AMONG the memories that GP and presenter Dr Rangan Chatterjee shares with me about his time spent in Edinburgh, where he is due to give a talk about his latest book next week, revolves around a phone call he received from his mother one night, while he was at Edinburgh Medical School. “Mum called me,” he says, “and this was out of the blue, at 10.30 at night, saying, ‘Listen, Rangan, you better come home now, Dad’s in intensive care and I’m not sure he’s going to make the night.’”
His father’s kidneys, she told him, had suddenly failed. That night Chatterjee was driven by his friend, Steve, down to Cheshire. Though his father recovered, he would be on dialysis for the rest of his life.
“That influenced my entire adult life until nine years ago, when he died. The only reason I left Edinburgh in 2003 was to help my mother and brother to look after him. I would have stayed otherwise.”
Many of his reflections in his book, Happy Mind, Happy Life, relate in some way to the health and death of his father, Tarun Chatterjee, a first generation immigrant from Kolkata, in West Bengal and a consultant in genito-urinary medicine. His father worked so hard, juggling a job as a consultant at Manchester Royal Infirmary, with GP night calls, that for decades he slept only three nights a week.
Tarun Chatterjee’s diagnosis with lupus at the age of 58 is one that his son blames on the toughness of that lifestyle. “Chronic stress, chronic resentment about his life, chronic sleep deprivation… did that lead to him getting lupus? Absolutely. You don’t tend to get lupus in Indian men at that age. It’s normally Caucasian women in their thirties.”
His father, he says, “killed himself working, chasing success, mistaking that for happiness”.
It is a warning we should all heed. “I love my parents,” Chatterjee reflects. “They gave me a great upbringing and dad left his family and friends to create a new life in a new country. I’ve never had to do that. So I’m not criticising him for making those choices.
“He did what he felt he had to do, but I feel I can learn a lot from that. That’s why I share his story. Because many people are following that pattern. Maybe not that extreme. But they are following that pattern in their own lives. It’s only when they get super-sick that they stop and take notice.”
The book’s arrival seems timely, published after we’ve been living with Covid for over two years, and when many are reassessing their lives. It feels as if it could have been written for this stage in the pandemic. But any regular reader of Chatterjee, watcher of his BBC1 show, Doctor In the House, or listener to his hugely popular podcast, Feel Better, Live More, will recognise it as the product of a building trajectory, a way of seeing the world.
“I didn’t really plan it around the pandemic,” the 44-year-old says. “That’s the truth. This is where my thought process was evolving anyway. I’m curious. One of my key values in life is curiosity. That’s why I host a podcast. I’m curious to learn.”
This July, it will be 21 years since he qualified from Edinburgh Medical School, training at the old Royal Infirmary. Since then, he says, his progression as a doctor has always been about asking “why is this patient here? As a GP, I’d be asking why this person presented on this day with this particular symptom. What’s the root cause? Not how can I put a sticking plaster over it.”
Initially, that led him to ponder on the fact that “80 percent of what all doctors now see in any given day, is in some way related to our collective modern lifestyles; the way we live.”
He began advocating that making a few changes in key areas of your life produces enormous benefits, as he advises in his book The Four Pillars.
This is not about putting blame on people. “I understand ,” he says, “that modern life is very difficult and it’s very hard for people to make the choices that they actually do want to make.” A line on this issue that stands out in his book is: “Our day-to-day habits are not a reflection of our strength or weakness of mind. They’re a reflection of how we feel about ourselves and the world around us.”
Too much of public health guidance, he observes, is too logical. “It’s too facts based. It doesn’t connect with people. Let’s take alcohol for example. The guideline is you shouldn’t drink more than this amount of units a week. Okay, great information. But the truth is, in my experience of seeing thousands of patients, most people who are drinking too much is because the behaviour is serving a role in their life. That was a big realisation for me over the last five years. All behaviours we engage in serve a role and you will never change the behaviour long term unless you understand the role that they play.”
One of the questions he started to ask himself was whether lifestyle was “the root cause” of health problems, or if there was something “that’s even more upstream to lifestyle.”
“This idea,” he says, “has been niggling away at me for years now.. I thought, why is it that some people change their lifestyle and they feel great for a month or two and then they revert back?”
What he came to see as “upstream” of those health changes was “our happiness, our mental wellbeing”.
“When we feel happier and more content in our lives,” he observes, “we naturally make better lifestyle choices. I think that’s quite intuitive to people. They recognise that if I generally feel contented with my work and the state of my life, I’m less likely to dive into the Ben and Jerry’s.”
What he discovered, as he looked at the research, is that it’s not just that happier people make better lifestyle choices, but “even after you account for the lifestyle, happier people are healthier.”
Two studies are quoted in the book, though he notes there are many more. “One is a study in nuns which shows that even when you account for lifestyle, the same diet, the same sleep, the same movements, the happier nuns live longer, and they’re healthier.”
The other is one in which two groups of people are taken into a lab and given rhinovirus, the virus behind the common cold.
“What they found was that you could determine who is more likely to get sick based upon their happiness. The people who were in less positive moods would get sick three times more often than the group who were happier. Your happiness is really linked to your health. This link is very under appreciated, across society, but also within the medical profession.”
In Happy Mind, Happy Life, he develops the idea of happiness as a skill that you can practice and develop, rather than “an impossible destination or mirage.”
“I’m making the case that if you work on these components, every day or regularly, you are going to feel happier,” he says. “I think too often the media interpretation of happiness is that billboard image with that couple on a beach smiling with the ocean behind them and the kids playing.”
For him, that’s not what happiness is. “That’s a pleasurable experience that can form part of a happy life. But I don’t think that’s happiness itself. Happiness, really, for me, is a direction that we choose to take in life, rather than a final destination.”
In this book, Chatterjee has come up with an idea of “core happiness”, and a “three-legged stool” model of how to move towards it that involves cultivating “alignment, contentment and control”.
He describes how doing the deathbed exercise of thinking about how we might look back on our lives is a good starting place for coming up with a series of “happiness habits”.
When he did it himself, he found he hoped that he would have “spent a lot of time with friends and family”, “done something that contributes to the wellbeing of other people in the wider world” and spent time on things he was passionate about: “Playing my guitar or playing snooker or going for a run”.
He then developed weekly habits around those things that included five meals a week with his wife and kids as well as doing his weekly podcast. Did his father share any reflections with him towards the end of his life? “My dad would never complain. He just got on with stuff. The one thing he did say to me, was that he, like so many of the doctors and nurses who were recruited by the British from India because there was a shortage, experienced a lot of discrimination. To give his family security he moved to a speciality that he didn’t enjoy. I understand why Dad made that decision. But the thing he said to me, was ‘Rangan, listen, I put up with that because I’m from India. I came to the UK, it wasn’t my home country. You won’t put up with this because you’re born and brought up here.’ I’ll always remember that. It’s pretty profound.”
The idea that we should, in terms of public health and societal wellbeing, be paying attention to happiness is not new. The economist and New Labour ‘happiness tsar’ Richard Layard kick-started the discussion of wellbeing in the UK. But, decades on, it’s still not taken seriously.
As Chatterjee puts it, “I think happiness has almost become a toxic term these days. It’s a bit unfashionable. People will say no, it’s not happiness, it’s meaning or purpose or it’s about contentment. Meaning and purpose are important, but I do genuinely believe happiness is what everyone wants.”
We are talking in a week in which there has been a report about the danger of Glasgow returning to its place as sick man of Europe, so I mention it. “Even when I was at med school, back in 1995,” Chatterjee says, “there was all this stuff about Glasgow in the press. We were hearing about Scottish habits.
“It seems to me there are multiple ways of tackling this. The book clearly is trying to do something for readers as individuals. And that works up to a point. But there are other levels at which things have to change.”
One means of producing a bigger change, in which Chatterjee is actively involved, is in the training of doctors and other professionals. He has created a course in prescribing lifestyle medicine, fully accredited by the Royal College of GPs, which has already trained 3500 people.
But even that, he notes, is not going to be enough. There is something bigger again. “Really this about the way we set society up. It’s about what we value as a society. The problem is in these capitalist societies where we measure everything according to the GDP, and the economy. We need to go upstream. We need to restructure how schools operate, how workplaces operate, what we value as a society.”
Chatterjee is also an advocate for the four-day week. “Imagine a scenario where you weren’t getting overworked and your personal time was valued and respected. You probably would get sick a lot less. You probably wouldn’t need to read one of my books or go see your doctor because your lifestyle wouldn’t be stressing you out so much. I would love it if that happened. I would love a scenario where no one needs to write health books anymore.”
Dr Rangan Chatterjee will be speaking at The Queen’s Hall, Edinburgh on May 16 at 7.30pm. His new book, Happy Mind, Happy Life: 10 Simple Ways to Feel Great Every Day, is out now.