Large Tech Companies like amazon, google and uber. Good evening and thank you to the strand book room. My name is nancy. For a little bit of history, the store was founded by my grandfather, benjamin, in 1927. And then my dad who passed away, tried and it was part of the famous crow that ran along Fourth Avenue just one block away from astor place to the union square and there were 48 used bookstores that all competed with one another. We are doing 400 events and discussions just like the one tonight and even tonight we have four events happiness is the best medicine yet americans will spend 3. 4 billion on medicine and health care this year, a sum that is large enough to send any family of four that check for 40,000 for their care. And we all know that happiness is not a big ticket item. Our guest tonight doctor Kelli Harding will discuss this. She is an assistant professor of psychiatry at Columbia UniversityMedical Center and a diplomat to the american board of psychiatry and neurology. She works up a room as at the hospital and as the daughter of a 91yearold and spent a lot of time there so i have a lot of admiration, she has appeared on today, good morning america, npr, New York Times and the u. S. News and world report. Doctor harding is here as the author of the rabbit effect. [applause] starting with the story of a nurturing feed of rabbits, she discusses the groundbreaking new research that shows how love, friendship, community and environment and lifes purpose can have a greater impact on our health than anything that happens in a Doctors Office. Joining doctor harding in conversation is doctor lloyd and adjunct professor at the Columbia School of Public Health was for 12 years the chief medical officer for the new York State Office of Mental Health, the nations largest state Mental Health agency where he continues there as a distinguished psychiatric advisor. Hes written many books including the one we have here tonight, addiction solution trading our dependency on opiates and other drugs. Shes also written a family guide to Mental Health care and improving Mental Health, more secrets in plain sight. Please join me in welcoming doctors harding to the strand for this important discussion. [applause] so first of all, thank you so much for having us and that beautiful introduction. It is such an honor to be here at the bookstore. I mean really i didnt grow up in new york and the strand has a mystique to it to be sitting here among these books is just one of the highlights of my life so thank you so much. And to be surrounded by so many people that i absolute free love, this is just an incredible treat. Ive seen so many faces from so many different. So thank you so much. Because this is a book about kindness we also just wanted to take one second and if you can say hello to your neighbor and introduce yourself if you dont know them. [inaudible conversations] good evening. We wanted to get to know you a little bit more. How many of you are from the Mental Health field flex how many of you are writers, journalists . A special form of writers. Let me ask this. How many of you are here tonight because you are a relative of doctor harding . [laughter] how many of you are here because you are her neighbor and relying on her medical advice . [laughter] and anybody here is that because you think it is a book about vampires . Because its not. That must be in one of the other rooms. [laughter] some of you are also probably wondering what is the deal with these rabbits, so we will talk about that. Lets learn a little bit more about you, kelli. We heard that you have a pretty busy life as an emergency room dr. You have three children. How in the world did you gather at the timthe time and energy te this book . This book is an incredibly important message. It became something that it felt urgent. I know this is something that you also share a passion about and that comes back to Public Health. It affects every Single Person sitting in this room. As clinicians, raise your hand if you are a clinician. As clinicians there is a love of mystery when it comes to the mismatch between what we expect when we know about it and what actually transpires in life and in the hospital. On paper they may sound like they are not doing well but in fact they are functioning and living their life fully. The flipside of that, patients who may be when you look at their lab and imaging and Everything Else maybe they are not functioning in life. It has to do with the mind and body connection i ended up with a Research Fellowship booking of medically unexplained symptoms until i heard about the rabbits. This book was part of your discovery of what you have been searching for i think you might want to hear about these rabbits studies. I think you heard something about them how the social world impacts them but he didnt quite know the detail so i searched and finally tracked down peace studiethesestudies in the late r done with the intention of looking at heart health and rabbits and at the time it wasnt known as a highfat diet made a difference, so these are sort of genetically identical. One of the groups have far Better Health outcomes than different markers than the other groups of markets and being a terrific scientist figured there was something wrong with the protocol said he looked at it again. A very caring woman who was actually picking up the rabbit, wasnt just giving them cable but having them she was talking to them and they realized could be a socia the social environmes actually changing their physiology like this. It was a radical idea they went ahead and replicated the study with a condition and got the same results. I just want to take a step back because a lot of the studies are somewhat serendipitous. This is a groundbreaking study showing that the world was having an impact but the thing is. When something makes sense you dont dismiss it, you pursue it. It protected them from disease, that is a phenomenal thing to discover. Somehow our social world is changing our physiology and that decides our understanding of how the body works right there but then trying to think about the mechanism and whats amazing is we have for decades of science since then every Single Person in this room, every Single Person listening on cspan, their lives are impacted by the kindness that they are giving others and the kindness that they are receiving. It comes back to so many different factors related to Mental Health and that is where we enter the discussion. And you described these as hidden factors. I described them as hidden factors and it is what they call the social determinants which is a bit of a mouthful but the thing to keep in mind is that its all these in our daytoday relationship so we are talking about what is happening in our home. Whats happening in our schools, communities, neighborhoods, and our broad social environment is compounding to really take care of one another. I want to take a second to think about kindness so lets just take a second and think about somebody that has shown kindness recently just for a couple of seconds. For me its easy because im looking out at the sea of people that have done that and sitting next to me so thank you. Its those things kindness makes us feel good but theres also this amazing science and emerging like really cool stuff about how the body works and how our social world is changing who we are. It seems like a resource that is hardly used. Why do you think it is so underused . After i wrote my book, it covers a lot of the same things theres all these secrets that are hidden in plain sight basically. Its hard sometimes to take science and actually implement it into the daytoday and you have a certain mindset so the goal of this book i realized this is information that needs to be every Single Person in this room stand because they need to recognize their actions do matter. A bigger predictor by far is your workplace. We think about health like diets, sleep, exercise, and occasional trip to doctor. For better or worse, how our stress levels are impacting ourr hopes on a daytoday basis and it is the conversation that we need to be talking about because the other perth is a big piece to this is mentalhealth and we know in this country Mental Health isnt something that has been, theres theres a lot ofa and you have seen it firsthand throughout your career. How do you connect loneliness to these problems with health and reaching one another and kindness . It comes down to taking care of one another. So, when we think about it and loneliness is a big piece of it, so theres all this date now but actually loneliness is as detrimental to your health is very wellestablished risk factors expecting 15 cigarettes a day. How many times does your doctor asked if you smoke or drink but are they asking you when is the last time you called a good friend or someone you care about if things got rough what you have somebody that you could reach out to come and it turns out that his really critical. So its time that we started talking about it. Have you gotten a bit of a hard time from your colleagues for saying that we are missing the bullet when we are asking about smoking or drinking or asking about missing this whole aspect of the relationship parts of our lives when is the last time a doctor asked about that. And do you have a hard time with your colleagues . I would love to hear from colleagues in the room about this. There are records i was just talking about this with the medical students. Record numbers of burnout among physicians and people who work in medical care and i think a big piece of that is because the Current System is just simply not acknowledging the major determinant of health which brings me to a statistic. Medical care probably only accounts for about ten to 20 of our overall health. So, just think about that for a second, ten to 20 . But when it comes to how we spend on health care in this country, we are spending 95 of our dollars on medical care and administrative costs. That being said, its important, access to medical care is absolutely critical that the same time we have to start looking at a Bigger Picture of health and that includes what is happening in our communities and thinking about the School System and all these other things that typically we some want minimized in that sort of glare of the razzledazzle of biomedicine which i loved it, i am a total science nerd. Is it hard to be kind, what are the barriers . Whats getting in the way . It is something you have to do every day because we are human beings and we fail at it all the time. I think this exciting is we can recognize it as somethin is somo strive for and i am not talking grand measures of kindness where you are donating buildings to various places or things like that, but looking at the person that gives you a cup of coffee in the morning we are talking really basic human decency things and talking about how we are treating other people, the promise of our society. How are we treating people that are not as fortunate as we are . Is strong in this different . Its already in the medical world when we talk about i would say when we talk about all these social factors it boils down to for me it was one of the great pleasures of writing the book was actually hearing my wonderful editor debate how do you talk about this to people who are not necessarily scientists or academics and it came down to kindness and its really true because that is the golden thread that runs through all of this and its got this amazing ripple effect. Because if you act with kindness towards someone else, they may continue to it just feels good when somebody does something nice for you and put a hand on your shoulder when you are having a rough time or when you know somebody has your back. I mean, really, we know those things make us feel better but now its cool because we are getting the science to show its so weve got to do more of it and i just want to also say i feel lucky because this room is filled with people that i know have had my back and i am just so grateful to you. That is another important idea that you have advanced as a practice which is gratitude. Tell us about the practice of gratitude. I think what is so cool about kindness but also kindness towards others and an easy way to do that is to start with gratitude the gratitude and mindfulness these are all good for our body it comes down to stress so its things that is an inevitable part of life. I love how you talk about stress in your work and its one of those things we have to think about offers because we know stuff comes up and that is a big part of the book to the resilience and also reserve of stress buffers stuff comes up that it isnt just on the floor. Of the inflammatory process is a phenomenon in our bodies that youve emphasized and its central to the development of disease and disability. How is kindness and antidote to the response . Whats happening here, help us understand this. This for me is some of the coolest science the narrow immune system basically, like not understanding how that was working into sort of explains to the patients i was seeing during my Research Fellowship, patients who just are not feeling well but we cannot quite find something wrong on our sort of traditional path and that is probably because they are not sort of measuring some of the writings necessarily, but i think that is also cool about it is, you know, in this country we tend to sort of separate line and the body and we do that in a very physical way when it comes to Mental Health we have a sort of separate Mental Health places of care. We dont think of people there is a doctor for every bit of your body coming and weve got some super sub specialized. On the one hand, it is helpful but on the other hand we still need to be stepping back and looking at these Bigger Pictures, and its these conversations that are going to be happening at bookstores and communities around the country. Are you asked by your readers or friends to coach them about how to talk to their doctor about the inflammatory response about kindness, about the social factors, how do people go about bringing this up with their dr. s . Its been fascinating and i would be curious to hear your experiences. People tell me i have this one doctor that is phenomenal and they are asking these kind of questions. Part of it is our system, the way that currently people in healthcare are paid up to ask other social life in a ten minute very focused visit, ten minutes is kind of if you are lucky. It feels like opening up the lid of pandoras box. So, there are one of the key ways ive been talking about in the book raise your hand if you are familiar. Youve been taking the lessons to heart. So, one of the things that actually thinking about experiences that happen and its something present in our environment all the time, kind of like smoking used to be back in the 1940s, people didnt really think that smoking causes lung cancer. I figured out many years before they figured out this is causing all kinds of diseases across the board, so it turns out, is actually one of those things and its something that we are not really talking about and many doctors dont know if theres a sort of easy test you can even take online. It is called aces to hide where you can see about the histor thf trauma. The crazy thing is every other person you pass on the street has some history of trauma in their past and there is a lot of shame and stigma around it so people dont talk about it necessarily, but it actually comes back to the question what do you do when you encounter somebody that is unkind because we know that hurt people hurt people and sometimes if somebody is being very unpleasant it can be helpful to keep that in mind but that is actually part of the story because i really, people think like kindness is great until suddenly there is a stressful situation or somebody is yelling at you or cut you off in traffic or whatever it may be, but again its like kindness is actually about conflict resolution, like how do we navigate our world and here are other peoples differences in a way that you know, we are able to actually come to some problem solving. Its absolutely no secret we are not doing a very good job of that right now and putting people at other camps. For our society and health, we need to be having more conversations where we are able to create a bridge. Trauma is a very big concept. What are some examples of the kind of experiences children have that leaves them with this residue of for perhaps the rest of their lives within inflamed byron system. So the data shows that instances tha that happened durg childhood can have a lifetime consequence when it comes to health. This was first studied in obesity is, and it was at that time yet again another incidental finding that just seemed too curious to let go and so whats interesting about it is the sort of things with the loss of a parent, witnessing abuse, many of the things we would sort of think about being very harshly talked to, things we might necessarily think about as trauma or on tha on that list is really empowering as we have some ability using trauma informed therapy that come in all different modalities and i see the heads shake. It comes in art, Mental Health, yoga, like theres all kinds of ways people are addressing the trauma that they have had to come and it actually seems to make a difference for their bodies which is amazing. These can be identified early in a childs life. When that happens, what can be done to help spare that child that kind of persistent problem . A big part of it, a lot of the work is being done in california where it isnt just what is happening in the clinic so you do a little screening and identify and then from there a lot of the resources are things in our community, but this isnt necessarily the kind of thing we are supporting with our current healthcare system. The thing is a lot of intervention to make a huge thae difference on health are r