After all these years, the movie Jaws still haunts me. I love to swim in the ocean but lurking in the back of my mind is the possibility of a man-eating monster lurking just below the surface. Apparently, I am not the only one. According to a survey, 43 percent of people who have seen Jaws have lingering fears of the ocean.

Consider the following:

• You have a 1 in 63 chance of dying from the flu and a 1 in 3,700,000 chance of being killed by a shark.
• Over 17,000 people die from falls each year. That’s a 1 in 218 chance over your lifetime, compared to 1 in 3,700,000 of being killed by a shark.
• In 1996, toilets injured 43,000 Americans. Yes, it is more likely I will come face to face with a hostile toilet bowl than with an angry shark.

Sharks inspire terror but the mosquito should make our knees quiver. No other species, including our own, is responsible for the loss of as many human lives each year as mosquitos that kill 725,000 people annually. Humans murder around 475,000 other people each year. Snakes kill around 50,000 while dogs (mainly from rabies) claim another 25,000 lives. Some of the most feared animal (sharks, wolves) kill fewer than 10.

When it comes to fear, logic and reason fly out the window. Barry Schwartz explains:

People have great difficulty understanding risks. The weight a person gives to a scenario—flood, fire, winning the lottery—should depend on its likelihood. In fact, it depends on how easily it can be envisaged. People will pay more for air-travel insurance against “terrorist acts” than against death from “all possible causes.”

That said, fear serves an important function.

It alerts us to danger and enables us to act quickly. Think of swerving out of the way of an oncoming truck—you turn the steering wheel before you even register you are afraid. It is instinctive.

We see this all the time in the animal kingdom. When a gazelle is chased by a lion, her body goes into survival mode—stress hormones flood the bloodstream, the heart goes into overdrive, extra blood is shunted to muscles to facilitate running, awareness intensifies and vision sharpens as the body devotes all its energy to escaping the beast. If the gazelle outruns the lion and survives, she returns to the watering hole with her fellow gazelles and resumes her routine hanging out and eating grass. Stress hormones return to normal, along with blood pressure and heart rate. She doesn’t dwell on how upsetting it was to be chased by a lion, nor does the fear of another attack consume her.

People are not like gazelles. Problems arise when we are in fight or flight mode all the time. It isn’t quite as easy for us to flip back into relaxation mode. Those with chronic stress and anxiety experience the equivalent of the lion chase throughout the day, placing them at risk for a number of mental and physical problems.

My advice:

• Ask yourself: what are the odds of this terrible thing really happening?
• Know what you can control and what you cannot.
• Personalize a strategy to calm your mind. Meditation, exercise, listening to music, spending time outdoors, reading a book, visiting a museum, spending time with friends, volunteering, and cooking are all examples of ways to quiet an unquiet mind.

Find the one that works for you to channel your inner gazelle.

Bottom Line: Remember, FEAR has two meanings. Forget Everything And Run or Face Everything And Rise. The choice is yours.

How do you spend your free time?

Before you say, “Free time? I don’t have any free time” consider the following. According to the most recent American Time Use Survey even busy people have more free time than they might think—close to four hours during weekdays and more than five hours during weekend days. The biggest chunk of free time is spent in front of a television or a screen. Screens trump socializing, exercising, and pretty much everything else.

The reality is we flitter away hours a day engaged in mind-numbing activities. This creates a perception gap—the feeling that we have no time even though we have quite a bit.

How much free time do we really need?

Authors of a research paper entitled “The Effects of Being Time Poor and Time Rich on Life Satisfaction” found that 2.5 hours per day (for people who work) is ideal. Less than that and we feel stressed. More than that and we feel like bumps on a log—lazy and unproductive. “Though so many people in modern society yearn for more free time in their days to do what they want, they really only need a few hours to enjoy optimal satisfaction in life,” explained the authors. The reality is that most of us already have enough free time. The problem is how we use it.

Time well spent

Why do we gravitate toward devitalizing pastimes like watching TV, surfing the internet, and checking social media, even though most of us recognize that these activities give us a fleeting boost at best? A study, “The Paradox of Happiness,” published in the Journal of Positive Psychology explores this curious behavior. “Because work is often highly demanding, people feel their free time is too precious to risk losing to yet more challenging activities, so they resign themselves to experiencing happiness through easy ‘relaxing’ entertainment,” explain the researchers. These activities even have a name. They are called “demand shielding” because they require little of us physically, intellectually, and socially.

But the relief provided by less-challenging activities is temporary. The moment we return to reality, the stress comes rushing back. It is more beneficial to adopt a more intentional approach which includes activities that provide the sense you are living your life in a full and satisfying way. Effortful activities that stretch the body or the mind may not be experienced as pleasurable in the moment, but when we recall them, we’re more likely to think, Wow, that was awesome! Or That was time well spent.

An antidote for feeling “crazy busy”

If passive leisure is not the answer, what is? A recent poll by the American Psychiatric Association found that engaging in creative activities is a reliable revitalizer. The report found that Americans who rate their mental health as very good or excellent tend to engage in creative activities more frequently than those who rate their mental health as fair or poor.

“Creative activities aren’t just for fun, they can help us take a step back from the daily grind, use our brains differently, and relax. Picking up that paintbrush or solving a tricky puzzle can truly move us to a different mindset,” explained APA President Petros Levounis, M.D.

When asked which creative activities they used to relieve stress and anxiety, adults reported a variety of interests:

• Listening to music: 77%
• Solving puzzles: 39%
• Singing or dancing: 25%
• Drawing, painting or sculpting: 24%
• Crafting: 19%
• Creative writing: 16%

Additionally, 15% attend concerts, 14% create online content for fun, 13% play a musical instrument, 9% visit an art museum, and 11% reported other activities such as gardening or cooking.

I have taken these findings to heart. The creative activities that suit me best are blasting Taylor Swift, doing Wordle and jigsaw puzzles, and going to museums. I recently saw the Lauren Halsey show on the roof of the Met and can say, unequivocally, that it was a mood-booster.

Whatever creative activity you choose, go all in. To get the most out of the experience, resist the urge to check your phone. Whenever we disengage, we turn blocks of time into fragmented time and dealing with streams of time confetti aggravates the sense of being time poor.

Bottom Line: The experience of being “time poor” or “time affluent” is influenced by the choices we make. As Beverly Adamo said, “It’s not about time, it’s about choices. How are you spending your choices?”

Mrs. S couldn’t talk but she sure could sing. I met her when I was an intern on the Neurology service. She had suffered a stroke that destroyed critical speech pathways on the left side of the brain. The cerebrovascular accident had left her literally speechless but that didn’t stop her from belting out “Happy Birthday.”

This is not news to neurologists. For over a century, this phenomenon has been observed in post-stroke patients with left-sided brain damage. What is new, however, is the finding that “singing therapy” can help some of these patients learn to speak again. By training the undamaged brain regions involved with singing, language can be restored.

In addition to helping stroke victims, there are many reasons to take a break from that podcast and press pause on the audiobook and let the music play instead:

1. Music makes us happy

When we listen to our favorite songs, dopamine is released by two distinct areas of the brain—one involved with intense pleasure and the other involved with anticipation. This combination may explain why people love music so much. Even sad music has been shown to help people feel better.

2. Music puts us in synch with others

“When people get together and hear the same music—such as in a concert hall—it tends to make their brains synch up in rhythmic ways, including a shared emotional experience” explains Ed Large, a music psychologist at the University of Connecticut.

3. Music facilitates emotional time travel

If asked to describe a memory from high school, you could easily recount a moment in time but if you listened to a song from that period, it would emotionally transport you back to what you were feeling and doing.

4. Music is a performance-enhancing drug

Listening to stimulating music can help you get in the zone and boost peak performance.

5. Music dampens the stress response

Let’s dig deeper…

Why do some songs sing to us and others fall flat? According to a study published in Psychological Science, songs that make us think of someone in our own lives are the ones that resonate most deeply. The secret sauce of the songs we love the most is that they encourage “narrative transportation” — but rather than transporting us out of our own lives, the lyrics activate thoughts of someone in our own life. It comes as no surprise that the study found that we prefer songs that use more second person pronouns like “you” and “yours.”

So when Whitney Houston sings, “I will always love you” or Hall and Oates croons “Your kiss is on my list,” the listener knows that the singers are not directly addressing them. (It’s disappointing but I’ve come to accept that Whitney will not always love me and that my kiss is was not on Daryl Hall’s list.) Instead, these songs are inviting us to slip into the performer’s shoes and to think of someone—our own personal “you”—whose kiss is on our list or who we will always love. Along these lines, when Taylor Swift sings “You showed me colors you know I can’t see with anyone else” and “I’ve loved you three summers now, honey, but I want ‘em all,” she is inviting us to think of a special someone. Of course, it is not only warm and fuzzy feelings about others that these songs activate. Sadness, sentimentality and empowerment are also on offer in these “other-oriented” songs. When Taylor belts our “We are never ever getting back together,” surely a not-so-special someone pops into your head. Whatever she sings, it is music to my ears.

As a general rule, as people get older they stop keeping up with popular music. “Taste freeze” apparently locks in around 33 years old. As an informal online study concluded, “for the average listener, by their mid-30s, their tastes have matured, and they are who they’re going to be.”

Not so fast. It is thanks to Taylor Swift that my “taste freeze” has melted away. Folklore was the game changer. Ever since I have become a card carrying Swiftie. Indeed it is because of Taylor that I got older and wiser. Along with every teenage girl on the planet, I know the words to almost every Taylor Swift song and feel inexplicably personally connected to her. Her songs may be about her life but they feel like they are about my life as well. From Lover to Mastermind, I feel the power and the pain. My obsession with Taylor was under wraps until I read the article in Air Mail, Rise of the Senior Swiftie: It’s not just tweens and teens who are knocked out by Taylor Swift. She’s a hit with boomers too.

While not quite a boomer, it was still a relief to learn that I am not alone in my (anti) hero worship. According to the article, attorney general Merrick Garland is a proud Swiftie. So is Shakespeare scholar, Jonathan Bate, who describes Taylor as a “literary giant.”

A New York City-based psychiatrist recently wrote an op-ed about how Taylor Swift has rocked her practice:

“What would Taylor Swift do?” is a refrain among certain patients in my practice. Teenagers suffer for many reasons. One is being fragile and in formation—a human construction site. Another is being surrounded by others who are fragile and in formation. Ms. Swift articulates not only the treachery of bullying but also the cruelty just shy of it that is even more pervasive: meanness, exclusion, intermittent ghosting. She says: Borrow my strength; embrace your pain; make something beautiful with it—and then you can shake it off.

I have always believed that well-being is a verb and that we are all in the process of becoming. Of course, Taylor captures it best. In Dear Reader, she sings “Desert all your past lives and if you don’t recognize yourself that means you did it right.” I am filled with immense gratitude to Taylor for reminding me to feast on auditory cheesecake.

While I like to think of myself as a supportive and responsive doctor, a recently published study in JAMA makes me think again. According to the findings, ChatGPT was more informative and understanding than a real doctor when answering patient questions. The study compared written responses from physicians and those from ChatGPT to real-world health queries. A panel of licensed healthcare professionals preferred ChatGPT’s responses 79% of the time and rated ChatGPT’s responses as higher quality and more empathetic. Not only was ChatGPT better at providing information, it was also better at caring.

A few months before this study was published, ChatGPT passed all three steps of the medical licensing exam. I studied for weeks for those tests but, in all fairness, the licensing exams cover facts and baseline medical knowledge so it is not that surprising that a large language model did well. But empathy and bedside manner? That’s a whole different story.

Many are already turning to ChatGPT to discuss their mental health. One Reddit user described ChatGPT as “better than my therapist.” She continued, “In a very scary way, I feel HEARD by ChatGPT.”

As good as ChatGPT might be, I am not ready to pass the baton just yet. (Hopefully my patients also feel heard.) That said, I am optimistic that ChatGPT can be used to enhance treatment. There is already evidence it can help assess suicide risk, prevent future depression, improve care and increase access to treatment. Artificial intelligence can help researchers figure out what makes some therapists more effective than others and assist in the training process of new clinicians. It can detect subtle changes in a patient’s speech pattern that might indicate a worsening condition that would otherwise go unnoticed. Driving down burnout in clinicians by drafting clinical documentation and responding to endless emails is yet another way artificial intelligence can be helpful. Harnessing artificial intelligence to diminish the time clinicians spend on burdensome paperwork and increase the time they spend with patients would be a win-win for all involved.

Using artificially intelligent companion robots to reduce loneliness is an area I am particularly excited about. Colleagues Murali Doraiswamy and Elizabeth Broadbent and I just published a paper in Science Robotics highlighting how robots can support health in elderly adults and help them remain at home rather than moving to assisted living. We argue that robots can enhance feelings of connectedness and reduce caregiver burden. Unlike human caregivers, robotic ones never judge, get impatient or frustrated. Robots will never be a substitute for humans but they amplify humanity.

At a conference a few years ago, I encountered Paro, a robot in the form of an adorable baby seal. Apparently the designers chose a seal because it wouldn’t conjure memories of a beloved deceased cat or dog. It is undeniably cute—big eyes, black batting eyelashes and a sunny personality. Paro coos, snuggles, and moves when it recognizes certain words and in response to touch. It learns to behave in a way that pleases the user, remembering and repeating actions that earned it strokes and avoiding behaviors that the user disliked. Paro has been shown to reduce loneliness, agitation, and blood pressure. For patients with dementia, Paro is a friendly companion and has proven to be a reliable mood brightener. I am not proposing that robot companions replace human companions, but robots may provide a bridge between what many isolated individuals need and what society currently provides.

In the spirit of fairness, I asked ChatGPT for its opinion on the subject.

“Any idiot can face a crisis; it’s this day-to-day living that wears you out.”

— Anton Chekhov

Do your days feel non-stop? Is your to-do list bottomless? The drudgery of everyday life is exhausting. Too often our days seem to be both bursting-at-the-seams yet unfulfilling. They have become a thankless game of Wac-A-Mole, but with no chance of winning even a sorry-looking stuffed toy.

“Everything I do these days feels like a ‘have to,’ not a ‘want to,’” one patient told me. Her observation made me think about how often the words “I have to…” roll off my tongue.

I have to pick up my kids.

I have to walk the dogs.

I have to work out.

I have to meet my friend for coffee.

I have to return my sister’s call.

I have to work on a talk I am giving next week.

I have to go to San Francisco for the APA conference.

The list goes on and on…

There is a begrudging tone to these pronouncements. “Have to” statements imply burden and obligation. They conjure dread and tedium. An “ugh” or exasperated sigh may as well accompany them. Using this turn of phrase connotes a passive existence and serves as a reminder that one’s days are dictated rather than self-directed.

There is evidence showing that how we talk to ourselves and others shapes how we experience the world. For instance, using your name and third-person pronouns (e.g., he, she, it, itself, they, them) to refer to yourself during a stressful moment can enhance your ability to control your thoughts, feelings, and behavior. In other words, asking “Why is Samantha upset?” instead of “Why am I upset?” has been shown to be an effective emotional regulation tool.

Reframe it

The more I learned about how language matters, the more I paid attention to what came out of my mouth. I realized that every time I said “I have to…” I glossed over the positive emotions that might accompany the task and extinguished the potential for gratitude. Drudgery swallowed the possibility of delight.

A simple remedy to disrupt this habit is to replace the phrase “have to” with “get to.” Saying “I get to meet my friend for coffee” and “I get to give a speech” reminds me of how unbelievably lucky I am. Instead of dwelling on the obligation, I became more aware of the appreciation I have for the opportunity to engage in these activities. When I have to do things, I feel compelled and beholden. When I get to do things, I am reminded of the privilege and the pleasure of the task and how the task connects to what I care about the most.

While there are plenty of things in our daily lives that are hard to get excited about, there is also a lot that deserves our delight.

Bottom Line: Watch your words. Don’t confuse the “have tos” with the “get tos.”

On that note, I get to write a new newsletter 😀

I must have refreshed my browser 1,000 times last week, hoping for an update and some positive news about the Titan submersible. Endless experts weighed in—engineers, explorers, and former passengers—offering insight and opinions about what might have happened to the lost vessel. Along with everyone else, I was glued to the story. Those promising knocks on Wednesday morning offered a glimmer of hope. Of course, by Thursday, we all learned the tragic fate of the five people on board.

Why was this story so captivating?

Even Adele stopped her concert to ponder this question. And, why, after over 100 years, does the story of the Titanic still have this siren-like hold over us?

Director James Cameron offered some thoughts about the enduring symbolic significance of lost vessels in a 2005 interview in The Independent:

“Wrecks are human stories. They teach us something about ourselves.”

A recent article in The Washington Post explains the ongoing fascination with the Titanic as likely due to human interest in the passengers’ stories coupled with the unique characteristics surrounding the shipwreck. After colliding with an iceberg, the ship took over two and a half hours to sink. Instantaneous catastrophes don’t give us time to ponder possible outcomes and, in a dark way, provide some solace. Did they suffer? is the first question asked after a tragedy. On the Titanic, the prolonged terror, the unfolding drama, and the impossible choices give it a mythic but also human quality.

It’s the stories that captivate us—especially extreme and one-of-a-kind stories. It a recent working paper, Harvard Business School’s Thomas Graeber describes how our memories hang on onto unique tales but quickly forget numbers. He calls this the story-statistic gap. Few remember how many people were on board the Titanic. It’s the vivid details we hang onto.

To push back on the narrative that the fate of the Titan submersible was so riveting because those involved were wealthy and white, consider the boys trapped in the flooded cave in Thailand in 2018 and the Chilean miners who were sealed inside a mountain for 69 days in 2010. Perhaps what makes all these stories so gripping is one cannot help but wonder, what would I do in that situation?

We often assume that these harrowing moments bring out the worst in people, but this isn’t the case.

A recently published report about the emergency response to the terrorist attack at an Ariana Grande concert in Manchester in 2017 found that, “the heroism shown by very many people that night is striking.” An article by Steve Taylor in The Conversation highlights how altruism often prevails. During the horror that unfolded in the terrorist attack at the Bataclan theatre in Paris in 2015, where 89 people were killed, a security guard risked his own life to help over 400 people escape. A woman who was pregnant at the time described his actions:

My life will never be long enough to thank him for what he did. And thanks to him, my baby has a mother. We saw the worst things that night, the worst human beings ever. And then we saw the best things.

Stories of bravery and goodness abound. Here is one that helps explain my ongoing fascination with the Titanic. My great-great-grandparents were passengers and died that fateful night. As the ship sank, my great-great-grandfather turned down a seat in a lifeboat nothing that there were women, children and younger men to be saved. My great-great-grandmother was offered a spot but refused to leave her husband’s side. “Where you go, I go,” she said before handing her sable coat to her maid who was among the seven-hundred passengers rescued. A survivor reported seeing them on deck, arm in arm, as the lifeboats pulled away and a wave swept them into the sea. My daughter is named after their youngest daughter, Vivian.

Beyond the tragedy, it’s the decency and dignity that remain.