I found that, that was probably the best research place that I could find in my field. Not only because of the talent of the people, but also because of the collaborativeness.
So I’m a psychiatrist and a neuroscientist. After moving to San Diego, I decided to specialize in aging. When I decided to do that, again, some of my friends and colleagues were skeptical. They said that geriatric psychiatry must be really depressing because mental illnesses have no cure, and aging is all gloom and doom. [Inaudible] with aging. But surprisingly, what I found that that was not true at all. With aging, physical health did decline, but mental health often improved. As people got older, I found that they started feeling happier, more contented. They could face stresses with greater equanimity than they did when they were younger.
At that time, I also started thinking about what is the significance of human aging? According to Darwin’s hypothesis of survival of the fittest, animals live only so long as they contribute to the survival of the species, and that is by procreating. So animals, when they produce children, they’re contributing to the species’ survival. But there comes a time when the animals lose their fertility. In the wild, the larger animals, they die soon after they lose their fertility and become physically disabled.
But look at humans—our lifespan has been increasing progressively. Today, the lifespan is 80 years in the US. In a few decades, it will be 90. What has not changed is the age of menopause in women, and andropause in men. That is about 45 to 50. So if somebody lives to age 90, that means that they have spent most of their life without fertility—that means without contributing to the species survival, and they’re also getting physically disabled. So why should nature allow that? Why should nature allow humans to live decades after losing fertility while they’re also becoming physically disabled? I thought that something must improve with aging, and what that something could be?
Growing up in India, like most Eastern cultures, there’s a belief that older people are wiser. There’s a considerable respect for the older people. Hence, it struck me that maybe there’s a wisdom that increases with aging, and that wisdom may be compensating for the loss of fertility, as well as loss of physical health in later life. I thought that this is then something that [inaudible]. When I first mentioned this idea more than 15 years ago about new research on wisdom, my colleagues said that, don’t do that. That wisdom is not a scientific concept. Wisdom is a religious and philosophical concept. And that is true, that wisdom has been there since antiquity. It is there in all the religions and all the philosophies. At the same time, the empirical research and wisdom has been quite limited.
So I started with a review of literature, empirical literature. And I found that the empirical research started in about 1970s in Max Planck Institute in Berlin and the University of Southern California in Los Angeles and it has been growing. [Inaudible] most of the research has been done by gerontologists, [inaudible], and [inaudible]. Many of them have done brilliant work, stunning work. But I noticed that really few physicians and really few neuroscientists would get involved in researching wisdom. And since my interest was as much in biology as psychology, I wanted to find out if wisdom had a biological basis. And of course, the [inaudible] was defining wisdom, because any scientific construct, you must be able to define and measure it before you can do anything else.
TS: Now, Dilip, there’s so much in what you’ve said already. We’re going to get into how you developed a working definition of wisdom so that you could explore its biological basis if there is one and measure it. But first I have a couple of questions for you. As I said, you’re an unusual person. Your friends said, “Why are you becoming a psychiatrist?” Your friends said, “Why are you going to specialize in aging? That sounds gloomy.” Your friends said, “Oh, come on, you’re not really going to try to discover the neurobiology of wisdom? That sounds like something you can’t pin down, even if you tried.” How did it feel for you? What’s inside of you that said, “You know, no matter what my friends say, this is something I have to do.” I want to understand more about that, about you.
DJ: Thank you. I accepted that as a challenge. I mean, I could see where they were coming from, but I did not agree with them. But I didn’t want to argue with them; I thought the most important thing was to show that they were wrong by actually getting some data. Because without data, this becomes opinions and perspectives, and different people can have different perspectives. See, if I believe in something, I need to show that it exists. Evidence, data, those are critical things in science.
So we subsequently did some studies of happiness across a lifespan. And we found that although the physical health declines in later life, happiness, well-being, satisfaction with life, all of them point the opposite direction. From age 20 to 100, contentedness, happiness, well-being increase. That really shows that our data showed that aging is not all gloom and doom, but actually it is associated with increasing happiness. Similarly, with popular studies on [inaudible] schizophrenia and serious mental illnesses. The thought was that there’s nothing you can do to them. It’s kind of a life sentence; once you have schizophrenia, you’ll have schizophrenia for the rest of your life. We didn’t always find that. Surely many people have chronic schizophrenia that doesn’t improve, but there is a proportion of people who were able to [inaudible], who have no symptoms, don’t need treatment.
Initially when we published studies, people didn’t believe that. They said these are not people with schizophrenia. So this is something we were seeing in our data, and someone like John Nash could actually prove that, could put a human face on schizophrenia remitting. Again, this is not something that happens to most people with schizophrenia, but it does happen. That is why I decided to focus on positive psychiatry.
To answer your question, what I find is that when people argue about something, I take that seriously and I want to prove—I don’t want to prove them wrong, but I want to prove myself right. And through the process, I learned something. It is not one side is right and one side is wrong, [but] to what extent I am right and to what extent I’m wrong? It has to be data-based.
So that’s why, starting with wisdom again, it is really important to come up with a definition, how you measure it, and then how you can look at the neurobiology, so other people can then try to replicate your findings or not replicate your finding.
TS: OK. Tell me how you went about defining wisdom.
DJ: So wisdom, I started with reviewing all the literature that was on PubMed: all the peer reviewed papers that had the word “wisdom” in them. Actually, I found that I had to exclude studies on wisdom teeth, which there was—but we found a number of studies of wisdom, but only some of them had a definition of wisdom. Most investigators agree that wisdom is not just one simple thing. There are several components to wisdom.
So, we wanted to find out what those components were. We created a table with different definitions and listing individual components. Our goal was to find out which components were most commonly used, because then that becomes the consensus definition of wisdom. Indeed, we found several components that were common in a majority of these definitions. They were self-reflection—ability to look inwards, analyze your own behavior. Second is prosocial behaviors, things that we do for other people and not for ourselves. These are things like empathy, compassion, altruism. The third is emotional regulation, control over our emotions. The fourth is acceptance of uncertainty and acceptance of diversity of perspectives—that I say that I have certain beliefs, but I can understand why other people may have different kinds of beliefs or perspectives. The next one is, interestingly, decisiveness—that on the one hand, we accept uncertainties and diversities, but you can’t sit on the fence all the time saying, “This may be right, that may be right.” You have to make a decision when it is needed. So that is decisiveness. And the last one is spirituality. Spirituality means continuous connectedness with something or someone. Whether that is God, it is soul, consciousness, nature, whatever it is.
So what we found was that these components, were there in at least the majority of the modern Western definition—[inaudible] of the concept was, this is modern Western definition. Wisdom, people said, is a cultural concept, and it will change from one culture to another. It will change over time.
So we decided to look at some scriptures. Coming from India, I was familiar with the Gita, the Bhagavad Gita, which is kind of the Indian Bible. So we did a qualitative, quantitative mixed methods study of wisdom in the Gita. In other words, what we wanted to do was, we wanted to find out how many times the word “wisdom,” or it’s opposite, which is “foolishness,” how many times they were used, but more importantly, in what context. For example, the Gita said that a wise person doesn’t remain indecisive, he or she makes a strong decision and then acts on it. So decisiveness is a wise person component. And so on. So using that, we identified components of wisdom in the Gita. And to our great surprise, they were almost identical to the modern Western definition. It also includes self-reflection, prosocial behaviors, emotional regulation, decisiveness, spirituality.
There are a couple of differences. For example, the Gita stresses lack of materialistic pursuits, whereas in the Western world, materialistic pursuits, they’re considered OK at least. And also the Gita is much more religious than the modern Western concepts of wisdom. But those differences are minor compared to the similarities. That really was a surprise, that [inaudible] a number of years back, and that the concept of wisdom we have today, according to these modern scientific researchers, is [inaudible] same. We thought that meant that wisdom must be biologically based, that’s why it doesn’t change. And so, if it is biologically based, where would it be based in the brain? So the next pursuit would be, was to find where in the brain wisdom is located.
TS: OK. I have a question about that. I get that wisdom stood the test of time in terms of its qualities and components, but then you made this, what I think of as a little bit of a leap, at least from the way I think. And because you’re wise, I know you’re open to contrary views and curious about it, and you and I are good here to leap. So then you said, “Oh, because it is true over time, it must be linked to brain function.” What if it’s just a human quality? How is it that you’re so sure that it’s linked to specific areas of the brain?
DJ: That’s an excellent question. When I say it is based biologically, that doesn’t mean that it doesn’t have psychosocial or cultural aspects. Not at all. I believe that biology and sociology and psychology, they’re closely integrated. It’s like what Freud said, psychology rides on the back of physiology. But culture affects our behavior, our behavior affects the brain, and brain affects behavior. So it’s a really bi-directional thing. So my point was not that it is only biologically based, but that it is also biologically based. I didn’t mean to rule out cultural, social aspects at all. Because I do believe that the cultural, social aspects are in a way as biological as biological aspects are cultural and sociological.
TS: OK. So we’re going to get into the specific brain mapping that you’ve done, that wisdom can actually be mapped on the brain. I want to get there, but I’m going to ask you another question Dilip, first. Which is, some people think that we also have a wisdom brain that lives in our heart and a wisdom brain that lives in our belly, that it’s not just the brain intelligence that’s inside our head. What do you think about that?
DJ: I would say that mind is a function of the brain. However, brain is affected a lot by other organs. For example, heart is clearly very important for brain function because brain depends on blood supply, specifically the glucose, and it is the heart that supplies blood to the brain. So tomorrow if the heart becomes inefficient, brain will have less supply, it will get less glucose and its functioning will drop, so clearly heart affects the brain.
Same thing is true about gut. There is gut-brain axis. Actually, we are doing some research on microbiome, and how microbiome is related to things like loneliness and depression.
So there’s no question that the rest of the body affects the brain. There are nerves that are in our parts of our brain. There is sympathetic system, parasympathetic system. However, the brain per se, the higher functioning brain, that is really located inside the skull.
TS: OK. Tell me what parts of my brain relate to wisdom and the components of wisdom.
DJ: Right. So what we did was, we looked at these different components of wisdom and looked at the brain imaging studies, some genetic studies, there were even some animal studies, to find out the localization of these specific components to a specific region. First of all, I should say that this localization is really relative. This is not a very fixed, there’s one area that does only one thing. Brain is a very complex computer, and there are lots of interactions going on all the time. This is relative localization, not fixed localization. But there are two parts of the brain that seem to be most important for wisdom. One is prefrontal cortex and the second is the limbic striatum.
The prefrontal cortex is the newest part of the brain in evolution. It is the prefrontal cortex that makes us human, that makes us different from all of the animals. Whereas the limbic striatum is the oldest part of the brain. It is responsible for emotions, and most animals do have emotions. But the prefrontal cortex does something really that is relatively unique to humans.
Reading the prefrontal cortex—I should mention that there are three sub areas that are important. I don’t want to be too jargony or technical. There is dorsal lateral prefrontal cortex that is responsible for inhibition, it inhibits certain responses. And if you’re well, it is necessary for self-preservation and it makes hard utilitarian choices.
In contrast, the ventromedial prefrontal cortex tends to be more empathic, compassionate, kind, prosocial. Again, I’m simplifying or simplifying to some extent. The dorsal lateral prefrontal cortex is more selfish, but at the ventromedial is more prosocial. Sometimes there’s a conflict between the two, naturally. Sometimes we can’t decide, if we go this way or that way. Then anterior cingulate, which connects the two, comes into play. So those are the areas that are important for several of these components, including self-reflection, emotional regulation, empathy, compassion. The amygdala or the limbic striatum, on the other hand, is set up dealing with emotions. Pretty disconnected with the prefrontal cortex, hippocampus, and so on. So emotional memory becomes also part of that.
TS: OK. So how does someone who is high in the components of wisdom, how does their prefrontal cortex operate differently than someone who is low in the components of wisdom?
DJ: OK. This is an area of research that is in the very early stages, so we are learning about this. Also, another thing is, our brain imaging technology isn’t as sophisticated as it should be. It will be, in the next 10, 20 years. What we know about brain today is quite limited, no question about that. But there have been brain imaging studies of people who were presented with a moral dilemma and how they solved the dilemma affected the increase versus decrease in the blood flow and other oxygen-related activity in the brain. That is how you judge the effect of certain kinds of behavior or association of behavior with certain brain regions.
To answer your question, what I would suspect is that there’s greater emotional regulation in people who are wise. That means, the amygdala does not get overactive with stimuli as much in wiser people as in people who are [inaudible]. So people who are not wise, anything that happens [inaudible] emotional, then you see increased activity of the amygdala in the functional MRI. Whereas people who are wise, we don’t see that same [inaudible] in the activity of their amygdala.
TS: Now help me understand—I’m just going to ask you very directly here, Dilip, how knowing about this relationship between wisdom and brain function makes a difference. Like, can I go out and take a wisdom pill because it’s now going to help this part of my brain? I would like that. Sounds True should sell that. If we can do that, that’s a business you and I should get into. But is it that simple? I mean, obviously not. How does this information actually help us?
DJ: That’s a great question, but that is actually the hope. I would say more than hope, that is something that’s likely to happen in near future. That if it is localized to some areas of the brain—and I can tell you, there have been some cases reported in the literature. One very famous case is that of Phineas Gage. He was a construction worker in Vermont, in the 1860s. There was an explosion, an iron rod went through his head. And his description, if you read it, shows that he was a really wise person to start with and became very unwise after that injury. Scientists had actually had preserved the skull and they could find out where the damage was, and that was in the dorsolateral prefrontal cortex, more on the left than on the right. And there have been a dozen such cases reported since then. There’s also something called frontotemporal dementia, in which only the front part of the brain is affected, and the symptoms of that look like loss of wisdom. So if you can lose wisdom because of injury or trauma to some region, would it not make sense to think that stimulation of those areas could increase wisdom?
Now, we can’t do that today, but there are actually exciting research going on in neurostimulation. There is something called transcranial magnetic stimulation and deep-brain stimulation that people are trying, and there’s good evidence that it works for depression, for example. So I expect that over the next 15, 20 years, and even sooner, if we are lucky, science will have advanced enough and that technology would have advanced enough that we could very specifically stimulate or inhibit really specific parts of the brain. When that happens, it’s really not science fiction, but we may be able to increase somebody’s compassion, improve somebody’s emotional regulation. And eventually, there could be pills because many of these things are based on some chemical interactions or some neurochemicals that maybe involved. So, we can either increase or decrease the level of that chemical. I know it sounds simplistic right now—and again, this is years away. Maybe even decades away. But I do think that it is not only possible, but I would say highly likely.
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TS: Now Dilip, this is really important because I would say we live in a society right now that on a whole, is disappointingly, to me at least, unwise, unwise in so many ways—in how we handle environmental issues, in how we solve our differences when we have them, I could go on and on. So if we were able to increase our collective wisdom quotient without people having to do a lot of lovingkindness practice or time on the cushion or other things. If it could be as simple as, “OK, everyone, we’re now prescribed—” it’s an injection or something, anything, that would be a really major breakthrough. I notice a part of me as you’re saying this, and you’re saying, “Oh, 15 to 20 years, that’s a ways away.” That sounds like tomorrow to me, that sounds really soon. And part of me just doesn’t believe you, sorry to say it like that. I’m a little bit like, “I don’t know. It sounds a little sci-fi.”
DJ: No. I don’t question that at all. When I talk about the paper, when we published the paper on this neurobiology of wisdom in an important journal, we said that it would be unwise of us to say that this is the neurobiology of wisdom. Because as science evolves, some of the long-held concepts are proved wrong. So who knows what the future will show as our technology advances, as our knowledge of brain advances?
But the basic concept I do think is there, that wisdom is a personality trait like resilience, optimism, or loneliness. These traits are about 50 percent genetically determined and 50 percent affected by behavior and environment. Because we indeed see families in which many people are, they function—they’re very compassionate, they’re helpful to others. And there are other families in which people are very secluded, they are not really social. So it is not really surprising to see that there may be some biological component, inherited component to wisdom, but only some component.
At the same time, wisdom is really modifiable. Just like resilience is modifiable, wisdom is modifiable. These traits are modifiable. One way of modification, as we were talking, will be through these brain-related changes, but there are others ,which we can do now, would be more behavioral and psychosocial. To come back to this mission of how [inaudible] will be really true, people [inaudible] for centuries saying that consciousness is not a biological concept. They said consciousness is philosophical and psychological concept. But then we know a lot about neurobiology of consciousness. Same thing about emotions, cognition. At one time, people dismissed those as a non-biological. And I think it is not biological or psychological, not at all. It’s biological and psychological. That’s how I feel about it.
TS: OK. I want to track back to something you said earlier and see now that you’ve shared what you have in our conversation so far, if my appreciation of what you said might deepen a little bit. You mentioned that you were amazed when you thought of human beings and our long lifespan. Living to 80, 90, and yet we don’t procreate after age 45 or whatever it might be. So we’re not here to be fertile and have babies anymore, but we’re here for some evolutionary purpose. But I wasn’t quite clear, what is that? Why are we here actually for those other 45, 50 years? And it seems like you’re implying we’re here to grow in wisdom and share our wisdom. That doesn’t appear to me what’s happening with the human species if I look around.
DJ: That’s a great comment. So there are two parts to that answer. The first part is, when I was talking about evolutionary value, I was talking about evolutionary value of human aging, not necessarily human life. But why do people get older when they can’t reproduce and their physical health is going down? There must be some evolutionary value to human aging that really long after fertility. There is actually very good evidence for what is called the grandmother hypothesis of wisdom. The hypothesis states that, when grandmother is involved helping her daughter to raise her children—that is, her grandchildren—all three generations live longer, they are happier, and the daughter’s generation process more children than the older generation did. This has been shown in bottlenose dolphins, killer whales, Asian elephants, and in a species of bird called Seychelles warblers.
It has also been shown in humans. There have been studies of people from Canada and Denmark, where they had long records available over 200 years. And they found—and these are, by the way, papers published in journals like Nature and Science, which are the topmost journals in the sciences. So these studies in humans showed that when grandparents are involved in raising the grandchildren and when those children, grandchildren became teenagers and adults, they had fewer behavior problems, fewer psychological problems, fewer mental illnesses than those in whose upbringing grandparents are not involved. So that is a grandmother hypothesis of wisdom.
And actually there is also a description of grandparent genes. There are some genes that are associated with greater longevity, as well as better functioning heart and better functioning brain. So if we inherit those genes, those gene mutations, that means we will not only live longer, but we will have the ability to transmit our wisdom to the younger generations. So human aging has an evolutionary value, which is that although older people don’t procreate, they’re essential for the younger generations because they’re transmitting wisdom.
TS: Now Dilip, interestingly, you referred to wisdom as a personality trait, and quite honestly, I never thought about it like that before. I thought about it as some kind of crowning capacity or set of capacities that we develop and cultivate. What does it mean if we understand it as a personality trait? How does that understand our appreciation of wisdom?
DJ: What it means is that it is not either/or phenomenon. It is not that some people are wise and some people are unwise. Everybody has wisdom, but the extent to which they have wisdom varies. It is like everybody has intelligence, but how much intelligence, that varies from person to person. So wisdom is something we have, and in a way, part of that we have right from the beginning. And we see that even in young kids—some kids, even at the age of six, seven, eight, they’re so wise, so compassionate and then others were exact opposite. And yet, wisdom often increases with experience and aging. We see in ourselves that as we get older, we become less stressed out by things that bothered us a lot when we were younger. We take things in stride. Studies have shown that people become more compassionate toward others because we have been through something. It is like when a kid sees another kid slips over a banana peel, he laughs. But after some time, he himself falls on a banana peel, so next time he sees another, then he is much more kind to them.
That’s what happens in life. After various life events, we mature, we become wiser, better control over our emotions. We become more self-reflective. We become compassionate, emotionally regulated. We accept uncertainties and diversities. OK, this doesn’t happen to everybody. There are older people who are very unwise and younger people who are wise. But by and large, it can happen. It can happen if people are active—active physically, psychologically, socially, and cognitively. That people are open to new experiences, they’re willing to change in those people.
Again, there is biology behind that. In old age, usually the brain shrinks. We lose neurons and synopsis. However, in people who keep themselves active, there’s something called neuroplasticity of aging. The brain continues to evolve, and that evolution of brain may help explain why certain wisdom components increase with aging.
TS: Now Dilip, part of the premise of your new book Wiser is that it’s actually possible for us to become wiser faster. Of course, we talked about the wisdom pill, but the wisdom pill is not here yet, and we don’t actually know when it’s going to be here and what exactly it’s going to do either. OK, fair enough. But knowing what we know right now today, someone’s listening and they want to become wiser faster. What would be your three biggest recommendations?
DJ: What we have to do is, the first thing is self-reflection. We need to find out what are our strengths and what are our limitations? In our book, we described a scale that we developed to measure wisdom that is called San Diego Wisdom Scale or SD-WISE. We provide a link that people can click on and then pick the test themselves, and they will get the scores on each of the components. So you can find out, for example, I may have high level of decisiveness, but may not have enough compassion. Or I may be self-reflective, but I may not be accepting uncertainty, so on and so forth. So the first step is to find out our strengths and limitations in terms of these components of wisdom. And of course, then try to improve where we need help, where we are lacking.
Second or in general, the most important component of wisdom is empathy and compassion. It is hands down the most important component. That is what distinguishes wise from unwise people. For example, if you take a mass murderer or terrorist, they are often really intelligent people. They may have emotional regulation, they may accept uncertainty, but they lack empathy and compassion. So, improving empathy and compassion [inaudible]. Empathy means understanding or sharing someone’s emotion, whereas compassion is acting on it. You actually help somebody. But also there is something like self-compassion that’s important to remember. I find that people who are sometimes very compassionate toward others are very harsh on themselves, that doesn’t help. We need to have an optimum balance of compassion and self-compassion. Self-compassion is different from narcissism. It is just being kind to yourself and understanding. So I would put that at the second most important thing.
The third, emotional regulation in a broad sense. In today’s world, you’re talking about tests that how does society in some ways is becoming less wise and there is such a polarized society. We have such strong emotions, and they’re really are always given in one direction. I mean, these days all the news, we get is bad, and it only increases our levels of adrenaline or noradrenaline and makes us very stressed all day, all night, and months and years. We are also becoming really lonely. There has been a pandemic of loneliness for the last 20 years, before COVID came. The COVID has made it much worse. But loneliness causes suicides, opioid use, and so on. So that is a huge problem.
To control these problems, we need greater emotional regulation. One example I give for that is the road rage. In California, in New York, you’re driving—say I’m going to work and getting late so I’m rushing and suddenly somebody cuts in front of me. I get so mad, I start honking, cussing, and [inaudible]. That’s not actually very useful to me, Right. So what I need to do is control my emotions. How do I control my emotions? One, is cognitive restructuring. So I say maybe that person cut in front of me, not because he’s a bad person, but maybe because he had a child in the backseat and the child had a seizure. Similarly, you sense a common humanity. You said, “I’m mad, but then everybody gets mad once in a while, and there’s nothing wrong with that,” so I accept it and move on. It’s almost like mindfulness.
So these are, I would say the top things, three things: Finding out your strengths and limitations; increasing our empathy, compassion, and self-compassion; and controlling your emotions. If we could do that, I think that will significantly reduce our level of stress. Your mind is really [inaudible]—a number of studies have shown that in the last 20 years, the rates of suicide in the US have increased by 30 percent. Opioid related deaths have increased six-fold. The level of stress and anxiety has increased in the last 10 years dramatically, this based on Gallup polls. So clearly there are social anomalies and distress that we’re experiencing. So there’s another pandemic, and just like we are looking for a vaccine for COVID, the vaccine for this behavioral pandemic is wisdom.
TS: Interesting, Dilip. Earlier, you mentioned this phrase, “positive psychiatry.” I think probably many of our listeners have heard of positive psychology—practicing optimism and gratitude and appreciation, that kind of thing. Now, applying this idea to psychiatry, that’s really novel. I haven’t heard anyone use that phrase before. What’s positive psychiatry?
DJ: Yes, no, thank you for asking that question. A few years ago, I became president of the American Psychiatric Association. That’s the largest psychiatric organization in the world with about 40,000 members. And one of my tasks actually during that year was to publish our diagnostic menu called DSM-5. It describes the various diseases and their criteria. And it may be the thing that this is an important part, of course, for psychiatry to diagnose diseases and treat. But is that all that we do? Is that how we want to define ourselves, as treaters of mental illnesses? Should our expertise not go beyond illnesses and [inaudible]. Twenty percent of people have mental illnesses. One hundred percent of people have mental health. And what distinguishes psychiatrist from other medical specialties is we change behavior. We can modify the most abnormal behavior like delusions, hallucinations, suicidality. We control those. At least we try to do that, through psychotherapy, medications, and what have you.
So I realized that we were really not talking about mental health on psychiatry side. I did a Google search for positive psychology and got a thousand articles. I did a Google search for positive psychiatry, zero. Not one article. The next thing I looked at was psychiatric journals and psychiatric textbooks. There were hardly anything on things like resilience, optimism, social engagement, compassion, wisdom. And I said, these are—for psychiatrists who are experts in mental health, these are the things we should embrace. I was shocked by how little psychiatry was doing that.
Positive psychology, on the other hand, [inaudible] work of prominent media, but it has become a part of the formal lexicon. And I thought it was important that on the medical side, psychiatrists should do that. That’s why I started this positive psychiatry. I defined positive psychiatry as science and practice of psychiatry that focuses on improving well-being and happiness by promoting positive aspects such as resilience, optimism, compassion, and wisdom.
I found that in psychiatry, typically we ask for what is wrong with the patient, and we diagnose them and we treat them. We don’t ask them what is right with them. You don’t ask them what they like about themselves. What are their strengths? You can use the strength to treat their weaknesses. I feel that this is something very important for psychiaty to embrace. You know, it may take some time, but I feel that it has been growing well. There are now several books on positive psychiatry, several associations now have specific directions on positive psychiatry. It will take time, but I think it is going to grow.
TS: Wonderful. Dilip, I just have a couple more questions for you. I’m going to ask a personal one here for a moment. Which is, as you described the different components of wisdom, I was reflecting on my own growth and development as a person, as maybe some of our listeners were also doing. Like, “Yes, I can relate to that.” Or, “Oh, that’s a little harder.” When you got to this notion of decisiveness, you said decisiveness and being OK, making a decision in the face of uncertainty. I thought, “OK, I’m fine with the uncertainty part. I don’t have a problem with that.” But often I find myself indecisive, and when I’m indecisive about something, I’m just like, “Oh, I’ll just give it some space.” But it sounds like that’s not really wise. If I wanted to become wiser faster and grow my decisiveness muscle, what do you suggest?
DJ: Decisiveness means making decisions, wise decisions in a timely fashion. However, the timeliness would vary according to the decision. So it is absolutely OK to sleep on some things and make a decision after we are sure what to do because sometimes the situation is uncertain. As a physician, I know that patient comes with symptoms, there are different possibilities and I can’t make a definitive diagnosis. So, I have to wait for some time how it evolves and then I would make a definitive diagnosis. Likewise, the situation may be pretty ambiguous and it may take some time to make a decision, and that is fine.
But on the other hand, some things we have to decide quickly. Is like we have to vote latest by November 3. That’s where the timeliness varies according to the priority of the decision-making.
TS: OK. That’s helpful. I’m also going to ask you a personal question. When you did the inventory combined with your own self-reflection, what component of wisdom is the one that you’re working on the most, Dr. Dilip Jeste?
DJ: So I’ve found—that’s a really interesting question. I found that—my wife and I, we work closer together, she’s a psychiatrist, too. I find that she’s much more compassionate than I am naturally, and that is usually true. Women consistently have been found to have greater compassion—not self-compassion, but compassion toward others. I find that on the other hand, I tend to be bit more decisive than she is because she’s accepting of uncertainties and trying to—so I am compassionate, but probably I could be more compassionate. So that’s something I would work on. I think I am becoming a bit more experienced and becoming more accepting. So it is compression in a way that comes from—I’m [inaudible] and I have lots of trainees with me and I want them to learn how to do research. Like the rest of life, there are ups and downs and the world outside is not always the friendly place. So I want to train them that they become strong and they study hard, and there is no shortcut to hard work. So sometimes in that process, I have to be strict and I have to be—I may come across as being non-compassionate, and I may be. So that’s where I’m trying to improve myself.
TS: I would say my empathic nature feels your compassionate nature. So I sense that and feel that, and just for whatever that’s worth, I want it to say it. OK, Dilip, one final question. I think probably all the people listening to Insights at the Edge would concur with me here that not only is it important that as individuals, we want to invest in becoming wiser faster, we want our society to become wiser faster. In fact, there’s pressure on us to have our society become wiser faster. What do you suggest? What are the most important factors to, at societal level, grow in wisdom?
DJ: That is a great question. I think it’s a very important question. I’ve been thinking about this for some time. I fully agree with you that the things that are happening in the last few decades, they’re not helpful at all. Especially in the last few years, that it is just getting worse, and I think all over the world. I think what we need to do is, as I said, if there’s a vaccine for COVID, there should be a vaccine for loneliness and this distress and anxiety, polarization that we are having.
If we take these components of wisdom and apply them at the societal level, education at all levels is critical. Education from childhood through professional school to businesses, to everything. But right now, our education focuses on hard skills. In school for example, the three arts are important, reading, writing, arithmetic. In medical school, we teach the students how to be the best disgnostician, how to be the best treatment prescriber. We don’t teach our students soft skills. We don’t teach them how to try to understand themselves, how to empathize and be compassionate to their patients, how to be self-compassionate, how to regulate your emotions, how to be self-reflective. These things are so important for people’s own longevity, as well as happiness that it’s a blunder that we are making if we don’t use them. Our education system, has been [inaudible] in some way. We now have classes for, say, physical activity, arts classes, sex education, these are all great. What about classes on empathy and compassion, emotional regulation, self-reflection?
I mean, if you think about that, how do we raise our children? When your two-year-old throws a temper tantrum, you say, “You can’t throw a temper tantrum every time you don’t get something. You have to control your emotions.” Then you ask the kid to share the candy with his sibling, or with neighboring kid. We teach compassion. We teach the kid about self-reflection. If you didn’t do well in school, don’t blame the teacher. You didn’t study hard, but then you can do something better with that. Self-reflection. We implicitly practice love—that is what good parents do, right? And what good teachers do. But we need to do that at the [inaudible] level, more formally. It is awful right now—there are suicides committed by 10-year-olds. Suicide rates are going up, especially in teenagers and people in their twenties, because there’s a lot of peer pressure, a lot of competition. You always compare yourself with peers and you think you are doing worse. Social media, they’re helpful in many ways, but they’re disastrous in other ways. And so I think really it is important that we embrace to change these wisdom-related skills and [inaudible]. I think that will have an impact on the society.
TS: Wisdom based education.
DJ: Yes. Exactly. You put it very nicely.
TS: I’ve been speaking with Dr. Dilip Jeste. He is the author of a new book along with his co-writer Scott Luffy, it’s called Wiser: The Scientific Roots of Wisdom, Compassion, and What Makes Us Good. Dilip, great to have you here on Insights at the Edge. Thank you so much for your good work. And as soon as you get that wisdom pill a little further along in the lab, you let me know, all right?
DJ: Thank you, Tami. I don’t think you need that pill. You already are wise enough to need it.
TS: Well, very good, but I want to replicate and distribute widely. Thank you so much.
DJ: Thank you.
TS: Thank you for listening to Insights at the Edge. You can read a full transcript of today’s interview at soundstrue.com/podcast. If you’re interested, hit the subscribe button in your podcast app. Also, if you feel inspired, head to iTunes and leave Insights at the Edge a review. I love getting your feedback, being in connection with you, and learning how we can continue to evolve and improve our program. Working together, I believe we can create a kinder and wiser world. SoundsTrue.com: waking up the world.
