Dr Craig Hassed talks about holistic model of health

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DR. CRAIG HASSED – ESSENCE OF HEALTH

JOHN PETROZZI:   Hi. Welcome to Living is Easy. Thanks for joining us today.

I’m John Petrozzi. Today, I’m really happy to be talking to Dr. Craig Hassed who is a senior lecturer and Deputy Head of the Department of General Practice at Monash University, and is also the author of a book which is called “The Essence of Health” which is the six pillars of well-being. That’s what I like to talk to Dr. Craig about today.

Hi, Dr. Hassed. Thanks for coming on the show.

DR. HASSED:   Hello, John. It’s a pleasure.

JOHN PETROZZI:  So I first came about your book just from my wife actually. She’s a psychologist. She heard you speak and present it at the Mind & Its Potential last year when the Dalai Lama came out.

DR. CRAIG HASSED:    Yes. It’s a couple of years ago now.

JOHN PETROZZI:   A couple of years ago, is it?

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:   So, what’s the background of your book?

DR. CRAIG HASSED:  Well, I’ve always had an interest in preventing illness so taking the simplest and most natural approach to managing an illness, if it does occur. Very often in Medicine, we sort of think of the drugs and the surgical procedures but often we forget the first priorities really. That’s what “The Essence of Health” is really all about.

ESSENCE is an acronym and it stands for Education, Stress management (that’s the importance of the mind, and how things like mindfulness and stress management can help us), Spirituality (the way we find meaning and purpose in our lives), the importance of physical Exercise, Nutrition, Connectedness (that’s on relationships and support), and Environment.

So that’s the ESSENCE of health. So you have there the seven pillars of well-being. And so if you sort of apply those things to the preventional management of any illness, then we actually really find there’s an enormous amount we can do for ourselves. So it’s not just what the doctor can do for us but it’s how we can get more actively involved in our own health care.

JOHN PETROZZI:   Okay. And Craig, are we talking about management of depression only? Or are we talking about anxiety? Are we talking about any sort of condition under the sun?

DR. CRAIG HASSED:    Well, the Essence of Health, ESSENCE, is really a model that can be applied not just to mental health problems but also heart disease, cancer—there are many chapters on  all of these things—diabetes, arthritis, asthma, MS—and the list goes on—improving immunity, better genetic function and repair. So it’s really these are the principles that should be applied to any condition. And then of course, the appropriate use of effective medical therapies when they’re indicated as well.

JOHN PETROZZI:   And where have you applied the model so far?

DR. CRAIG HASSED:   Well, all our medical students at Monash University actually go through what we call the Health Enhancement Program which is based from the ESSENCE model. So they actually learn about it by applying it to themselves so and what we found is it significantly improved their own health and well-being. But also so that when they’re doctors, when they’re helping people with chronic illness, that all of these things are being taken into account.

And then there are lots of other groups of, you know, the [0:03:28] Foundation, cancer support programs, MS Australia; we have wellness states that are based on the ESSENCE model. And so there’s a wide variety of applications. I was just speaking at the Prostate Cancer Foundation conference up in the Gold Coast a couple of weeks ago about the ESSENCE of managing prostate cancer.

JOHN PETROZZI:   Okay.

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:   So, it’s quite applicable to a lot of illnesses?

DR. CRAIG HASSED:   Yeah, when you think about it. I mean, the mind affects the body in profound ways. There’s nothing that the mind doesn’t have an influence on, in terms of not just coping with the outcome of the illness but nutrition. So poor diets or conversely, a lot of the [0:04:14] healthy diet; there’s nothing that a healthy diet can’t help. Physical exercise – if you can put the benefits of exercise and do a [0:04:23] taking it, that’d be an expensive [0:04:24] with that, you know. So these are really universal things that need to be applied to really any condition that we could think of.

JOHN PETROZZI:   And how do you see your vision of ESSENCE, the ESSENCE model, sort of panning out across Australia, and how accepted will it be?

DR. CRAIG HASSED:  Well, my vision of it would be that any time a person is having a conversation about remaining well or preventing a specific illness, or has a chronic illness and is looking to manage it in the best possible way, that these kinds of elements would be right up front as the first priorities in health care. Because if those things are not put it place, then medical therapies are often far, far less effective than we’d often like to believe if those things to put in place, and then we use the appropriate medical therapies as well. Then it’s a far better action. I could demonstrate, you know, some of the research on how disease and cancer if there’s interest.

So I would hope that it’s a kind of thing that every doctor is having a conversation with their patient about in the future, because healthcare, if we ignore these things, is far more expensive and far worse outcomes, both in terms of quality of life and progression of the illness.

JOHN PETROZZI:   So, I’m just trying to, I’m just getting images in my head here of some hospitals of the future.

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:   Can you see hospitals sort of taking up this model in their Tech Department or part of their Rehabilitation Department? Or is it something that primarily healthcare practitioners have to educate their patients about?

DR. CRAIG HASSED:  Well I think that probably the frontline will be in primary care, so your GPs. Not just GPs, it’s a model that any healthcare practitioner could use, but also in hospitals. So it could be, say for example, an oncologist who’s got a patient with cancer; maybe the oncologist is not the one who is going to be giving lots of lifestyle advice and helping them with the stress management, but as a part of their conversation of the management of their cancer, they might be saying, “Well, here’s the medical things I’ll be helping you with, but look, here’s a unit within the hospital or here’s somebody I can refer you to within the hospital who can come and sit and have a good long conversation with you, provide you with some quality information and some strategies for how to implement this in your particular life with your situation,” or “Here are some support groups you can go to, where you can explore these elements and apply them in your healthcare early on in the phase.”

JOHN PETROZZI:   Okay.

DR. CRAIG HASSED:   So this is probably the best model that has been researched so far. All this has been in the Ornish program. Ornish was a cardiologist and he was looking at outcomes for people with heart disease in the first instance and then cancer later on. Although the Ornish program is not based on the ESSENCE model, all of the elements of the model are really built into his program.

And he was looking at, say, people with heart disease who were going through rehab, and if they had all of these kinds of things built into their support group, then what he actually found was the body had a capacity to reverse heart disease without having to go on to have bypass operations, and so on. There were two and a half times as many heart attacks in the people who just had the standard care by itself, instead of the standard care with all of these other elements added.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:    Huge cost savings as well.

JOHN PETROZZI:   So just in terms of the application of the model, are we talking, you’ve been seeing down groups of people sort of periodically over a month or so or over two months if for an hour or so, and just giving them some information about those various pillars you’ve spoken about?

DR. CRAIG HASSED:   Well, I’ll give you an example of how we teach our students. So we say to the students, “Well, look, here are the ten lectures with all the information and the science and the clinical applications, but here are six two-hour tutorials. In those tutorials, you’re going to learn about this in a far deeper way by applying it to yourself. So the education is not just the information, but education about understanding our own psychology-

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:    -and our own tendency to often sabotage our own health, and difficulties with motivation and making behavior change. So the students actually, if you like, start to look at themselves and how difficult this can be to translate into action. Then we give them a range of strategies, mindfulness and stress management, behavior change strategy, setting goals, and so they learn by applying it to themselves, across all of the elements.

Now the mindfulness, I think, is the most important element because it underpins the whole program and it helps to get the reins on the mind, which makes it easier to make other changes, to diet, do exercise, and so on. And so the students actually learn by applying it to themselves week by week and keeping a reflective journal about the challenges and the insights and the breakthroughs, then week by week, the benefits of making the changes that they’re making.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:   So that at the end of the program, hopefully, they feel better, but they actually understand much more from the inside out what it’s like for patients trying to make these changes.

JOHN PETROZZI:   That’s right.

DR. CRAIG HASSED:    It’s not easy.

JOHN PETROZZI:   Yeah, of course.

DR. CRAIG HASSED:    You sit down with the doctor on your side, “You should do this”, “You should do that,” here’s the information on why.

JOHN PETROZZI:  Yeah.

DR. CRAIG HASSED:    But it’s not easy to make those changes in one’s own life.

JOHN PETROZZI:   Of course. Well, for all those who have just joined us, today we’re talking to Dr. Craig Hassed about his book called “The Essence of Health”The Six Pillars of Well-being. So Dr. Craig, with the education model of this, you’ve got education as #1 in your model.

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:   Is that just purely educating a person about the particular illness or disease they’re going through?

DR. CRAIG HASSED:    Well, that’s a part of it—to know about the illness and prognosis and the various treatment options. That’s a part of it. Having an education in the conventional sense of the word is actually good for our brains and health and making healthy choices. But education, I think, in the deeper sense, is being educated about ourselves—understanding our own minds better, being able to pay attention better. Sometimes, people who are working in this field talk about the enabling strategies.

So you give the person information, and we’re often not very able to act on that information although we might want to. But if we actually understand how to motivate ourselves better, how to set a goal and work towards it, how to manage our stress, improve our focus better, so like mindfulness, so, all of those things help the person to be able to take the information onboard and actually to act on it. So education is a very broad concept and it’s not just giving a little bit of factual information about a particular illness.

JOHN PETROZZI:   It’s almost educating about the “self” as well ‘cause you mentioned mindfulness and goal-setting and those sort of things.

DR. CRAIG HASSED:    Yeah. All the ancient Greeks, I mean, Plato said that self knowledge was the very essence of knowledge, you know. It’s the most essential thing. In many ways, I think he was right on the money with that because I think that’s, in some ways, the most challenging thing to learn about, but it’s the most rewarding if we understand ourselves better.

JOHN PETROZZI:  Yeah.

DR. CRAIG HASSED:    Self-knowledge.

JOHN PETROZZI:   Yeah. A segue on the stress management, so are we talking here just regular stress management of sort of the stress of everyday or- what are you talking about here?

DR. CRAIG HASSED:    Well, stress management in the model really covers the whole area of how mind and emotions affect the body. I think the most effective single approach for managing stress and improving performance and well-being is probably mindfulness, which incorporates a meditation—mindfulness meditation exercise—but also learning to be more mindful, more present, more attentive in our day-to-day life. 

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:    And under the stress management, the whole influence of mind on body as well, we also talk about the importance of sleep, because sleep has a profound effect on our mental health, so chronic insomnia is a big risk factor for depression. In fact, many people with depression have learned to sleep better not through drugs; but through behavioural strategies, their depression will resolve. And there are a lot of people on anti-depressants, who, it may actually be more important for them to actually learn to improve their sleep and the depression will resolve.

JOHN PETROZZI:   Isn’t it interesting, though, like as an aside, people going to a general practice who is really busy—big long waiting lists—and they prescribe anti-depressants because maybe sometimes there’s a time constraint for the doctor to see the patient as a whole person.

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:  So how do you sort of bypass that obstacle of busy, waiting rooms, busy doctors and patients with various conditions that maybe would be best treated without medication?

DR. CRAIG HASSED:    Well, yes, John. That’s a really important point and it is a big challenge because the system doesn’t really, I mean, they lip-service the importance of prevention and well-being, but the system doesn’t actually support that. The longer time a doctor spends with the patient, potentially the more expensive it is, or at least, the far less rewarding it is. They reward very quick turnover of patients is the way that doctors are remunerated. So we’re not actually remunerating preventive strategy.

So that’s part of it, because it takes more time. But the doctors who are motivated to do this work tend to find it far more satisfying. In the long run, patients have better outcome.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:    And so very often, a doctor might say “Look, these issues obviously come to light now. Because of everybody else who’s waiting at the moment, I don’t have time to go into it in the depth that it might require. But look, on Tuesday afternoons and you know, Friday mornings, or whenever it might be, I set aside some long consultation times for exploring these kinds of issues. So please come back and make a long or prolonged consultation and we can actually go into this in more depth when we both feel comfortable and got more time.” So a doctor can be a little bit proactive in doing that.

JOHN PETROZZI:   Yeah. That’s great. Certainly I find it in my practice—I’m a chiropractor—my whole philosophy is about prevention and trying to get the body to work as best as it can to heal itself.

DR. CRAIG HASSED:      Yeah.  

JOHN PETROZZI:   But sometimes you do sort of run out of time because people might sort of come in a bit late and the way the room might fill up quite quickly, and so if you do, you do miss out on that time of the education process.

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:   And I used to do small education classes once a week, but then time sort of gets in the way again with that sort of thing. So I do, just thinking back on those workshops, probably the best educated bunch of people coming through the door at that time were the ones going to those workshops, where I talked about exercise, nutrition, stress management, all of those sort of things.

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:  So, it’s going to be really interesting to see who takes up this model, your ESSENCE model, and applies it in the best way.

DR. CRAIG HASSED:   Yeah. I think another important issue that we don’t use is their potential for groups enough. You know, we as practitioners are often working one-on-one with patients.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:   But actually, within the practice, if you’ve got, say, ten people with a range of issues, you actually feel a lot more motivated when you’re working in a group.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:    You learn a lot from other people’s experience, you feel more inspired, and you often don’t feel so alone.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:    When we’ve got a health problem, we think we’re the only ones who feel like this or have this difficulty. When you sit in a group, you’ll realize “Whoa! Geez! We’ve all got a dose of the human condition.” And so I think that we don’t utilize the group process enough in our healthcare system. It could be very cost-effective as well.

JOHN PETROZZI:  Yeah. Number three here, Craig, you’ve got spirituality, how does that fit in the model?

DR. CRAIG HASSED:    Well, spirituality is really where we find meaning and purpose in our lives. I guess it boils down to that. For a lot of people, and I guess traditionally, it’s been through religion. But spirituality, in the way that we made it in the model, is not just about religion. People can explore and express spirituality or meaning in lots of different ways. It could be not so much of religion but through philosophy, not faith but through questioning and inquiry.

For another person it could be through altruism. I understand that Fred Hollows was not necessarily a very religious man but he was certainly a person who had tremendous compassion for people in need and the Fred Hollows Foundation, for example, was based on the work he did to help people and that gave his life enormous meaning.

JOHN PETROZZI:   Meaning. Yeah.

DR. CRAIG HASSED:    If you’re an Einstein, it would be through your science, you know. That gave him a sense of wonder and awe at nature and so on. So I think there’s a lot of ways of exploring and expressing meaning.

But I actually think it’s not an option. I think it’s actually a basic human need that it’s in our human nature to explore and express meaning. If we don’t have that in our lives, then our life is much the poorer. And certainly, for people who are coping with major illness—cancer, a debilitating illness, MS for example, if there’s a way of making meaning and having a big perspective around the issue, then it helps a person to cope so much better.

JOHN PETROZZI:   Yeah. I agree. Actually, just looking at your whole model here, Craig, it seems to be almost a kind of holistic model that can be applied to anybody even for someone caring for someone who’s got a disease, or even if you got, say, a high university project to work on, you can almost look at all those six pillars that you’ve got in your ESSENCE model and most of these would seem to ground you again and bring you back down to earth and see that things are quite equal and things are okay.

DR. CRAIG HASSED:    Absolutely.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:   I mean you mentioned carers, for example. Somebody who is caring for somebody with a major chronic illness will have significant immune suppression, so their immune system is not working so well because of the stress, will have poorer health. If we’re not coping well with that, our genes will be aging faster and so our DNA is actually aging faster, the health implications are enormous, not just for the person with the illness but for the person who’s caring for him.

JOHN PETROZZI:  Yeah.

DR. CRAIG HASSED:   So, yes absolutely. It’s not just about the person with the illness. But if the person who’s got big demands in their life and is applying these things, then it will help them to cope a lot better. But in a lot of work places as well, when thinking about performance—

JOHN PETROZZI:   They you go. Yeah.

DR. CRAIG HASSED:   —so students thinking about improving their focus on their study and coping with the pressures of doing year 12; or in the business setting, people who are wanting more sustainable and improved performance for senior staff, for example—if you apply all of these things, then it has significant benefits on improving focus, (how the brain functions – we know that when we’re managing your stress better, the brain works a whole lot better), helps to prevent chronic illness and also acute illnesses (less likely to get coughs and colds), and improves learning and memory centres of the brain.

This includes things like exercise and healthy nutrition. Nutrition seems to be very important for preventing depression and anxiety. It gets almost never mentioned in the management of mental health problems, the important role that healthy nutrition can play.

JOHN PETROZZI:  Why do you think that is, Craig? Why is it that some of those links are missed out?

DR. CRAIG HASSED:    Well I think that sometimes, we see depression as just a chemical change in the brain, so we just got to get a drug to change one chemical in the brain and that’ll be the solution to the problem. And that’s just, I mean, I’m not saying there isn’t a chemical change in the brain, because there is, but it just reduces the whole thing to a very superficial level.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:    It’s what’s producing the change, and we know that lifestyle, being very physically inactive, sleeping poorly, not managing stress, all of these things make us much more vulnerable to stress, particularly if we got a genetic disposition to it.

JOHN PETROZZI:   Yeah.

DR. CRAIG HASSED:   On the other side of the coin, if we address all of these things, healthy diet, whole food diet, omega 3, fatty acids, [0:21:33], (for example, physical exercise, particularly aerobic exercises is an anti-depressant), mindfulness, basic stress management, helps to prevent recurrence of depression. We could go on and on with all of these things. If you put them together, now, you’ve got a powerful therapy and preventive model.

JOHN PETROZZI:   You’ve got- actually your second last pillar is connectedness.

DR. CRAIG HASSED:    Yeah.

JOHN PETROZZI:   And can you tell us a bit about that? What you mean by it?

DR. CRAIG HASSED:   Yeah. Well, it’s social support, a sense of belonging, peer community, supportive relationships, all of those things have a big effect, not just on helping us to feel better but actually less likely to get heart disease. For example, better immune function because anything that improves our emotional state, improves our immunity. So, all of these things—social support and supportive relationships—are actually very important.

Just considering the other side of the coin, when we don’t have supportive relationships and we feel socially isolated, particularly an adolescent, for example, who doesn’t feel connected at home or in school, is much more at risk of mental health problems, drug and alcohol abuse, violence, getting into crime, and so on. So relationships, again, it’s just a basic human need.

JOHN PETROZZI:   Yeah. And then last, you’ve got environment. Are we talking the environment again of the person, where they’re living, that sort of things?  Or-

DR. CRAIG HASSED:   Yeah. But it’s not just that. So environment includes healthy air and quality water. Often, noise, you know if you’re in a very noisy environment that’s more stressful and you got poor health, air pollution, you know, it’s not just living in the city, but the way you live in the city. If you’re living very close to a freeway entrance, for example, there’s a little pocket of pollution there. If you’re living very close to a high-voltage power line, then that has an effect. So it’s that kind of stuff.

But environment also includes the social environment, you know, the urban environment. Is it a pleasant place to live? Have we got a green space? Is the environment inviting for getting out there, and being physically active? Is the environment that we’re in, like at school, conducive to studying and enjoying school and learning?

JOHN PETROZZI:  Yeah.

DR. CRAIG HASSED:    So it’s really as much as social as well as a physical environment.

JOHN PETROZZI:   That’s great. Craig, just in terms of adding pillars to your model, do you think that your model’s quite complete, or do you think it’s got a bit more potential to add more pillars, or consolidate the model?

DR. CRAIG HASSED:   Well, if you can tell me anything that we’re missing that’s important, I’d love to hear about it, but I can’t think of it myself.

JOHN PETROZZI:   Okay.

DR. CRAIG HASSED:   And again, all of these are big-letter items that we can add. They’ll either work against us because we ignore them, or they can really work for us. That’s where I think that doctors could never end, and all of the health professionals. But I think often, there are doctors where, you know, we sometimes drag the chain or the system doesn’t help us to do this sort of work, but we can invite and help people to be far more active participants in their own health care.

JOHN PETROZZI:  Fantastic. That’s all we got time for it, unfortunately.

DR. CRAIG HASSED:    Thanks, John. Well, it has been a pleasure chatting, and hopefully you had some useful tips there.

JOHN PETROZZI:   There are for sure. And actually, I’ll just give a little bit of background. Do you have a website, Dr. Hassed, that people can go to look at your book or- ?

DR. CRAIG HASSED:   Well, the book’s published through Random House, so you can find out more about it through Random House.

JOHN PETROZZI:   Okay.

DR. CRAIG HASSED:   And certainly, there’s lots of information around, talks and programs and, you know, whether it’s MS or cancer, and so on. If people sort of Google, they should be able to find out lots of things about talks and programs that are going on.

JOHN PETROZZI:  Right.

DR. CRAIG HASSED:   Yeah. So there’s plenty of information there. It’s all, I should say, too, the book is very heavily referenced in terms of all the sources of the information and the evidence to support the principles that are being discussed. It’s all in the back of the book as well so people can use that as a real springboard for further reading and learning.

JOHN PETROZZI:   Excellent. Thanks, Craig. Thanks a lot for coming on the show today.

DR. CRAIG HASSED:    It’s been a pleasure, John.

JOHN PETROZZI:   And that was Dr. Craig Hassed, Deputy Head of the Department of General Practice at Monash University and author of this great book which is called “The Essence of Health”—The Six Pillars of Well-being. If you want to listen to this as a podcast, please go to the website, which is www.livingiseasy.com.au.

Well, thanks for joining us today. I’m John Petrozzi. Until next time, stay well and stay happy.

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