Nyhavn in Copenhagen

On March 10th, 2015, I went to a lecture about if we Danes are the happiest in the world. It was a free event at the Tårnby Health Center and open to the public. 

We are called the world’s happiest people – although several thousand Danes take medication to get out of bed, be around other people, or go to work. When is medicine the best solution and who should evaluate it?

Hear three researchers talk about stress, personality disorders, and alternative medicine.

1. The latest results in the field of stress research with Malene Friis Andersen from Copenhagen University

2. Personality disorders with clinical leader Pia Glyngdal from the Psychiatric Center in Hvidovre

3. Alternative medicine with Lasse Skovgaard from Copenhagen University

The program started with PostDoc Malene who works at the National Research Center for the Working Environment. She began by saying that there is no official definition of stress and that there are many ways to define and measure stress. In fact, she reported that, in 2012, “what is stress?” was in the top 10 most googled questions in Denmark.

There are primarily Realistic and Constructivist perspectives, where the one is based on measurable attributes of stress, and the other is based on people’s perceptions and experiences with stress. There are direct and indirect ways to measure stress, such as asking the person about their feelings of stress versus measuring heart rate, blood pressure, cortisol levels, etc. She simplified stress by attributing it to the fight or flight response, where our minds and bodies react to stress by either fighting a situation or fleeing from it.

In relation to her work on workplace environments, she mentioned a concept I had not considered before, but it makes a lot of sense:  Cognitive Capitalism. The basic idea is that work processes and environments are not like they used to be in the Industrial Era, where we essentially performed like conveyor belts, all in a row, performing our one work activity as part of a larger product assembly. Work, and the final products, are now much more cognitively-driven, and the ideas that we use to produce our work cannot be removed from the person having them. So, much of our end-products that come from work have their value in the cognitive processes:  our personal and individual ideas create the capital. She then went into how work environments have not fully adapted to this, and we are often met with superficial and fragile identity experiences, and we are still expected to act like the other employees around us yet produce results that are distinct and different. This can cause a dehumanization of our personal overtones at work – we are expected to take our personalities and individual qualities out of our work environment, but still produce work that is largely driven by these very qualities.

She also talked about how social acceleration can create feelings of stress. We feel that we are constantly living with a lack of time and that each day we must rush to fit in our many activities, with many of them left unaccomplished or spilling over to the next day. This leaves us feeling that we are always behind, yet we need to maintain a full schedule in order to be considered productive or efficient. She also mentioned how we now tend to speak in psychological terms, which means we are pathologizing our daily lives. “Oh, I know I’m a bit neurotic about this… so and so acts like a psychopath… his ADD distracts him… etc.”

Her talk about stress really reminded me of my own research on quality of life (QOL). Similarly, there is no one official definition of QOL and there are many ways to define and measure the concept. It can be looked at from the macro level, meaning the quality of life of a society – access to education, healthcare, employment, food and drinking water, etc., and also the micro level, so how an individual views their social relations, the quality of their experiences, the events in their daily lives and near surroundings, etc. Again, similar to her talk about measuring stress, there are direct and indirect questionnaires. The direct questionnaires are often viewed as the subjective perspective, meaning asking the individuals their opinions, whereas the indirect questionnaires are viewed as objective, and certain attributes of quality, such as income level, frequency of social interactions, etc., which can be measured. One of the differences between measuring stress and measuring QOL, is that stress often produces physical reactions in the body which can be used to confirm and grade the presence of stress.

I really liked the last things she discussed, about cognitive capitalism and how ideas and innovation are the valuable products on the market now. And I completely agree that society now has a tendency to pathologize daily life. To this last point, I will further say that I am disappointed in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders 5th Edition, used in courts and for the clinical diagnosis of mental disorders). I also wrote about this in my PhD thesis, about how 75% percent of the editorial board had direct ties to the pharmaceutical industry and the 5th edition even classifies normal grief (after losing a loved one) as a mental disorder. It TOTALLY pathologizes EVERYONE:  suddenly, we all can be viewed as psychologically abnormal or mentally unwell. You can read another person’s similar opinion on this here. Of course, the goal is that if they can diagnose, they can prescribe… but certainly not everything needs to be treated as an illness. We are meant to have grief, we are meant to experience stress, it’s ok to be confused and uncertain – all of there are normal and healthy to a degree and certainly shouldn’t be wiped away with medications.

After her 25 minute talk, there was time for Q&A. One question was about the role that managers at the workplace can play or cannot play in mediating or mitigating stress in employees. Malene said that they are currently starting a research project on this, so she doesn’t have a set answer for us yet, but they are hoping to find out how big of a role managers play. Another question was on personality traits and stress, and Malene said that there are some traits that make people more susceptible to stress, but it is hard to determine the degree that personality plays and which way the stress can go. She said the main culprit for people taking stress leave from the workplace is that they become over-involved in their work and the other areas of their lives start to suffer:  there is a work-life imbalance and this greatly increases the stress response. Finally, she was asked about why some people are able to return to work after a stress leave, and some are not able to return to work. Malene said that we currently don’t have a timeline or know which types of stress or people influence successfully returning to the workplace. It largely depends on the person, the situation, and their symptoms, so it is very difficulty to give a general answer for this.

Next, we heard from Dr. Pia about personality disorders. One of the first things she said, is that you can’t have both a personality disorder AND happiness. I wonder if this is true, since there is a spectrum of attributes in personality disorders, and I would tend to believe that the two do not necessarily oppose each other. But, she is the psychiatrist….. She talked about how having a healthy personality means having a spectrum of reactions and having a disruption in our personality leads to limited emotional reactions. Ok, this makes sense, but I wouldn’t think that limited emotional reactions means that one cannot have happiness…. maybe it is happiness to a limited degree of what we would think it should be in a healthy person (although happiness, like stress and QOL, is also very difficult to define and measure), but it is not the absence of happiness.

Well, anyway, she talked about a history of personality research, astrology, Hippocrates, Carl Jung’s ideas on introverts and extroverts, etc. She also characterized a few personality disorders and showed visualizations on how they experience a limited spectrum of personality traits and how these dominant and out-of-proportion traits can disrupt how the person views themselves, others, the world, and their surroundings. She also talked about how doctors and medical students have a hard time understanding personality disorders, and this may be because they tend to look for clinical symptoms and solutions, so nuances in personality are difficult for them to grasp and recognize when they are disturbed. She also said that personality is 50% temperament (how we are born) and 50% character (how we develop from life experiences).

At the end of her 25 minutes, there was time for questions. One was on the role that stress plays in personality disorders, and she answered that both come into play in how one feels they can live up to expectations, and stress can aggravate personality disorders but does not typically cause them. A follow-up question was on if we are born with personality disorders or if they are developed. She said, again, that it is 50/50. We are born with a lot of our personality traits and our life experiences also help to shape those. She gave the example of Post-traumatic Stress Disorder, which would be one example of a personality disorder which is developed during life.

I also wondered a bit about this. Before I moved to Denmark in 2005, I was a very optimistic, outgoing, and a social person, I was very comfortable with public speaking and performing on stage. After moving to Denmark, I became much more withdrawn and developed some kind of social phobia or anxiety. My face would get all flushed and hot and I would get so self-conscious when I would speak – whether it was in conversation or in public speaking. These were all new things for me. And, oddly enough, I had met a good handful of other foreigners who had similar experiences where they had been very outgoing before moving to Denmark, and suddenly developed this social anxiety. Most of us concluded that it had a lot to do with how closed the Danes tend to be, especially in the smaller city of Aalborg (about 150,000 people) where people were not as comfortable speaking in English or with foreigners. I picked up Danish quite quickly, but have still experienced a few times that when I go into shops and ask for a particular item or a different size or color of an item, and the workers get all clammed up. They will just say no…. So, um, can you look in the back for a medium in this sweater or ask someone else?…. no….. So weird, and all you can do is try again another day and hope it’s someone different working at the store. Anyway, I guess it’s not too hard to figure out that after multiple experiences like this, foreigners become a little shy about speaking to Danes, even if we are trying to use our Danish. I guess, what I am trying to say, is that I feel like some aspects of my personality have dramatically changed since I moved here and due to life circumstances. It would be an interesting study to see if this is a common experience among foreigners…..

Then we had a break where we could eat fresh fruit, nuts, homemade wheat buns, and have coffee or tea. Then, it was time for the final talk on alternative treatments.

Lasse spoke about how, in Denmark, there is an increase in disorders (including chronic conditions) and an increase in the use of psychopharmaceuticals. There are two general ways of looking at the medical system. Type 1 is medicalizing and tends to be passivistic, and Type 2 uses alternative treatments and other systems than the traditional medical treatment. He then went into the clinical understanding of psychological disorders and how the issue seems to be a separation in the treatment of the mind and the body. He illustrated this by describing Descartes’ dualism of the mind and body, and how this separation follows the development of modern medicine.

Lasse defined alternative treatment as that which is carried out by a person who is not authorized to treat (for example, if no authoriziation exists), or is an nontraditional method carried out by a person who is authorized to treat. He reported, that in 2010, 52.8% of Danes used alternative treatments, not including the use of herbalism (herbal medicine). And why did they choose to do so? He found that the goal is most often:

39% were treating mild symptoms and disorders

22% were using it for preventative care and to increase their health

15% were using it for chronic conditions

He also said that there are psychological conditions and other reasons that didn’t fit into the questionnaire of their SUSY study, but that a combination of the physical and psychological treatment is very common. He further discussed how alternative treatment differs from traditional medical treatment in that it takes a holistic approach, serves to strengthen (as opposed to treating after weakness), is individualized, and allows people to play an active role in deciding their treatment approach and how they want to carry it out.

There was time for Q&A again. One question was on what is best for the Danes’ mental condition? Lasse described two viewpoints:  one being evidence-based (traditional medicine) and the other being speculative and experience-based (alternative treatment).

Lasse’s talk got me thinking about chronic conditions and how there is an increase in the prevalence of people living with chronic conditions, also tied to how people have longer lifespans. This is a rather new phenomenon, because in previous generations, people would die in their 50’s or 60’s and wouldn’t really live long enough for their lifestyles to catch up to them and create these chronic conditions. And there is also an increased prevalence in conditions that we don’t fully understand, such as Multiple Sclerosis, arthritis, living after a stroke, etc. I started to wonder about how it is difficult to treat chronic conditions in the traditional medical system, and how living with chronic conditions can often lead to social isolation and psychological symptoms such as depression, which are also difficult to treat with the traditional medical practices. I wonder how big of a role the depressive symptoms play in seeking out alternative treatments (compared to treating only the physical symptoms). I also started to think about how the Baby Boomers are radically changing the way health and social care is offered and received, and wondered if they will result in an increased use in alternative treatments and a paradigm shift in medicine and care. Perhaps I will contact Lasse about a study in this one day here in the near future.

So, that wraps up the summary on the lecture on whether or not the Danes are the happiest people in the world. None of the speakers directly addressed the question, which was a bit disappointing. As my PhD was on QOL outcomes in dementia care, I went quite deep into what QOL is, how it is defined and measured, and specifically wrote about how Danes have ranked quite high on QOL and happiness indices. I was really looking forward to hearing some Danish researchers address the question, and it was interesting how they addressed topics that are related to QOL and happiness as a society, yet, when I discussed with other participants afterwards, they also felt a bit disappointed that the topic question was not really discussed. All in all, it was an interesting evening out to listen to experts discuss the current research in the field. There is another lecture in April, on if warm hands can be replaced with technology and plastic – another topic I studied and wrote about during my PhD. I will be sure to let you know how it goes!

Did this raise any questions with you? I would love to hear about them in the comments!