EP. 44: THE POWER OF COMPASSION

WITH JAMES DOTY

Jan 11

WITH JAMES DOTY, MD

A neurosurgeon, inventor, and philanthropist shares his insights on the neurocognitive and interpersonal effects of compassion.

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Episode Summary

What if we could scientifically prove that compassion improves our well-being, our cognitive function, our longevity, and societal welfare? Here to explore these questions is our guest on this episode, Dr. James Doty, a neurosurgeon, inventor, entrepreneur and writer. As the founding director of Stanford's Center for Compassion and Altruism Research and Education, his academic focus is the neurobiological effects of meditation, compassion, and altruistic behavior. His bestselling 2017 memoir, Into the Magic Shop, details his path from a troubled childhood to becoming an internationally-renowned surgeon and philanthropist. He serves on the board of a number of nonprofit organizations, including as Chairman of the Dalai Lama Foundation, and is on the International Advisory Board of the Council of the Parliament of the World's Religions. In this episode, we discuss his unlikely journey to medicine and the incredible insights on compassion he has collected over the years.

James R. Doty, MD has been on the faculty of the Stanford University School of Medicine since 1997 in the Neurosurgery Department as a professor and more recently as an adjunct professor. He is also the founder and director of the Center for Compassion and Altruism Research and Education (CCARE) at Stanford, of which His Holiness the Dalai Lama is the founding benefactor. Most recently, his academic focus is on meditation, compassion, and self-compassion for which he has lectured throughout the world.
Dr. Doty attended U.C. Irvine as an undergraduate, received his medical degree from Tulane University and completed neurosurgery residency at Walter Reed Army Medical Center. Dr. Doty served 9 years on active duty in the U.S Army attaining the rank of major. He completed fellowships in pediatric neurosurgery and electroneurophysiology.
He is an inventor, entrepreneur and philanthropist. He holds multiple patents and is the former CEO of Accuray (ARAY:NASDAQ). Dr. Doty has given support to a number of charitable organizations supporting peace initiatives and providing healthcare throughout the world. Additionally, he has supported research, provided scholarships and endowed chairs at multiple universities.
He is a consultant to medical device companies and is an operating partner and advisor to venture capital firms. Dr. Doty serves on the Board of a number of non-profits and is the vice-chair of the Charter for Compassion International and the former chair of the Dalai Lama Foundation. He is on the Senior Advisory Board of the Council for the Parliament of the World’s Religions. Dr. Doty serves on the Board of Governors of Tulane University School of Medicine and the President’s Council at Tulane University.
In this episode, you will hear about:
• Dr. Doty’s difficult childhood experiences and how the kindness of strangers pulled him to medicine - 2:10
• How Dr. Doty dealt with the fish-out-of-water experiences in medical school - 11:00
• A discussion of negative self-talk and how to overcome it - 17:30
• How Dr. Doty went from developing a neuroscience center in impoverished Mississippi to establishing an altruism research lab at Stanford University - 20:19
• A discussion of the eponymous incident of Dr. Doty’s book Into the Magic Shop and how it profoundly shifted his view on compassion - 26:06
• A review of some of the exciting findings of Stanford’s Center for Compassion and Altruism Research and Education - 32:36
• Reflections on how Dr. Doty practices compassion in his daily life - 38:29
• A brief discussion of the power of belief and how it shapes our reality - 44:00
• A discussion of how the dehumanizing bureaucracy and profiteering of the medical field is failing physicians - 49:55
Henry Bair: [00:00:01] Hi, I'm Henry Bair.
Tyler Johnson: [00:00:03] And I'm Tyler Johnson.
Henry Bair: [00:00:04] And you're listening to The Doctor's Art, a podcast that explores meaning in medicine. Throughout our medical training and career, we have pondered what makes medicine meaningful. Can a stronger understanding of this meaning create better doctors? How can we build health care institutions that nurture the doctor-patient connection? What can we learn about the human condition from accompanying our patients in times of suffering?
Tyler Johnson: [00:00:27] In seeking answers to these questions, we meet with deep thinkers working across health care, from doctors and nurses to patients and healthcare executives. Those who have collected a career's worth of hard- earned wisdom probing the moral heart that beats at the core of medicine. We will hear stories that are by turns heartbreaking, amusing, inspiring, challenging and enlightening. We welcome anyone curious about why doctors do what they do. Join us as we think out loud about what illness and healing can teach us about some of life's biggest questions.
Henry Bair: [00:01:02] What if we could scientifically prove that compassion improves our well-being, our cognitive function, our longevity and societal welfare? Our guest on this episode, Dr. James Doty, is a neurosurgeon, inventor, entrepreneur and writer. As the founding director of Stanford's Center for Compassion and Altruism Research and Education, his academic focus is the neurobiological effects of meditation, compassion and altruistic behavior. His bestselling 2017 memoir, Into the Magic Shop, details his journey from a troubled childhood to becoming an internationally-renowned surgeon and philanthropist. He serves on the board of a number of nonprofit organizations, including as chairman of the Dalai Lama Foundation, and is on the International Advisory Board of the Council of the Parliament of the World's Religions. In this episode, we discuss his unlikely journey to medicine and all the incredible insights on compassion he has collected over the years. Dr. Doty, welcome to the show and thanks for being here.
James Doty: [00:02:02] Well, thank you for having me. I appreciate it. And certainly anything to do with the doctors art I'm interested in.
Henry Bair: [00:02:10] So I want to start with your challenging upbringing, which you describe in vivid and often heartbreaking detail in your book, Into the Magic Shop. To set the stage for our listeners, can you tell us more about your childhood experiences?
James Doty: [00:02:25] So I had a challenging background. My father was an alcoholic. He was binge drinker. My mother had had a stroke when I was younger and was partially paralyzed, had a seizure disorder, and unfortunately was chronically depressed. Actually had attempted suicide multiple times. We were on public assistance, and I'm sure you can appreciate that when a child grows up in those types of environments without role models, without opportunities, without mentors, it's really challenging. Probably many of your listeners are aware, too aware of what we call adverse childhood experiences. And certainly these types of situations where you have drug and alcohol abuse, mental illness, poverty, the more of those you have, if you will, the less likely it is that you will succeed in life by traditional standards. And in fact, many children from these backgrounds themselves become alcoholics or drug abusers or have mental illness. So that was sort of my background. And of course, as a result, I had a lot of feelings of hopelessness and despair.
Henry Bair: [00:03:41] Thank you so much for for sharing that. So how did you go from that upbringing to a career in medicine? How did you go from that to medical school and medical training after that?
James Doty: [00:03:52] Well, like so many of us, one experience can change the course of our lives. And for me, the way I got interested in medicine was that in my fourth grade class it was career day. And we had a pediatrician visit and he was very empathetic and kind. And in fact, I'm sure you've experienced being in the junior person. You can have two experiences. You can have one person who treat you as an equal, as nice to you, as compassionate as kind. Or you can have somebody who's arrogant and narcissistic. And as a result, of course, generally, you shy away from people like that. In my case, though, this individual was the epitome of a physician: kind, compassionate, listened to you, empathic. And he made me feel comfortable asking him questions. And he very kindly answered them. And in fact, afterwards, he went out of his way to talk to me. And I was so impressed by that. That at that moment I decided to become a doctor.
Henry Bair: [00:05:03] Wow. So how were you drawn to neurosurgery in particular?
James Doty: [00:05:08] Well, that's a longer story. Let me just say, though, that from my background, you can say you want to be a lot of things, but actually manifesting them is far different. So even though that was in the back of my mind and that's what I focused on a lot, the likelihood of that actually happening, becoming a doctor was much less likely, in fact. So to fund my way through medical school, I accepted a health profession scholarship from the military, the army, and as you probably know, they fund your way through medical school and then you have an obligation to pay that time back. So I accepted that scholarship. So I decided to do a flexible internship, which is different than, if you will, a specialty internship. As an example, most people who go into general surgery, which is actually what I thought I was going to go into, do a surgical internship. But for me, since I felt that I would be doing surgery the rest of my life, I wanted to do a rotating internship and that involved rotating on pediatrics, obstetrics, etc.. And in fact, out of the group of 12 interns, I was the actually the only one who was doing a flexible internship. And this was as part of the program at my institution, which was at Tripler Army Medical Center in Hawaii.
James Doty: [00:06:43] So there were 12 of us all competing for a general surgery residency, because unlike in the civilian world, you have to compete for an internship and a residency separately. And the reason is, is that the military requires or has a need for general medical officers posted at bases to do sort of family medicine. And what they'll do is they'll train an intern and then send them out to do that. My real interest, though, was beyond general surgery because I wanted to do craniofacial surgery, which, as you may know, involves operating on children, typically with facial deformities. And this appealed to me. And of course, to do that, you have to do general surgery, generally speaking, then plastic surgery, then a craniofacial fellowship. And I had actually sort of lined all of that up. As I got more into general surgery, I realized I did not like it. I did not like abdominal surgery. I didn't like dealing with those types of bodily fluids or things like that. So so I realized that, jeez, having to do five or six years of that, I probably wasn't going to be that happy. And coincidentally, at that point, I began rotating on neurosurgery. And the individuals who were involved in that, which were two, were sort of the kindest, nicest people, very thoughtful.
James Doty: [00:08:13] Obviously, neurosurgery is technically demanding. That appealed to me. The fluids, if you will, were clean. So the combination of those things made me have an interest in becoming a neurosurgeon, and the two individuals were very encouraging. So I decided to do that. Now, you have to understand this was probably an April when I rotated and you had to turn in your application for residency many months before that. And I had applied for general surgery. So I talked to these and the neurosurgeons. They said, well, the army only trains one neurosurgeon a year, and that's at Walter Reed. And also there's a three year wait to get that residency if you're accepted. So what I did was I had 30 days of vacation. I took it to do a rotation at Walter Reed and neurosurgery. So I left to do that. And I did very well, met with the chairman, and he was impressed with my work. And he said, Well, Jim, we'd love to have you. Unfortunately, there's a three year wait, so you would have to go out as a general medical officer. And I looked at them and I said, Well, that's not really acceptable to me. So he looked at me and he sort of laughed. He said, Well, it may not be acceptable to you, but that's the way it is.
James Doty: [00:09:38] So I left there. After completing that, I went back and I told the chairman of General Surgery that I was not going to do general surgery residency and to withdraw my application. And I said I was applying to neurosurgery. So he looked at me and he said, Well, first of all, you're not going to get into a neurosurgery residency next year. And I think you should continue your application with general surgery. So he actually refused to withdraw my application. Interestingly, what happened was, though, that the individual who was slotted for the next year in neurosurgery, he ended up having a relationship with the head nurse on the neurosurgery floor. And they broke up. And then apparently he may have started stalking her, or at least she complained about this to the chairman. He then decided to withdraw his appointment for that position and actually arranged for him to be sent to South Korea for there to be a general medical officer after he had just spent three years as a general medical officer. And so suddenly they had an opening. The two other individuals waiting in line were already assigned. So they gave me the slot so I didn't have to wait at all, actually.
Tyler Johnson: [00:10:57] Okay. First of all, that's a- There are many adjectives we could use for that story, but we'll choose 'remarkable' for right now. But on the adjectives to describe that story, I want to roll the real back a little bit. So, you know, one thing that I'm struck by is that unlike you, I was blessed to grow up in an environment that was absolutely boring and supportive. There was nothing dramatic about my parentage. In fact, they were it was just it was socially stable. We were nowhere close to wealthy, but we always had clothes to wear and things to eat. And my parents were, you know, I didn't grow up thinking that it was my destiny to go to the Ivy League or anything. But they made it clear very early that we were supposed to go to college and they were big on teaching, good study habits and all that kind of thing. And they were also demanding in the sense that we were always required to have jobs growing up and provide a lot of our own money and work our way through college and all those kinds of things. So I say all that to say that when I got to medical school, I felt like I was drawing on every shred of social capital that I had been given through 20 years growing up in this incredibly supportive, stable, etc., etc., household.
Tyler Johnson: [00:12:10] Right? Like I was using every card that I had in terms of how to study, right, and how to work hard and how to maintain my equilibrium in these incredibly challenging circumstances. And and with that, I made it through. But it was really, really, really challenging. And so I guess I say all of that by way of saying that makes it all the more remarkable that someone who, by your account came from a place where there was very little social capital and very little in the way of, you know, you having almost, I don't know, study habits and how to maintain an equilibrium and how to be resilient. And all of these things could then make your way through the gantlet of medical school, especially because, correct me if I'm wrong, but my understanding is that when you were going through medical school, there was much more of a sense of sort of like, "we're going to knock out the weaklings early on and only the strong will survive." Right? Which is mostly not the case so much in medical school now. What was that like for you coming from such a different background and then having to kind of I mean, forget about cranial nerves and the brachial plexus, but just figuring out how to be a student and how to adult, as they say.
James Doty: [00:13:23] Well, I think that sort of shines a light on many aspects of children who are, as example, the first generation to go to college or children who grow up in poverty. It's not easy whatsoever on several levels. One, on a social level, because when you grow up in an affluent or at least a stable, loving environment, there are certain behaviors that you learn to maneuver yourself through the world. And if you don't have those at all, it's like walking into a room on a different planet. There's a whole different set of norms, interactions, way to speak, how to act, how to look, that you don't know anything about. And in fact, I remember going out to dinner with somebody and it was like the first time-- you know, for me, you have a knife and a fork at dinner right? Here, you had two or three spoons, two forks, three knives, a spoon above your plate. You had a plate here for your bread. And I'm like, looking at this with no clue. I mean, like. And so I just had to look and sort of watch what other people were doing.
James Doty: [00:14:39] And in fact, that's how in some ways I survived and learned, by imitation. And the fortunate thing for me is I'm white. And what I mean by that is that if you're white and you dress the right way and you talk the right way, there is an assumption that you belong. And so I learned this very quickly. But again, it was a challenge because I had no clue how to study. I was intuitively smart and on some level intelligent. But that only goes so far. And so I actually also worked quite hard and would stay up night after night to get through. So it was difficult.
James Doty: [00:15:30] The other aspect to it's lonely because again, whether it's at an Ivy League college or at a a prominent medical school or any medical school, most of the children who go there are from stable, affluent backgrounds. I mean, that's just the way it is. And if you're not part of that, you know, you're still an outsider. So I think that sits with you as well. And you always feel like an outsider.
Tyler Johnson: [00:15:59] So first of all, I just have to say this seems so insignificant and silly in comparison, but it just gives me a little bit of a frame of reference. I know when I got to. So I went to the University of Pennsylvania for medical school, but when I went there, I had not gone to an Ivy League college for my undergraduate degree and I felt enormously self conscious about the whole thing. Right? Because I, I sort of assume that there was this informal kind of secret club of people who had gone to Ivy League colleges. And I was very self conscious of not being a member of that club and felt very much out of place. But the the issue is that that was almost entirely illusory, right? I mean, it was I mean, there's no club and I mean, maybe there were people who looked down on people who didn't go to Ivy League colleges, but it was almost entirely in my mind. But it still was with me all the time. I mean, it just it was the in large part, the prism through which I saw myself in medical school was this made up idea that I was somehow inferior or didn't know the the ways that I was supposed to act there or whatever.
James Doty: [00:17:05] The secret handshake.
Tyler Johnson: [00:17:06] Yeah, the secret handshake, exactly. But I can only imagine, to your point, if you really did grow up in a place where you just didn't even know the social mores, let alone if you grew up that way. And then in addition, you had had a different color of skin or were otherwise visually very different- I'm just acknowledging how much I don't know about what that how that experience must feel.
Tyler Johnson: [00:17:30] But I also want to turn to a parallel question. So you were just talking about what it's like to be an outsider, but what is even perhaps more striking, whatever you lacked in terms of study habits and in terms of knowing how to use the the third fork away from the plate and that kind of stuff; what I think is much more striking by your own telling of what was lacking in your background and your upbringing was a sense of social coherence, a sense of emotional stability, right? The the ability to even have your own emotional reservoir filled up, let alone have enough in your own emotional reservoir to then go out and share it with other people. And yet then not only do you grow up to be a neurosurgeon, but you grow up to be a neurosurgeon who forms a research institute and then writes and whatever else about altruism. So how does that work? I mean, how how do you go from a place of having presumably when you were growing up little to nothing in your emotional reservoir, to being in a place where it's full enough that you then also develop the impulse to go start ladling it out to the people around you.
James Doty: [00:18:41] That's a very short question. (laughs) Well, I think there are several components to that. The first aspect is you mentioned yourself the self created illusion of not belonging. And I think this is true of many people and even children from affluent backgrounds who have some degree of negative self talk. And this is, of course, what limits all of us. It's this negative self talk that has been with us since childhood and occurs for all sorts of reasons is could occur from a background like mine. It can occur from, let's say, being coming from an affluent background with an abusive parent or a narcissistic parent. I mean, negative self talk is a very common event that occurs. So how do you overcome that? Well, I think for me. It was understanding the origins of that and the fact that that's not true. The second part is when you come from a background like mine, they're typically two directions you can go. One is you become an alcoholic and end up with all the negative attributes of a background like that. Mental health issues and things like that. The other is you put your head down, you ignore everything and you overachieve, right? Because you carry this baggage that says you are inferior or you carry shame. So you want to prove to everyone that you're worthy. Now, that can get you a long way.
James Doty: [00:20:19] The problem is, of course, you still carry that baggage and that sense. So that allowed me, if you will, to achieve. But the other aspect was understanding ultimately, one, that everyone suffers. And why are some people attuned to being sensitive to the feelings of others and why are some not? And so what happened was I had been at Stanford for some time, and then like many people, decided to go off and do some entrepreneurial stuff. But then after that, I was approached to consult for developing a neuroscience program at a hospital in southern Mississippi. And I used to work for a company that did that. And so I went down there and, you know, dire poverty. It was a public hospital, not a whole lot of resources. And what happened was I had outlined a plan to these people. And because they were trying to attract people to come, they're selling them that you'll cover the emergency room. Well, that is probably the least interesting part of any physician. (laughs) You know, like, oh, okay, well, you're paying me to come here and cover an E.R. Wow. How wonderful. What I presented to them was a narrative that you're coming here to develop a neuroscience center of excellence. And part of it is covering the emergency room. And that's completely different narrative. If you try to sell in a place that people don't necessarily want to be, that you're covering an E.R., you get three types of people.
James Doty: [00:21:57] You get those who have recently gone through drug and alcohol rehab. (laughs) You get fundamental personality disorders or you get people who've gone through a very challenging divorce and want to get as far away as possible or a combination of all three. But if you present a narrative of we're building something to improve the community, it's going to be a cohesive group of people. It's going to be outstanding. Here's the plan. We're going to develop a neuroscience center. We're going to have all these specialties. We're going to create a neuro-ICU. We're going to create a rehab center. That's much more appealing. And so that's what I ended up going there, and I ended up doing that and created all of that. And it became a referral center. It's the only center, believe it or not, in Mississippi that was stroke-certified. And so it actually brought people together. And so how does that relate to the ultimate question you ask? Well, as I was leaving there, I began to think about what are the drivers that make somebody altruistic or care and what keep them from doing that. And this led to not only a personal exploration, but when I decided to go back to Stanford, I decided to study this. Now, the interesting thing is that I brought together a group of psychologists and neuroscientists and said, I want to study compassion.
James Doty: [00:23:22] And the unfortunate thing about that was that when I met these individuals, they basically said, you can't study compassion. And if you do that, that's an academic dead end. And this was at a time where everybody talked about mindfulness. The thing about mindfulness, though, there is no explicit component of compassion for self or compassion for others. And so what it can do is it can lead somebody to actually be a very ruthless person who is able to attend and be present. And and, of course, I'm sure you probably run across people like that. And in fact, this is why on Wall Street, they teach people mindfulness, right? So they don't have to think about other thoughts that go by. There can be completely focused. Anyway, so what happened was, though, that scientists, if you fund a project, they're happy to do the project because they're always looking for research dollars. So anyway, we began a journal club. We began doing some preliminary research and two out of the four individuals changed the focus of their work actually to compassion because the data was so compelling. And this then actually led to me engaging the Dalai Lama, who became the founding benefactor of the work at Stanford. As soon as the Dalai Lama got involved, two individuals came forth and made significant donations.
James Doty: [00:24:49] And then the next thing I know, I find myself in front of the dean who says, "What are we going to do with all this money?" And I said, "Well, I want to create this center." And he said, "But Jim, you have no background in this area of research." And he said, "You know, how can I support you being head of a center of which you know nothing about that area of expertise?" And so what happened, fortunately, was that the chairman of the Neuroscience Institute and my chairman said, "look, you know, we're supportive of Jim. He's a smart guy. We back up this proposal of his," which they did, and the center was ultimately created. And if you look at the trajectory of this work, it's been quite powerful in the sense that we've done a number of studies. And if you look at what's happening outside now, everyone talks about mindfulness and compassion, right? That is sort of the bedrock of all of this is compassion for self and compassion for others. I ended up editing being the senior editor of a book that Oxford published called The Handbook of Compassion Science. And sort of compassion is now recognized as a very powerful tool for self improvement, but for improvement of society as well as the individual, of course.
Henry Bair: [00:26:06] I'd like to delve more deeply into what your research questions on compassion are. But for now, I want to pause here and go back to the start of your journey in mindfulness, meditation and compassion. I know from your book, this all began in a literal magic shop, the eponymous title of your memoir. It's a remarkable story. So can you tell us more about that formative experience?
James Doty: [00:26:32] Sure. Let me just say this book "Into the Magic Shop," you know, it's it's actually been quite phenomenal because it was a New York Times bestseller, but it ended up being a bestseller in a variety of countries. Also actually was used by this Korean pop music band, BTS as the basis for their third album, which is quite extraordinary. And in fact, that album was called Love Yourself: Tear. And there's a song there called Magic Shop. But now the book is in, I think, over 40 editions all over the world. It's been a bestseller in Romania, Russia, Poland, South Korea, United Arab Emirates and other countries. And so the point you said earlier, you know, the message here resonates with a lot of people. And I think also the book has many layers to it. It's not only the memoir, it includes a neuroscience, it includes contemplative practice and includes, if you will, many life lessons that help people who are struggling, which is most of us, actually. But anyway, getting back to your question. So at the age of 12, I was in a situation where I did feel the sense of hopelessness. And what would happen is when there were things occurring at my house that were unpleasant, which was not infrequent, I would get on my bicycle and ride as far and as fast away as possible. And on one of those journeys, I ended up at a strip mall. And in the strip mall was a magic shop, and I had had an interest in magic.
James Doty: [00:28:02] So I went in. The owner wasn't there, but his mother was there, and she was reading a very thick paperback book with glasses on her nose and a chain around her neck. And she looked up and she had this radiant smile. And it was an inviting smile that was kind. And, you know, oftentimes when you interact with somebody, they have a whole lot of choices about how they're going to connect with you. And in this case, she made me feel psychologically safe, which meant that she treated me with respect. She treated with me with dignity. She interacted with me as if I was an adult. And it made me feel comfortable. And as a result, she began asking me some questions, which I answered truthfully, which normally I would not do. She asked me about my background, about my parents, about where I lived. And at the end of our conversation, she said, You know, I really like you. I'm here for another six weeks. And if you come in every day, I think I can teach you something that could really help you. Now, this is very strange, of course, that somebody you don't know whatsoever gives you sort of this offer of a gift. And I was 12. Well, I had no insight or self awareness. What I did know was, one, I had absolutely nothing else to do.
James Doty: [00:29:21] And two, she was giving me chocolate chip cookies, which were actually the driver for me to show up every day, which I did. And through the course of that six week period, she taught me a couple of things. One, this concept of relaxing the body, because if you come from a background like mind, which is chaotic and traumatic, you are always waiting for the shoe to fall. You never know what's going to happen next. So as a result, your sympathetic nervous system is chronically engaged and you're very tense. So she taught me first to relax, and she taught me a breathing exercise, which, as you know, can shift you from engagement of your sympathetic nervous system to engagement of your parasympathetic nervous system. And then she also made me realize that the negative dialog went on in my head, which we sort of alluded to before, is illusory. It's not you. It is a creation of your own insecurities. And as a result, with typical mindfulness, you let those thoughts go by without attaching to them. But in this case, she also taught me how to change how I reacted. She made me understand that that dialog was not truth. And then she gave me tools to change that dialog, if you will, to self affirmation. And the problem is, if you believe the narrative in your head, in some ways it limits you because oftentimes you can't see beyond that.
James Doty: [00:31:00] Or you sit there and tell yourself that you're not worthy, that you don't deserve it. And so in some ways it's a way of creating a trap or prison for yourself. So in some ways she liberated me from that. And then the next thing was she taught me that I deserve to be loved, to be accepted. But it also changed how I looked at the world because it made me realize that everyone is suffering and the actions that they often engage in are not themselves necessarily, but they're driven by these internal dialogs. And so it made me have a much more kind and compassionate view of the world and of everyone in the world. And in fact, it allowed me to no longer have anger or hostility towards my parents. So that was actually really a gift. The other aspect, which I think is important, is that people have the ability to intuit your emotional state. And that's how we survived as a species. And when you carry anger and hostility within you all the time, then people react to that. So having a much more open, thoughtful kind demeanor actually changes how people interact with you. And this is what I tell people is that when I changed how I saw the world, the world changed how it interacted with me, and that interaction with Ruth, this woman in the magic shop, really changed the trajectory of my own life.
Henry Bair: [00:32:36] Well, it's incredible how you go from that encounter from when you were 12 to eventually founding this this Compassion Center at Stanford, the the Center for Compassion and Altruism Research and Education. Right? So you had earlier told us how that came to be. So I'd like to return to that. And, you know, you mentioned that you met a lot of resistance and skepticism while you're trying to set that up. So I would love to to hear from you. What exactly are you trying to find out? What does that compassion research look like? You know, you mentioned talking about the data is strong here, that it's so strong that more and more people are coming on board. What does the data show?
James Doty: [00:33:15] Well, based on my own work and that of a variety of other people, there are several aspects of this. One is that when you act compassionately, it actually stimulates the reward or pleasure centers in your brain. And in fact, more so actually than even doing selfish acts toward yourself. And what I mean by that, there are a number of studies that have been done as an example with students where they're given money and they have a choice of distributing it to others or to keeping it. And actually, their reward centers are more activated by giving it than taking it themselves. And this has been shown over and over again. So you can understand why this is because we are attuned, if you will, to the suffering of others. If you look at our species, we began as hunter-gatherers and we're attuned to the suffering, if you will, of our children or our loved ones. And as a result, we care for them. But the reason we care is because we're rewarded, Right? Because why would you spend so much time and energy to care for your offspring if there wasn't some reward at the end? And that reward is oxytocin is one of the hormones in that it stimulates your pleasure and reward centers. But just as importantly, when you care, when you're open and inclusive, this actually is when your physiology works its best because it shifts you into the engagement of your parasympathetic nervous system. And as a result, your cardiac function is improved.
James Doty: [00:35:03] Your heart rate variability, which is actually a correlate of engagement of your parasympathetic nervous system, actually is decreased. Your blood pressure is lowered, your immune system's boosted, the expression of inflammatory proteins is diminished. The hormones typically associated with stress are diminished. So it has a huge, huge positive effect. And as an example, if you look at people who come from these areas in the world where typically people live to be over 100. Oftentimes this is attributed to diet, right? You hear everybody talk about the Mediterranean diet. And in fact, there are probably 10,000 cookbooks on the Mediterranean diet. But the interesting thing about that is by far what is most important is actually human connection and personal relationships. And so why does that correlate with compassion? Because, again, when you connect with somebody authentically, you get all the benefits, as I just described to you. And how is that different than modern society? Well, the reason it's different is unlike in these areas in the world, we live to be over 100; where you're born, where you die, You live and intergenerational groups. Everyone knows you. They know the good and the bad. And guess what? In the face of all of that, they still love you. No matter what you do, you are still accepted. You were loved. You don't have to hide. The very nature of that has a calming effect and chronically engages your parasympathetic nervous system.
James Doty: [00:36:47] Unlike modern society where you don't frequently live with your parents or their not proximity or your loved ones. You oftentimes are in positions where you don't know the people you're interacting with. So what does that lead to? It one leads to fear of judgment. Two. It leads to chronic engagement of your sympathetic nervous system. And as a result, you have all these deleterious effects in terms of your health. There are an immense number of conditions that are, if you will, mind-body disconnects. As an example, if you look at businesses such as Google, where their typical employees are between 25 and 45, you know, they don't suffer from hypertension or heart disease as a major determinant of health. They suffer from stress and anxiety. And the point is that that is the major problem in modern society. When you're able to instill, if you will, compassion or authenticity, it has a very, very profound positive effect on everything. Whether it's in business, because you decrease health care costs, you decrease human resource costs, you increase productivity, or whether it's in health care, where if studies have shown it simply, if you're kind and compassionate as an ER doctor, it decreases the response to medication. It decreases the need for pain medication, it decreases length of stay, a whole variety of determinants which are positive in terms of health care, just by being kind and compassionate. And certainly on a personal level, of course, it has a profound effect.
Henry Bair: [00:38:29] Thanks for describing the the more scientific aspects of compassion. Now I'd like to explore the less quantitative side of things, the less physiological side of things, and and ask. So now that you've told us the many ways that compassion can change our brain chemistries and make us feel better and happier and improve our relationships and all that, what does compassion actually look like for you in practice?
James Doty: [00:38:58] So I think in some ways it's giving people the benefit of. The doubt, if you will. And what I mean by that is. When you look at another person and you think about the drivers of their behavior, it changes how you react to them. And this is something that has been alluded to, to Viktor Frankl and his "Man's Search for Meaning" is this idea between stimulus and response. There's a pause. And within that pause lies your freedom. And let me give you an example. I had a colleague, a physician, who I was working with on a research project in his thirties. We would meet every couple of weeks. It was always congenial. We had a good time. He had decided to quit his job, take another job. He had a young family, two children. And as you know, in the United States, you get COBRA insurance between jobs, Right. Which you pay for to ensure that you have health care. Well, being young, he decided he didn't really need it. There was only a three month gap between his new job. So he didn't get Cobra insurance. So he comes to see me one day and it's immediately argumentative, which is very unusual for him. Like all of us, if somebody is confronted to you, you typically get aggressive back to them. But instead of doing that, what I did was I looked at him. And I said, you know, "this isn't you. What's wrong with you?" Well, he burst into tears. And what it turned out was that a week before his wife had noticed a lump in her breast, she got a biopsy and it was cancer.
James Doty: [00:40:41] Well. Imagine what that's like.He has no health insurance. He's between jobs. He has a young family. He doesn't know what he's going to do. And he's terrified. So that was the driver of his actions. It had nothing to do with he and I interacting. Now, the good thing is that we were able to get him retroactive COBRA insurance. His wife had surgery. It didn't metastasize. She only required the resection and everything was fine. But the point of the story is that we never know what's going on oftentimes underneath the surface. And when you're much more thoughtful and you take the time to ask, it changes the narrative. And I think if you look through the lens like that, it gives you actually a tool to function much better in society.
James Doty: [00:41:31] And the other thing is that people are afraid of being authentic. As an example, I give a lot of talks, and if you've seen any of them, you will see me oftentimes, as I tell a story, get tearful, my voice will crack. One time I did that and a woman came up to me after and she said to me, she said, "Oh my gosh, I saw that. I felt so sorry for you up there." And I looked at her and I said, "What are you talking about?" She goes, "You must have been so embarrassed because I heard your voice crack and it look like you shed a tear there." And she said, You know, "that must have been horrible. You must have felt so bad." And she said, "listen, I'm a psychiatrist and a hypnotherapist. If you come to me for three sessions, I'll get rid of that."
James Doty: [00:42:19] Now, my point is that this is where your humanity is. You know, I have given so many talks, and the very fact of showing your emotions like that allows everyone else to show their emotions. And I can't tell you the number of times where people have come up to me and have asked for a hug. And the point is that when you give them that gift of your humanity, it actually is very powerful and and allowing them to be their authentic selves. So I think that's really important. Now, of course, in medicine and especially neurosurgery, there is a opinion that you can't show your humanity, that that will interfere with the relationship. And I will assure you, at least in my own experience, that has never been the case. You know, I routinely hug my patients. I will cry with them sometimes. It doesn't diminish me as either a physician or a human being. Now you sit there and say, Well, don't you have to operate on these people? Of course you do. And at least for me, I'm able to. Turn on and off between being a, if you will, a neurosurgeon who is a technician who is there to do a very specific job versus being the kind compassion individual. Now, I may be different from others, but I don't have any problem with that. You know, I can go in and turn all those emotions off and do the job that I have to do and then be back and be able to hold them and to cry with them. And as you know from my book, there are multiple examples of that.
Tyler Johnson: [00:44:00] When Henry asked you to describe the research that the Center is doing, you talked a lot about a lot of neurobiological and neurohormonal and all of these very interesting physiologic explanations of all of the goodness that your body puts out when you engage in altruism, all of which I'm sure is true and is wonderful because, you know, aren't we glad that we get positive reinforcement from our own bodies when we do what's right? I just want to probe a little bit, though, from, I guess, maybe a neuro philosophical standpoint and ask. I always get a little bit worried when we talk about things in that kind of a frame where we say, Oh, well, if you're altruistic, then oxytocin and dopamine and this and that and the parasympathetic nervous system and all the rest. Not that it's inaccurate because I don't think it's inaccurate, but I always worry that if we're not careful, it becomes reductionistic, as if all altruism is is a way to get an oxytocin hit or whatever. And so I guess I'm I'm hopeful that -I mean, here I guess I'm sort of putting words in your mouth- but I'm hoping that you or the center or something also would agree with the contention that while that is it, that's not all that it is. That there is also something, whatever you want to call it, metaphysical or spiritual or something that is just sort of puts you in alignment with the universe. When we're altruistic beyond just the neurohormonal changes that the body experiences. Does that sort of make sense?
James Doty: [00:45:33] Well, I understand what you're saying, but at the end of the day, I'm a scientist, and all the mumbo jumbo you're talking about, frankly, on some level is irrelevant. Now, let me then back up and say the following. It is reductionistic. And yes, you can look at it through the lens of that. But the other side of the coin, which you allude to, is this idea of spirituality or connection to the universe. Well, I have no ability to measure that. I also know that there's a subset of people who can create a very destructive narrative to hate other people while making statements about how great they are. And in some ways, it's the same narrative. And what I mean by that is. We can create in our minds what we wish to believe. And that belief can be very powerful, both from a perspective of how we see the world and it can have a huge impact on us physiologically. So I understand that we have the power within us to create, on some level, reality. And it's very powerful and it can also create reality for others who are succumb to that belief system. All of that is fine and good if it's doing positive in the world. I will tell you that there are probably in fact, I would suggest no one who has as many relationships with spiritual and religious leaders in the world than I do. And I don't mean just I've met them. I mean I've spent time with them. I've talked to them. And whether that's the Dalai Lama, whether that's Sri Sri Ravi Shankar, whether that's Amma the Hugging saint, whether Thich Nhat Hanh, whether that's Desmond Tutu.
James Doty: [00:47:46] I have spent a lot of time with these people. And in fact, it has been said to me by many of them that I'm one of the most spiritual people they know. Well, what does that mean exactly? It does mean that I align myself with positivity and the belief that the world is a good place and that our place in the world is to do goodness. But I am under no illusion that there is any evidence to prove that. I have chosen that as a belief system I live by. But frankly, if you look at the randomness in the world, it's random. This explanation that if there's a tornado or an earthquake or a flood had to do with somebody being gay, of course, is ridiculous, just as if it occurred because they were sinners or they were nonbelievers. It's it's absolutely ridiculous. What I do know on a human level is and even in relationship to animals, if you're kind, if you're compassionate, if you act altruistically, your world and the world of others is a better place. I don't need to believe in an afterlife or I don't need to believe in some magician in the world who has omniscience, who decides what's right and wrong. I'll never know the answer to that. And it doesn't matter. I choose to live with a belief system that if I can create positivity in the world and that affects another person, that's enough. And that's sort of what I believe. Does that make any sense?
Tyler Johnson: [00:49:24] Yeah. No, I appreciate your articulating that. I, I agree with you that I think at the end of the day, there is that which is provable and then at some level, that which we have to choose to believe. And sometimes those things, the relationship between those things is complicated. We've kept you over time. But I want to ask you one last question.
James Doty: [00:49:44] (laughs) One last question.
Tyler Johnson: [00:49:45] I know I know the sort of founding hypothesis of this whole of the whole project of this podcast is that physicians are in large part losing meaning with what brought them to being physicians in the first place. Right. And there is I've just sent Henry in the last couple of days to new articles just from the last couple of days, these sort of very poignant pieces by doctors who have now quit medicine because of fill-in-the-blank. Right. There's all kinds of different reasons. You can find 100 of these essays online. But the point is that a lot of people are leaving. And and, of course, the reasons for it are complicated. But at base often it is that they have lost meaning. It may be they've lost meaning because of the bureaucracy or because of the business of medicine or because of having to see too many patients or whatever it is. But still it's a loss of meaning. And so as someone who well, who thinks a lot about the deeper motives behind doing what we do, what parting thoughts can you give us either on a personal level for a doctor who's out there struggling to find meaning in what they do or on a systematic level for CEOs or whatever who are running health care organizations? What thoughts can you give us about how we could help to restore a sense of meaning to the practice of medicine?
James Doty: [00:51:06] Well, I would preface this by saying I don't think there is any profession that has more meaning than having the privilege of caring for those who are suffering. There just isn't. The challenge is that how do you hold your humanity and care for others when you have so many things that are taking that away from you? Whether it's the requirement for working endless hours, whether it's the electronic medical record which separates you from the patient, whether it's not being able to do what you were trained to do because of certain limitations that are independent of actually caring. I mean, this is what causes moral injury to so many physicians, and it leads to them suffering because they want to do what they were trained to do and the system systemically actually works against them. Part of the problem is we cannot. Take physicians and call them health care providers. We cannot take physicians and make them into a widget. These are human beings who have a unique calling and gift, which is extraordinarily powerful and critically needed by so many people. We have to honor these individuals and as a result, give them enough time to care for themselves and their family. Pay them enough so that they can live reasonably well and create an environment that is supportive and soothing and gives them resources not only to help others, but to help themselves. I would suggest, though, for those who are suffering that you open up, and what I mean by that is so many physicians have this notion that somehow they are supposed to be perfect and not be affected by long hours or patients who have suffered and have impacted them.
James Doty: [00:53:14] They should be able to be in an environment where people will hold them, hug them, give them time to recover, recognize their struggle. And there should never be any shame with this. Unfortunately, also we have a profit motive, which in many ways overshadows all of this. I mean, the reason for the electronic medical record, you can argue it's to get clarity with patient care, but it's complete BS. It is a tool to bill insurance companies to get paid more. And the long working hours are a way for systems to get free labor. So be under no illusions that this is because of some other external problem here. This is a systematic extractive mechanism which destroys our humanity and allows for a small subset of people to benefit at the cost to in fact, all of us. And until we rise up and demand a different narrative, a different way of doing things, this is only unfortunately going to continue. Look at what has happened in emergency rooms. You've seen private equity companies come in. They've recognized that it's an inefficient system, so they've created a way to maximize billing, maximize the workload of a physician and charge more and make a ton of profit while screwing the doctor and the patient. You cannot expect the people who have the power and the position which benefits them solely to do anything for the common person. And I think we have to orient how we live a society towards the average person and maximize the benefit for them.
Henry Bair: [00:55:00] Yeah, I agree. To your point about the need for clinicians to share their humanity and in this way help themselves heal. That's exactly our hope for this podcast that in our own small way we can advance our ability to do that. So we want to thank you again, Dr. Doty, for being a part of this conversation and for sharing your story and insights.
Henry Bair: [00:55:22] Thank you for joining our conversation on this week's episode of The Doctor's Art. You can find program, notes and transcripts of all episodes at www.theDoctorsArt.com If you enjoyed the episode, please subscribe, rate and review our show available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.
Tyler Johnson: [00:55:41] We also encourage you to share the podcast with any friends or colleagues who you think might enjoy the program. And if you know of a doctor, patient or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments.
Henry Bair: [00:55:55] I'm Henry Bair.
Tyler Johnson: [00:55:56] And I'm Tyler Johnson. We hope you can join us next time. Until then, be well.