[Editor’s Note: Dr. Gorski is on a brief vacation this week; in his place we offer new guest contributor Michael Booth’s inaugural post. Enjoy!]
The belief that positivity can prolong life or improve health seems ubiquitous. It is a claim that is repeated often in popular media, and fills countless pages of self-help books on happiness, thriving, optimism, and so on. But is there evidence to support optimism and the right attitude being positively correlated with health and longevity? Do personal beliefs actually matter in determining whether or not a chronic disease progresses or remits?
Having the right attitude is even more important for your body than daily sunscreen and a weekend spa getaway, every other week — yes, that important. Humor improves immune cell function, helps you ward off illness and decreases your chances of cancer — and apparently also increases your chance of living after heart disease hits. Not bad!
This latter conclusion is drawn from a study of 607 heart disease patients in Denmark that according to Dr. Oz and Dr. Roizen “found that patients whose moods were overall more positive were 58 percent more likely to live at least another five years.” Dr. Oz and Dr. Roizen continue, “the scientists can’t say for sure if positivity led to exercise or if exercise improved mood, but we say that the important message is the same either way: Positive thinking and regular physical activity are really important for life (and beauty, too).”
My father has been slowly dying of cardiomyopathy and a left bundle branch block for the last six years. Wonderful doctors have kept him alive, and I will forever feel indebted to them. Claims like the one made by Dr. Oz and Roizen are bound to catch my interest.
Looking at the study the celebrity doctors drew their rhetoric from, the researchers conclude “Patients with higher levels of positive affect were more likely to exercise and had a lower risk of dying during 5-year follow-up, with exercise mediating the relationship between positive affect and mortality.” The researchers clearly state, “Patients engaged in exercise were less likely to die during follow-up,” and “Patients with higher levels of positive affect were more likely to exercise.” Nowhere does the study show that attitude or humor “increases your chance of living after heart disease hits.” An emphasis on improving mood may help with exercising more, and exercising more may improve mood, but the critical variable for improving my father’s chances of survival according to this study, is exercise.
Many people like myself who are living with a chronic disease and a dying family member find that without an emphasis on the bright side of things, the negatives would be too overwhelming. However, I believe it is important to be careful with generalizations about positivity. As in the example above, saying that “patients whose moods were overall more positive were 58 percent more likely to live at least another five years” is a misrepresentation of the data. Used as medical advice in popular media venues, such generalizations are bound to have social and cultural repercussions.
A bit of satire, to ease the sting
About a year ago I had a relative tell me that all I have to do to rid myself of rheumatoid arthritis is have the right attitude. After the anger at the veiled accusation subsided, I couldn’t help but picture in my mind a caricature of what an optimistic visit to see my doctor would look like: As I pull up to the curb, I hop out of the car, high fiving the kind gentleman in the valet service, and skip up to the revolving doors of the University Hospital. As I walk into the lobby, I greet everyone I pass with a smile, stop to listen to the piano being played with tears of joy in my eyes, and empty my wallet into the tip jar at the coffee counter. When the receptionist greets me at Clinic 2, Internal Medicine and Rheumatology, I begin singing a song as if I were Maria in The Sound of Music, dancing around the waiting room with my arms spread wide to the sky, my head tilted back in joyous rapture:
Warnings on syringes and biologics in the kitchen
Bright copper Humira and warm swollen extensions
Brown bottles of prednisone tied up with words of caution
These are a few of my favorite things
As I finish the first verse, a woman in a wheel chair jumps up, and twirls gracefully from one end of the room to the other while singing the next:
Cream-colored splints and crisp achy mornings
Doorbells and deliveries of this week’s injections
Wild pamphlets filled with the side effects of methotrexate
These are a few of my favorite things
Curious as to the commotion in the waiting room, my doctor pokes her head out. Her eyebrows rise in wonder, and then she joins us, hopping up on the chairs to belt out a solo in her Polish accent:
Rheumatoid factor now diminished and gone
Clinical assessment tells me positivity got it done
The future is filled with all in remission
These are a few of my favorite things
Good news for grouches
Satire aside, in the July 2016 issue of Skeptical Inquirer, there is an interesting article by Psychologist Stuart Vyse entitled, “Good News For Grouches: Happiness May Be Overrated.” The discussion is centered on a similar though slightly different topic, the relationship between happiness and longevity. Vyse cites a recent analysis of the “Million Women Study,” published in December of 2015 in The Lancet, by Bette Liu of the University of New South Wales, and fellow collaborators at Oxford. At the ten-year follow up, 4% (31,531) of the 719,761 women who began the study without a life threatening disease had died. Testing the question of whether or not happiness alone was related to longevity, the researchers found that “women who reported they were happy most or all of the time were more likely to be living ten years later.” However, and here is the key point, when the experimenters add another variable, self-reported health, the effect of happiness on longevity disappears. The authors conclude:
In middle-aged women, poor health can cause unhappiness. After allowing for this association and adjusting for potential confounders, happiness and related measures of wellbeing do not appear to have any direct effect on mortality.
Due to the nature of correlations and the difficulty of objectively quantifying emotional states while imposing rigorously controlled experimental conditions, problems of directionality can arise. In this case, the direction that poor health leads to lower levels of happiness and a shorter lifespan seems far more plausible than the claim that happiness leads to better health and a longer lifespan. This sort of confusion is not limited to the present or simply to the association of happiness and health. Historically, personality traits, attitudes, and moral character have been associated with many diseases like cholera, tuberculosis, and cancer, both as part of folk wisdom and professional belief when little was known about cause or treatment (See Susan Sontag’s Illness as Metaphor for a historical review).
James Coyne and Howard Tannin state in a research review, “Positive Psychology in Cancer Care: Bad Science, Exaggerated Claims, and Unproven Medicine“:
A positive psychology perspective on cancer also is quite consonant with entrenched cultural beliefs and media portrayals of cancer as a life-threatening disease that can be defeated by character strength, persistent effort, and maintenance of a positive attitude, and it seemingly provides a scientific basis for these beliefs.
The “Positive Psychology in Cancer” review turned up negative findings in the domains of:
(1) the role of positive factors, particularly a “fighting spirit” in slowing the progression of cancer and extending the life of persons diagnosed with cancer; (2) the effects of interventions cultivating positive psychological states on immune functioning and cancer progression and mortality; (3) benefit finding in the face of health threats; and (4) post-traumatic growth following serious illness and other highly threatening experiences
This led the authors to state that “In their enthusiasm to advance positive psychology, its advocates have created an enormous gap between their assertions and scientific evidence.”
Conclusion: Caution is warranted
Surely the relationship between attitude and health is being purveyed in unsophisticated form. Unfortunately for those of us living with chronic diseases, such hasty generalizations can lead to a culture of positivity that has a dark undercurrent to it. It implies that those of us who suffer with poor health could either remedy our situation with a change in attitude, or have avoided it entirely had we only been happy.
One of my favorite authors of popular science, Stephen Jay Gould, was diagnosed with peritoneal mesothelioma in 1982, a deadly cancer of the abdominal lining. Shortly thereafter he wrote an essay for Discover Magazine on the statistics of disease prognosis that later became part of his book, Full House, The Spread of Excellence from Plato to Darwin. Gould believed in the value of mental calm and tenacity in combating deadly diseases, and hoped a biochemical process of thought, emotion, and immunity would be scientifically understood. He also saw the implication of such an idea taken beyond its limitations: “…We must stand resolutely against an unintended cruelty of the ‘positive attitude’ movement—insidious slippage into rhetoric of blame for those who cannot overcome their personal despair and call up positivity from some internal depth.”
Many people who fight like hell and give it their all suffer greatly from various diseases. Many die prematurely. To imply that one can will away or believe oneself out of the pain and long-term effects of a disease is a grave insult to many of us who are doing our absolute best to cope with devastating conditions.
My brief critique is not generalizable to the whole field of positive psychology or every practitioner of it. The main problem I wish to point out is the lack of evidence for the monolithic narrative of positivity as a curative, mitigating, or protective factor in disease that has become pervasive in popular culture and common in alternative medicine and new age circles. Some of this popular narrative is tied to the discipline and its engagement with the public, some of it is not. Propagation of exaggerated or unsubstantiated claims related to the role of positive psychological factors in health inadvertently creates more problems than helpful solutions. Echoing the philosopher David Hume, let us be wise, and proportion our beliefs to the evidence.