Review of Marsha Snyder’s Positive Health: Flourishing Lives, Well-Being in Doctors

Positive Health

I first met Marsha Snyder, MD, MAPP, an American psychiatrist, at the Health of Health Professionals conference in Auckland, New Zealand, 2011. I have sat in on her presentations over the past three offerings of the Australasian Doctors’ Health Conference/Health of Health Professionals conference. Marsha sums up her years of work and personal experience in this book, Positive Health: Flourishing Lives, Well-Being in Doctors, published 2014 – the same year as my book, Re-humanizing Medicine. Marsha’s book adds to what I have been calling the counter-curriculum of self-care and compassion revolution in health care.


Marsha describes a curriculum that builds on positive psychology, which she studied under Dr. Martin Seligman for her Master’s degree at University of Pennsylvania. She creates an expansive curriculum of positive health and builds upon evidence-based principles of resilience and positive psychology to transform “physician ill-being” into well-being and flourishing.

Marsha describes five themes for her book:

1) The “cause of ill-being in medical students extends beyond the students, into issues with faculty and administration.”

2) Many “physicians who are troubled or burned out relate some of their difficulties to ethical issues in the system.”

3) There is a need for “understanding, defining, and teaching of resilience skills to physicians.”

4) The “creation of well-being in doctors and the rest of society by incorporating the science of positive health.”

5) Medical “training and practice must move out from an outdated pathology-based model to a health-based/prevention-based model,” (page 2).

Marsha adds in various exercises, including mindfulness, and discussion questions to the curriculum and stresses the need for “spirited multi-disciplinary teams.” She includes a chapter on “Spirituality and Well-Being,” defining spirituality as “a search for the sacred,” (240) and she reviews the links between spirituality and health. I particularly like the chapter, “Posttraumatic and Post-Ecstatic Growth in Medicine.” I was familiar with posttraumatic growth which describes the potentially transformative response to trauma, but I had not heard of “post-ecstatic growth,” which describes how highly positive experiences can also lead to transformative growth of “different areas of the self, including meaning in life, self-esteem, or social bonds,” (233).

Positive Health: Flourishing Lives, Well-Being in Doctors is a welcome addition to the growing literature on the need for self-care and personal growth in doctors and health care workers. Marsha’s focus goes way beyond limiting the negative to expanding joy and flourishing in the lives of those working in health care.

A Work of Joy.4: Dave’s Personal Reflections on Joy

This is the fourth of a series of blog posts examining Joy in Work. I have been calling it: A Work of Joy! It is part of an ongoing discussion between Dave Kopacz and Sandy Carter on this topic and will include each of our thoughts individually as well as our dialogue on Joy in Work. This fourth blog follows Sandy’s personal reflections on joy with Dave’s personal reflections. These personal reflections then will set the stage for our later writings on Joy in Work.

Dave Kopacz, M.D. works as a psychiatrist at the VA in Primary Care Mental Health Integration. Prior to this he was Clinical Director at Buchanan Rehabilitation Centre in Auckland, New Zealand. He is Board certified in Psychiatry and Integrative & Holistic Medicine. He is the author of Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine.


Sandy: “How about you Dave? Has joy always been a part of your life? If not, when did you first experience it and what is your relationship with joy now?”

Dave’s Personal Reflections on Joy:


Sandy, thank you so much for your story of opening to joy in your life. I like the descriptions you give of joy and I think similarly, that it can happen in the most ordinary moment, and yet it is transformative. Creative, surrender, flow, deep connection, expansion, light, grounded – all these words you use I relate to.

For me, I think I have always had moments of joy at different points in my life, while at the same time I have had painful times with a lack of that feeling. The essence of my personality is introverted, creative, and idealistic. These aspects of my personality can both contribute to and hinder my experience of joy. I think I am a serious person with a good sense of humor and when my seriousness and humor are balanced, it is easier to be open to feeling joy. When I have time to myself, when creativity is flowing, and when I feel a sense of meaning and purpose in my life, I am more open to the possibility of joy.  But when I feel overly pulled into the mundane demands of the external world, when I don’t have a creative project or outlet, and when I don’t live up to my own ideals or the world does not live up to my idealistic view of how it should be – I become overly serious and can get quite pessimistic and negative.

Since at least when I was in high school, I have embarked on a conscious project of personal growth. I have become more capable of enjoying extroverted activities and I think this has increased my capacity for joy. Deep connection is an integral part of the joy experience for me – generally connecting Self, others, and nature. I have come to think of this like an epiphany or a theophany – a sudden in-breaking of the Divine into my life. This can be very expansive, as you say, but it can also be very grounding, maybe the most mundane thing suddenly takes on a vast and important meaning.

With joy, there is this component that it comes unbidden (theophany, epiphany), but there is also a component of making one’s self capable of joy. It does have a paradoxical nature, as you note. The scholar of esoteric Islam, Henry Corbin, writes of “making oneself capable of God,” (Alone with the Alone: Creative Imagination in the Ṣūfism of Ibn ʻArabī). That has stuck with me since I read it. He goes on to speak about how we can only experience that which we are capable of experiencing. To me, this means our baseline capacity for joy. However, he also implies that we can make ourselves more capable of God/joy through inner, spiritual work. What this means to me is that, through spiritual work, we can experience deeper and more frequently God/joy in our lives.

I equate God with Joy and I think this can thus apply in a secular or spiritual framework. To me, the two words are interchangeable. We could also use words like the Divine, or a word that Jung uses frequently, the numinous. In the Kashmiri Shaivisim tradition, which flourished in Northern India around 700 to 1100 C.E., the ultimate reality is described as a “compact mass of bliss” (Dyczkowski, The Doctrine of Vibration).  I think this is what is meant in the Christian tradition when it is said that “God is Love.” Love and joy are deeply connected. When I come home from work and our dog (who happens to be named Henry Corbin) greets me – bouncing, spinning, barely able to contain himself – I feel the experience of love & joy.

I’ll include two photos of myself that capture this sense of joy. This first one is from a journey I took after I graduated from university. I took a backpack filled with books and food and camping gear, took a 50 hour bus trip from Chicago to Seattle, and went on a solo backpacking trip in the Olympic National Park. There was a great deal of physical and emotional suffering that I went through in the early part of the trip. I think that suffering and joy are not necessarily opposites. I do think that suffering is sometimes necessary to help break us down and open us up in order to become more capable of joy. Just as you describe, Sandy, your opening of joy following a sense of suffering, I think this can often be the case. Native American visionary, Joseph Rael, even speaks of the use of “intentional suffering” (fasting, physical exertion) as being a necessary part of vision quest. This “crying for a vision” is what helps us to become more capable of God/joy. I took this photo as I crested a mountain ridge and a panoramic view opened up before me.


Here is my journal entry from that day:


Today I am born.  I AM ALIVE.  Today alone was worth the price and troubles of the trip.  I am seated atop a mountain.  The view is breathtaking and it is even more spectacular because I climbed up the whole damn thing!  I passed snow in the shady spots coming up.  Except for a couple of chirpers and a multitude of bugs…it is silent.  What more could there be?


When nothing is lost

nothing is gained

When nothing is gained

things are not as they should be


With a hat on my head and a sack

at my side

I walk with the breeze and the

moon on my staff


And here is my journal entry for the next day:



Right now I am at Kyak.

Yesterday…well, there is that earlier entry.  After that I went up still higher and a view opened up that was indescribable.  I had been on the north face of the mountain and had been viewing the smaller mountains to the north.  After I crossed over to the south side and climbed a bit higher, I could see the entire Olympic Range, along with snow/glacier covered Mount Olympus.  Breathtaking is the only way to describe the section of mountain I stood on.   There was about a 60 degree slope of about 150′ without trees.  The only thing between the mountains and valleys beyond and myself was air.  I stood and stared for quite a while.  I think it would be hard to say that you had been alive if you have not seen something so spectacular.

By the time I had hiked 9.2 miles and found a decent site, I was in a foul mood once again.  If I would have seen the guy who wrote that shit about nothing lost, nothing gained, I would have pushed him off a cliff.  In the last dying light of the day I opened Zen Mind, Beginners Mind and the only word I could make out was “constancy.”

Yesterday was anything but constancy, from the highest of highs to the lowest of lows.  I don’t want constancy in the form of a continual mellow, but it’s just that the way I felt last night seems so childish.  Can that be overcome while still maintaining the ability to feel and express anger and frustration?


I think my journal entry points to some of the things we have been discussing with joy. This episode came following intense physical and emotional suffering as I got my feet under me, adjust to being alone and the constant neurotic chatter of my own mind, and as my body gradually built up strength for mountain hiking.

Then – comes this sudden epiphany, I take a photo, write some lines and have an intense experience. (A note on the photo, the most important thing is seeing my face and remembering that experience, but I have so much “baggage” that you can barely see the scenery around me – well, anyway, that was not the important thing at that moment). Then, this experience is blown away by an even greater experience of joy – the joy beyond describing – and I don’t write about it or take a photo, there is nothing but pure experience. Then, this is followed once again by a descent into despair and I turned to my friend Shunryu Suzuki and he said, “constancy.” Maybe that literal peak experience was only possible from the suffering that led up to it. Maybe the constancy is allowing ourselves to be pulled apart by the extremes of life, while still resting on some inner sense of being that is constantly expanding which is both painful and joyous.

Here is another photo that comes to mind when I think of a joyful moment that has been captured on film. This is a photo from a Holi celebration we had at Buchanan Rehabilitation Centre, where I was working down in New Zealand. We had a small group of amazing and fantastic staff who put on the Exploring Mental Health through Yoga group. Sneh, a wonderful Fijian Indian social worker led us in the yoga and would put on these holiday feasts for us. Sneh would often have us do “laughter yoga” at the end of our sessions. Hearing her spontaneously laugh always made me laugh really deeply.


The Hindu festival of Holi involves throwing handfuls of colored powder at each other. It is kind of like a water balloon fight, only with colored powder. We were so covered with colored powder – it was everywhere! My friend, Arishma, took this photo of me, but right as she was taking the photo, I threw a handful of color at her. While this was all a blast, she did get some powder in her eyes while taking the photo and I felt bad about that, but this photo is right before that happened. This photo captures, for me, the joy that I had working at Buchanan in New Zealand.

What is my personal relationship to joy at this time in my life?

Joseph Campbell coined the popular phrase, “Follow your bliss.” He took this from the Hindu concept of reality as consisting of Sat Chit Ananda, which means Being, Consciousness, Bliss. Campbell wasn’t sure he knew what proper Being or proper Consciousness was, but he did have an internal sense of what brought him joy, Bliss, and rapture. He choose to follow that. While this has often been taken to mean some kind of hedonism in popular culture, Campbell did not mean it in that way. In fact at a later point he said in an interview, “I should have said, ‘Follow your blisters!” This perhaps captures it if we combine both – follow where you are pulled and called to go through your Bliss, but be prepared to develop a lot of Blisters in the process!

Ok, well, for me, at this point in my life, I am trying to have an awareness of the deep reality of joy that is the fundamental nature of Consciousness, Being and Reality. The emotions on the surface are often not joyful, sometimes they are, but sometimes they are not. I am always working (Joseph Rael’s grandmother told him, “work is worship”) to create more capability for joy in my life. This is what makes life worth living, opens us up to colorful, peak experiences, and sustains us through the inevitable trials and tribulations of life.

How about some pet photos to end with? These always make me smile and feel joy in my heart!


Henry Corbin



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Also known as “Sea Biscuit” as he loves to drink the ocean, but too much isn’t good for him.



Neo in closet




Review of Re-humanizing Medicine on Gold Foundation Blog


There is a new review of my book, Re-humanizing Medicine: A Holistic Framework for Transforming Your Self, Your Practice, and the Culture of Medicine, up on the Arnold P. Gold Foundation Blog. The Foundation focuses on promoting humanism in medicine and their motto is: Working to keep the care in healthcare.

Check out their blog. I also did a guest blog a couple months ago on “A Counter-curriculum of Self Care.”


Joy: Personal Reflections by Sandy Carter

What is Joy in Work, Where has it gone, How can We bring it Back?

This is the third in a series of blog posts examining Joy in Work. It is part of an ongoing discussion between Dave Kopacz and Sandy Carter on this topic and will include each of our thoughts individually as well as our dialogue on Joy in Work. This third blog gives some background on Sandy’s personal reflections about the nature of Joy.

Sandy Carter, Ph.D. works as a physician coach and consultant in Michigan. Sandy is a professional certified coach, holds a PhD in organizational management with a specialization in leadership, and Masters in Business Administration and Social Work. Her research is in the area of transformational leadership with physicians, and wellness and resiliency.


When did I first consciously feel joy as an adult?

When I reflect back on a childhood experience that feels joyful, roller-skating is my earliest memory of fully embodying joyfulness. I was in elementary school when my parents enrolled me in a roller skating class. Reflecting on this memory many decades later, I can relive sensations of joy and happiness as I go back in time to those early years when I was first learning how to skate. At the time, skating made sense to me in a way nothing else in my life did. It brought everything together and I was fully engaged and present. After mastering the basics, I would spend hours practicing at the Rolladium Skating Rink by our house, circling around the rink again and again. As I gained confidence, I took greater risks and brought my whole self into the experience. I think that’s why it felt so joyful – I was immersed in the present moment and felt a heightened sense of aliveness and as much as a child can – felt completely on purpose. Unfortunately, my skating opportunities diminished as my parents were forced to cut back on expenses. My parents felt terrible, and I know this must have been a terrible loss for me. Strangely, I don’t have a memory of the loss. Now, all that’s left is the memory and a felt experience of those joyous days when I let skating consume me. My parent’s promised to get my brother and I back into skating when times were better. However, those better times never came for my parents. At least, they didn’t come until my brother and I had left home and took responsibility for our own lives.

It would be many years later before I would feel the lightness of joy again in my life. I had disconnected from this earlier childhood experience and buried it very deep. I had no sense of what it even felt like to feel joyful by the time I completed grade school.

As I entered adulthood my life often felt heavy. All of my earlier role models were burdened as they struggled and suffered from life events. In fact, my first adult experience of deeply feeling joy didn’t happen until I was in my mid-forties. I had experienced happiness and excitement many times over the years, but not Joy. Of course, not having a point of reference – I didn’t even know what I was missing.

My first conscious experience with Joy in my adult life happened in an ordinary moment. I was driving my car on a winter day. I remember feeling how good it was to be alive for no particular reason. There wasn’t anything special about this day from any other day.

As I drove, I remember feeling fully present taking in and completely accepting everything around me. I wasn’t thinking about the past or the future. I was not judging nor wanting to change anything or even defining experiences as good or bad – I was just “being.” That’s when it happened – trying to describe what “it” is feels paradoxical. I felt myself EXPAND, connect to an energy source that was both ethereal (graceful, light and spacious) and resilient (substantial and grounded). Suddenly, I felt uplifted and a part of everything. I also remember having a sense that I had opened a channel, a place where energy moves through me and not a place where I push, pull or demand things to happen.

I intuitively knew this was a defining moment. A few nights previous to this experience I had been working in my home office until 3:00 in the morning. As my family slept, I got up from my desk and walked a file box down the stairs to the basement to place next to the 2-dozen other file boxes with taxes and other organizational papers, that had accumulated over the years. As I heard the box hit the floor, something shifted in me. The clunk got my attention in a way I had never experienced prior. I found myself taking stock and asking myself why was I allowing work to burden me? Why was I sacrificing my health and wellbeing and even my happiness to work so hard? I decided I did not like being driven – it was sucking me dry. I allowed myself to feel completely how unhappy I was in that early morning moment in my stark, cold basement amongst the piles of file boxes. I felt the meaning of this fully, shuttered, shook off the depressing feelings and went to bed.

It was only a few days later that I experienced (what I’ve come to realize) was Joy! I often think about that day. I know I opened a portal into creative space that allows my work to come through me. Somehow that night I set an intention to let go of the push/pull and drive and making things happen exclusively through my willpower. Instead, I found a new source of working/creating where I am in flow if I surrender control, ask for guidance and maintain presence. A by-product is a state of wellbeing and gratitude that supports me in my relationships and work. Sometimes I forget when I feel performance pressure or am outside of my comfort zone and I will start to engage in that heightened state of driven frenzy, but once I start to feel burdened – I know I am not working from my best self, and most often I can shift. I smile as I reflect on my childhood experience of roller-skating and recognize the portal I opened was in part, reclaiming that child who loved, loved, loved to roller-skate!

Tea Party

My sister, father, me, and my mother having a tea party!

I feel most fortunate to have reclaimed that little girl as now I have a grandson (Carter), and the child in me can really relate to this little guy. I can fully immerse into his joyous world of 2-year old play in a way I would not have been capable of earlier in my life. I would have “tried” very hard because I would have felt guilty (sad) by not playing with my grandson. I know now, that “exerting effort” restricts my capacity for joy, and that letting go of “trying” opens up space for freedom, discovery, and playfulness, rippling into JOYFULNESS!

Sandy with Carter

With Carter when he was born!

Carter Drunk on Bliss

Carter celebrating his first birthday – Drunk on Bliss!

Being out in nature really brings me back to that experience I mentioned earlier of being both light and spacious and feeling grounded. I love the peace and isolation of wilderness hiking. I instantly expand and connect deeply while in nature. In many ways, I am continually connecting to nature and don’t necessarily have to go into the wilderness, but in such settings I go deeper into self-reflection and experience profound peace. And, playfulness and adventure (in spite of the challenges) are very joyful experiences for me!

Sandy on Appalachian Trail

Backpacking the Appalachian Trail

Sandy hiking

Wilderness Hiking

How about you Dave? Has joy always been a part of your life? If not, when did you first experience it and what is your relationship with joy now? 

Answer – next week…