We all would be fortunate to have Kelli Harding, MD, MPH as our doctor. That’s because she comprehends the power of the interplay of body, mind, and social circumstances: the behaviors we engage in; the environments we inhabit; the kindness or cruelty that characterize our relationships; the adequacy or inadequacy of our income; our housing stability and the security of our next meal; education—learning to be more exact; and purpose in work and meaning in life—the factors that principally determine the degree to which we will enjoy good health or disproportionately suffer from the ailments that beset the human race.
If that sounds like a lot, that’s because it is. But it’s not rocket science; instead, it’s the science of wellbeing, and what that requires of us. Dr. Harding terms many of the drivers of health and disease “the hidden factors.” Not because they are undiscoverable but because we tend not to recognize them, nor give them their due.
Yet, as she so kindly and clearly writes, her aim is to reveal these factors both to her patients and to we her readers because therein lie the ways we can pursue and achieve greater wellbeing, and not passively accede to illness and despair. The Rabbit Effect is not the usual self-help, list of to-dos.
After a medical residency at New York’s Mount Sinai hospital and a psychiatric residency at Columbia, Dr. Harding must have known she needed to know more. There was still too much mysterious and elusive about our lives. Too many “inconsistencies,” not enough explanatory power in (even the vastness of) today’s biomedical enterprise. She wondered what the “hidden factors” in health and illness are and which are ubiquitous but effectively generally lost to the ministrations of conventional medical care.
Dr. Harding stayed on at Columbia to take a National Institute of Mental Health (NIMH) Fellowship, with a particular focus on unexplained symptoms. She trained, as well, in the psychiatric sub-specialty of psychosomatic medicine—where mind and body blend into the whole that more fully defines us.
Her epiphany came, as the book title portrays, from the rabbits. Arthur Barsky, MD, her fellowship mentor (and a former colleague of mine at Massachusetts General Hospital), pointed her to some rabbit studies. Certain white rabbits, like humans, are prone to develop heart disease if they are fed a high-fat diet (like fried foods and red meat). The rabbit research she then discovered, thanks to her mentor, revealed the relationship between high cholesterol and heart disease. Curiously, one group of rabbits exposed to the same cholesterol loads had 60% fewer fatty deposits than the others. Many great discoveries occur when an investigator, instead of dismissing an aberrant finding, chases after its meaning.
Those who disdain “touchy-feely” explanations will meet their nemesis in this group of white rabbits. Why were they spared the cardiac artery fatty deposits that interfere with blood flow and increase risk of heart disease and myocardial infarction? Turns out this particular colony of rabbits were cared for by a wonderfully nurturing graduate student. Could kindness explain their having been better safeguarded from disease? The research group then replicated the study, not by happenstance as it had occurred, but by design. Their findings appeared in Science. Unhealthy life experiences, their work implied, could be mitigated by affection and nurturance. Dr. Harding’s professional course was now struck. The “hidden factors” were staring us in the face, if only we deigned to look.
Which takes us full circle to her book, The Rabbit Effect: Live Longer, Happier and Healthier with the Groundbreaking Science of Kindness. The book has two principal sections, namely The Hidden Factors and Essentials of Health.
Healthy relationships (trustworthy and enduring attachments) and social ties through our friends and community lead off her discussion of the factors hidden in plain sight. Work defines us, as well, especially if we have the good fortune to find meaning and contribution in what we do. As does discovering and pursuing our purpose; she quotes the Buddha who said, “Your purpose in life is to find your purpose and give your whole heart and soul to it.”
Drawing on the work of Nobel Laureate, Dr. Elizabeth Blackburn, Dr. Harding, our caring guide, highlights how the length of our telomeres (where longer is far better), the protective caps on every DNA strand in our bodies, are shortened by a life of stress. The natural or stress induced shortening of telomeres is spared by purpose (and a healthy lifestyle) which mitigates the effects of stress. The result is longer, healthier lives.
All of these hidden factors, well explained by Dr. Harding, are topped off (in the last chapter in this section) by a life in which fairness prevails (so often denied to those living in poverty or racial/ethnic discrimination) and compassion rules. The best evidence for compassion, ironically, derives from those children who are traumatized by its opposites, namely neglect, physical and sexual abuse, domestic violence, parental incarceration or active substance abuse, to name a few. These are now famously understood, yet poorly prevented and treated; they are called Adverse Childhood Experiences (ACEs).
Each chapter on the hidden factors ends with what our physician guide calls “Expand Your Toolbox.” She offers clear and feasible ways by which any of us can strengthen our attachments and social ties, alter our experiences of work, or practice fairness and compassion. Her toolboxes are not prescriptive or preachy; they offer the kind of do-able and wise solutions that make for a better life.
The final section of this book is about the Essentials of Health. Here Dr. Harding digs into her training and experience as a psychosomatic and public health doctor (that’s the MPH she lists after her MD). She illustrates the deep connections between stress—and the inflammatory response it evokes—and our physical and mental health.
Attention to diet, sleep, exercise, a variety of mind-body activities (like meditation, yoga, slow breathing, mindfulness) and to finding and sustaining caring relationships are the royal yet truly pedestrian roads to longevity and wellbeing. Gratitude is another means of reinforcing the “rabbit effect;” it is a practice that can simply be adopted by ending each day with a list of those people whose effect on you was beneficial—and to whom you owe gratitude (even if unspoken, as in a notebook). And the last chapter takes us from the individual to the collective—to the community of others around us, where trust and humanity are built one person, one encounter at a time. We are all in this world and life together.
This review would be incomplete without noting the book’s Conclusion. And we are back to the lessons we need to learn from the care of the white rabbits. Dr. Harding leaves us with the greatest of kindnesses, namely urging us to find opportunities to provide moments of kindness. To those we love and to those who are part of our communities, small and large. Random acts of kindness are fine too! She quotes Ben Franklin, who reportedly asked, every day, “What good can I do today?” She beautifully identifies kindness as an endlessly renewable resource—the light we all can shine on the lives of others and in so doing bathe in its grace ourselves.
Lloyd Sederer, MD, is Medical Editor for Mental Health for The Huffington Post, Adjunct Professor at the Columbia/Mailman School of Public Health, and Chief Medical Officer for the NYS Office of Mental Health. The opinions expressed here are entirely his own.