Many people regard dementia as a fate worse than death, in large part because it strikes at the essence of our humanity — our memories, identity, and relationships with others. Unlike diseases that primarily afflict the body, dementia erodes the mind, leading to a gradual fragmentation and loss of self and autonomy.

The burden of this disease on caregivers also cannot be understated. Not only does dementia require comprehensive, long term care that addresses the afflicted individual’s cognitive, behavioral, and physical issues; witnessing a loved one's slow and irreversible decline often exerts an immense emotional toll on the caregiver. Additionally, the pervasive stigma and isolation associated with dementia can leave caregivers feeling unsupported and alone.

Our guest on this episode is Dasha Kiper, a clinical psychologist who works with caregivers to people with dementia. She's the author of Travelers to Unimaginable Lands: Stories of Dementia, The Caregiver, and the Human Brain (2023). The book explores the complex relationship between caregivers and dementia patients, which are frequently rife with heartbreak, guilt, frustration, helplessness and shame. Over the course of our conversation, Dasha shares her transformative personal experiences working as a caregiver, why caregivers deserve more empathy and understanding, ethical dilemmas over medical interventions and patient autonomy, navigating the distorted reality in the mind of a dementia patient, coping strategies for caregivers and healthcare professionals, and more.

In this episode, you’ll hear about:

3:13 - How Dasha “stumbled” into working as a live-in caregiver for a dementia patient while still in school

4:44 - How serving as a caregiver for a dementia patient shaped Dasha’s views of neurological illness

10:23 - Managing the “loss of shared reality” that often occurs between the caregiver and the dementia patient

23:45 - The added emotional toll that dementia can take on family members

32:46 - What human dignity means in the context of dementia care

36:55 - Fostering self-compassion as a clinician or caregiver by connecting with community

49:16 - Dasha’s advice for finding community support if you are a family caregiver

Dasha Kiper is the author of Travelers to Unimaginable Lands: Stories of Dementia The Caregiver and the Human Brain (2023).

Past episodes and works discussed in this episode:

Episode 62: Navigating my Father’s Alzheimer’s as a Doctor | Sandeep Jauhar, MD

My Father’s Brain: Life in the Shadow of Alzheimer’s by Sandeep Jauhar, MD

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.

Copyright The Doctor’s Art Podcast 2024

There once was a time when indoor smoking was allowed in workplaces all across the United States, when trans fats were ubiquitous, and when fast food restaurants didn't have to post calorie information on their menus. That wasn't so long ago, and it's in large part thanks to the pioneering efforts of Tom Frieden, MD, MPH, Health Commissioner of New York City from 2002 to 2009, that these changes were made. Dr. Frieden’s city-wide initiatives during this time included steps to reduce tobacco use (by banning indoor smoking, increasing tobacco taxes, and aggressive anti-tobacco ads), to ban trans fats and mandate proper nutrition labeling in restaurants, and to rapidly expand screening for diabetes and HIV. All of these efforts have since been adopted nationwide and have gained practically universal acceptance by the public.

Prior to this, Dr. Frieden spearheaded tuberculosis control measures in New York City and India, drastically slashing rates of multidrug resistant tuberculosis. He was also director of the Centers for Disease Control and Prevention, during which time he led the CDC's response against the H1N1 influenza pandemic, the Ebola outbreak in West Africa, and the Zika virus epidemic. Most recently, he leads Resolve to Save Lives, an initiative aiming to prevent cardiovascular disease primarily through advocacy of lifestyle interventions.

Over the course of our conversation, Dr. Frieden shares his personal path to a career in infectious disease and public health, lessons learned from his work on tuberculosis control, striking the balance between curbing personal liberties and protecting community health, key insights into effective public health communication particularly when dealing with incomplete information or data, the evolution of the political and partisan nature of health policy, why preventing heart disease is so critical, and more.

In this episode, you’ll hear about:

3:00 - How a conversation with his father drew Dr. Frieden to a career in public health

5:40 - Dr. Frieden’s early work tackling tuberculous as a “management problem”

9:05 - Balancing individual rights with the health of the public

17:55 - The formula Dr. Frieden has used to choose which particular public health issues to focus on

28:08 - Strategies for effective health communication with the public

33:08 - The mission of Dr. Frieden's organization Resolve to Save Lives

39:16 - Dr. Frieden’s thoughts on how to navigate public health communications in the light of changing scientific knowledge

45:50 - The important lessons that Dr. Frieden learned from his patients about public health during his time as a clinician

Dr. Tom Frieden is the President and CEO of Resolve to Save Lives.

Dr. Frieden can be found on Twitter/X at @DrTomFrieden.

People and Work discussed in this episode:

Dr. Karel Styblo

Dr. Nancy Messenior’s February 2020 COVID address

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.

Copyright The Doctor’s Art Podcast 2024

It is well documented that descendants of Holocaust survivors exhibit greater levels of anxiety, depression, and vulnerability. The trauma of domestic violence can ripple through generations, with maladaptive coping mechanisms and emotional instability perpetuating subsequent cycles of trauma and dysfunction. The brutal history of slavery in the United States is seen today in the form of persistent economic disparities and ongoing social injustices, affecting mental and physical health across generations. All of this, in various forms, is intergenerational trauma. Extending beyond the individual, the emotional and psychological wounds of this type of trauma embeds itself within the family lineage through behavioral patterns, emotional responses, and even biological alterations.

Our guest on this episode is Mariel Buqué, PhD, a health psychologist who specializes in helping individuals experiencing intergenerational trauma. Her book Break the Cycle: A Guide to Healing Intergenerational Trauma (2024) reveals the invisible threads that link the past and present and highlights the necessity for healing not just individuals, but entire family systems and communities. Over the course of our conversation, Dr. Buqué shares how she draws on her experiences as an Afro-Latina immigrant from the Dominican Republic in her work, how a health psychologist connects with patients, how intergenerational traumas happen and their devastating effects on individuals, families, friends, and community members, and more.

In this episode you’ll hear about:

2:00 - What drew Dr. Buqué to the field of psychology

5:19 - What health psychology is

8:40 - What occurs in a course of treatment with a psychologist

18:30 - An overview of intergenerational trauma

28:00 - The far-reaching effects of intergenerational trauma in society and how psychology can help unload the burden

35:50 - Breaking the cycle of intergenerational trauma

40:30 - The role of stigma in access to mental health care

45:10 - Dr. Buqué‘s approach to building trust with patients

48:28 - How all clinicians can better empathize and connect with their patients through trauma-informed care

Dr. Mariel Buqué is the author of Break the Cycle: A Guide to Healing Intergenerational Trauma (2024).

Dr. Buqué can be found on Instagram at @dr.marielbuque.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.

Copyright The Doctor’s Art Podcast 2024

The Genocide Against the Tutsi, occurring in Rwanda between April-July 1994, was a devastating episode of mass violence in which nearly 1 million people were killed over a period of 100 days. Fueled by longstanding ethnic tensions, political power struggles, and a deep seated history of discrimination, the genocide saw members of the Tutsi ethnic group slaughtered indiscriminately by extremists of the Hutu ethnic group.

Growing up amid this chaos, Christian Ntizimira, MD witnessed some of humanity's most horrific atrocities. Instead of turning away, however, he chose to enter medicine, a profession that would allow him to address the immense suffering he saw. Today, Dr. Ntizimira is a palliative care physician and the founder and executive director of the African Center for Research on End of Life Care.

In this episode, Dr. Ntizimira joins us to share his personal experiences with the Rwandan Genocide, his journey to palliative medicine after initially exploring a career in surgery, what palliative care means to him, what it looks like to honor the dignity of a patient, how he advocates better access to palliative care and chronic illness care, and his unique approach to medicine rooted in “ubuntu,” a philosophy emphasizing the universal bond that connects all humanity that is best summarized by the phrase “I am because you are.”

In this episode, you’ll hear about:

2:45 - How Dr. Ntizimira’s experience as a young person during the Rwandan Genocide inspired him to become a physician, and how he eventually found himself drawn to palliative care

14:25 - Dr. Ntizimira’s distinction between “treating the disease” and “treating the person”

20:22 - How Dr. Ntizimira teaches doctors to fully conceptualize patients as people instead of focusing only on their medical ailments

25:50 - The heart of palliative care that transcends cultures

30:54 - The importance of presence in palliative care

38:27 - What “reconciliation” means in Dr. Ntizimira’s approach to palliative care

47:17 - “Ubuntu,” an African philosophy emphasizing a shared connection among humans, and how it can revolutionize how we care for patients

Dr. Christian Ntizimira is the author of The Safari Concept: An African Framework for End of Life Care.

Dr. Christian Ntizimira can be found on Twitter/X at @ntizimira.

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.

Copyright The Doctor’s Art Podcast 2024

Death and grief are much more “hidden” from society today than they once were. The medicalization of dying means that death now occurs more frequently in hospitals and care facilities than at homes. The secularization of society means that traditional religious or communal rituals surrounding death and mourning have diminished. The fast pace and optimistic lens of consumer culture means less contemplation of aging, mortality, and grief.

But Mikołaj Sławkowski-Rode, PhD, a professor of philosophy at the University of Warsaw and research fellow at Oxford University, argues that experiences of mourning and grief are crucial to the human condition. They allow us to foster empathy and connect with others’ suffering. They encourage us to reflect on how we value life, relationships, and the responsibilities we have towards others, both living and deceased. They revitalize communal rituals and practices, creating a sense of shared humanity.

Professor Sławkowski-Rode has written widely on the philosophical and ethical dimensions of mourning, grief, and memory, and his works have appeared in The New York Times as well as various academic publications. Over the course of our conversation, we discuss the nature of grief as a multifaceted emotional response, extending beyond a psychological state and reaching into existential realms; the role of memory in the grieving process; why love and grief are fundamentally inseparable; how the atomization of modern society affects our ability to mourn; and more.

In this episode, you’ll hear about:

3:20 - The focus of Sławkowski-Rode’s current work and what his day looks like as a philosopher

8:10 - The value of philosophy in society

12:42 - How Sławkowski-Rode became inspired to study grief

14:57 - Why grief has become more “hidden” in society over the past century

23:49 - How the “cult of individuality” leads our society to ignore aging and death

33:45 - How Sławkowski-Rode defines “human flourishing”

36:31 - How the atomization of modern society affects our ability to mourn

50:00 - Practical advices for clinicians on how to navigate grief and mourning for themselves and their patients

Mikołaj Sławkowski-Rode is the author of the New York Times op ed It’s OK to Never ‘Get Over’ Your Grief and numerous academic publications.

Dr. Sławkowski-Rode can be found on Twitter/X at @MikolajRode.

Works and past episodes discussed:

The Hours of Our Death by Philipe Aries

Episode 21: Pain, Pleasure and Finding the Balance | Anna Lembke, MD

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts. If you know of a doctor, patient, or anyone working in health care who would love to explore meaning in medicine with us on the show, feel free to leave a suggestion in the comments or send an email to info@thedoctorsart.com.

Copyright The Doctor’s Art Podcast 2024

For a profession like medicine in which suffering — be it physical, psychological, existential, or spiritual — is so commonly encountered and experienced, we have developed remarkably little shared vocabulary to talk about what suffering means. That is, if we even have the conversations at all.

In early June 2024, during the American Society of Clinical Oncology annual conference in Chicago, we hosted a live podcast event at Northwestern University's Feinberg School of Medicine, gathering Sunita Puri, MD and Jay Wellons, MD, MSPH to explore the great problem of suffering. Dr. Puri, a palliative care physician and author of the best selling book That Good Night: Life and Medicine in the 11th Hour (2019), last joined us on Episode 74: The Beauty of Impermanence. Dr. Wellons, a pediatric neurosurgeon at Vanderbilt University Medical Center and author of the memoir All That Moves Us: A pediatric neurosurgeon, His Young Patients and Their Stories of Grace and Resilience (2022), last joined us on Episode 28: The Brain and All That Moves Us.

The four of us, the guests and co-hosts, start by sharing our personal encounters with suffering, both in our patients and in ourselves, before discussing our philosophical approaches to and practical strategies for accompanying patients through suffering, managing spiritual distress, contextualizing our own humanity in these encounters, maintaining our own well-being, and searching for meaning amid these tragic moments, if it is possible. After our main discussion, we also answer audience questions about managing the sometimes unrealistic and complicated expectations patients have of clinicians, and the role of interfaith discussions among healthcare professionals.

We thank Kelly Michelson, MD, MPH and the Center for Bioethics and Medical Humanities at Northwestern University for making this event possible.

In this episode, you’ll hear about:

3:58 - Stories of confronting suffering, both in professional and personal contexts

29:02 - Practical tips for coping with suffering and uncertainty as a physician

31:53 - The importance of psychological safety in feeling and expressing your emotions as a physician

36:52 - Being present in the moment while accompanying patients through difficult times

40:00 - Helping doctors re-connect with the deeper reason of why they feel called to medicine

42:24 - The inexplicable relationship between love and loss

52:04 - The deep sense of meaning inherent in the work of a physician and what makes it “real”

54:41 - Q&A: How physicians can better navigate the challenging expectations patients have as well as medical skepticism

1:04:05 - Q&A: How we can better incorporate interfaith dialogue into medical training and practice

Dr. Jay Wellons is the author of All That Moves Us (2022) and can be found on Twitter/X at @JayWellons5.

Dr. Sunita Puri is the author of That Good Night (2019) and can be found on Twitter/X at @SunitaPuriMD.

Most of us take free will for granted — from the biggest of life decisions to choosing an ice cream flavor, we are generally capable of freely deciding how to think and how to behave without outside influence. But Robert Sapolsky believes our decisions cannot be disentangled from our genetics, environment, and neurobiology. In other words, to him, free will does not exist.

Dr. Sapolsky, a neuroscientist and primatologist at Stanford University, is a leading thinker on the biology of stress, human behavior, neurodegenerative diseases, and the science of free will and determinism. He is the author of multiple bestselling books, including Why Zebras Don't Get Ulcers (1994), Behave: The Biology of Humans at Our Best and Worst (2017), and Determined: A Science of Life Without Free Will (2023). His works have been featured widely in the popular press, from National Geographic to The New York Times.

Over the course of our conversation, Dr. Sapolsky presents his arguments against free will, along the way making detours through chaos and complexity theory, philosophy, ethics, and neuroscience. He shows how subtracting free will from the way culture thinks about crime, mental health, and human development have resulted in more humane health, justice, and educational systems. Finally, we contemplate together what human flourishing even means in the context of a life without free will.

His ideas have profound implications not just on our society, but also on our understanding of human nature, challenging our perceptions and provoking deep reflection on how we navigate the choices in our lives.

In this episode, you’ll hear about:

3:08 - How Dr. Sapolsky chose a career straddling both neuroscience and primatology

5:04 - The moment when Dr. Sapolsky realized he did not believe humans have free will

16:16 - How society becomes more humane when free will is factored out

23:29 - The deep implications that free will and determinism could have on criminology

34:13 - How a belief in a lack of free will can negatively affect motivation on a societal scale

43:11 - What does human flourishing look like in a world without free will?

48:07 - The best moments in life in which to utilize this understanding of free will

Dr. Robert Sapolsky has authored numerous publications, a full bibliography of his works can be found here.

Dr. Robert Sapolsky can be found on Instagram at @robert.sapolsky.

Works and past episodes discussed:

What’s Expected of Us by Ted Chiang

Episode 79: Transcendence in the Age of Science | Alan Lightman, PhD

Visit our website www.TheDoctorsArt.com where you can find transcripts of all episodes.

If you enjoyed this episode, please subscribe, rate, and review our show, available for free on Spotify, Apple Podcasts, or wherever you get your podcasts.

Copyright The Doctor’s Art Podcast 2024

Conventionally, we are taught that evolution implies there is no ultimate purpose to our existence, that life lacks inherent meaning — we are the product of countless intricate molecular and genetic accidents. And to many, evolution leaves little room for, and perhaps even contradicts, the existence of a deity.

However, our guest on this episode, Samuel Wilkinson, MD, a professor of psychiatry at Yale University, thinks there is another way to look at evolution. Drawing from an array of disciplines ranging from evolutionary biology to cognitive science, Dr. Wilkinson provides a framework for evolution suggesting not only that there is an overarching purpose to our existence, but what that purpose is. He presents this framework in his 2024 book, Purpose: What Evolution and Human Nature Imply about the Meaning of Our Existence.

Over the course of our conversation, Dr. Wilkinson shares how an existential crisis during medical school led him down the path of exploring the ways evolution can be reconciled with fundamental questions and answers about life's meaning; how navigating the dual potential of human nature — pulling us between selfishness and altruism, aggression and cooperation — is key to understanding our purpose; why evolution does not exclude the possibility of existence of a god or gods; the importance of relationships in living fulfilling lives; the role of free will in the choice between good and evil; and more.

In this episode, you’ll hear about:

3:37 - How a drive to understand human nature drove Dr. Wilkinson to leave his engineering studies and pursue a career as a psychiatrist.

4:44 - The scope of Dr. Wilkinson’s work at Yale

7:13 - What studying depression has taught Dr. Wilkinson about human nature

9:00 - How Dr. Wilkinson views the connection between evolution and God

24:00 - How the central argument of Dr. Wilkinson’s book differs from intelligent design

26:41 - Dr. Wilkinson’s view of selfishness in human nature

37:49 - The deeper meaning that Dr. Wilkinson sees within the biological patterns of evolution

39:04 - The validity of moral relativism

43:42 - “The Rider and the Elephant” as a metaphor for human nature

45:43 - Dr. Wilkinson’s thoughts on free will

55:15 - How marriage can provide a cornerstone to building “a good life”

58:10 - The way in which Dr. Wilkinson’s faith fits into his personal view of human nature

1:04:42 - How Dr. Wilkinson brings these principles into his clinical practice

Dr. Samuel Wilkinson is the author of Purpose: What Evolution and Human Nature Imply about the Meaning of Our Existence (2024).

Works and Individuals Discussed:

The Selfish Gene by Richard Dawkins

Determined: A Science of Life Without Free Will by Robert Sapolsky

Michael Behe and the concept of intelligent design

Free Will by Sam Harris