Posts Tagged ‘Pessimism’

Mind and Medicine

March 19, 2018

The title of this post is identical to the title of the title of a chapter in Daniel Goleman’s book “Emotional Intelligence.” There are two extreme views regarding the mind and medicine. One view, and it is unfortunate that there are physicians who hold this view, is that there is no relationship between the mind and medicine. The other extreme is that the mind controls all and medicine is unnecessary. Actually, this extreme view is the view adopted by some religions such as Christian Scientists, that prayer and meditation, not the mind, provides the basis for treating all illnesses. As the reader will see, the truth lies somewhere in between.

The truth is that there are links between the immune system and the central nervous system, and the field that studies this, psychoneuroimmunology (PNI) is a leading-edge medical science. It’s name acknowledges the links: psycho, or mind; neuro, for the neuroendocrine system (which subsumes the nervous system and hormone systems); and immunology, for the immune system.

Some surgeons will cancel scheduled surgeries for people who are panicked by the prospect of surgery. Every surgeon knows that people who are extremely scared do terribly in surgery. They bleed too much, they have more infections and complications, and they have a harder time recovering. Patients do much better if they are calm.

A study of anger in heart patients was done at Stanford University Medical School. All the patients in the study had suffered a first heart attack, and the question was whether anger might have a significant impact of some kind on their heart function. While the patients recounted incidents that made them mad, the pumping efficiency of their hearts dropped by 5 percentage points. Some patients showed a drop in pumping efficiency of 7% or greater. This is a range that cardiologists regard as a sign of myocardial ischemia, a dangerous drop in blood to the heart itself.

Another study by Dr. Redford Williams of Duke University found that those physicians who had had the highest scores on a test of hostility while still in medical school were seven times as likely to have died by the age of fifty as were those with low hostility scores. This is a stronger predictor of dying your than were other risk factors such as smoking, high blood pressure, and high cholesterol.

Anxiety, the distress evoked by life’s pressures, is perhaps the emotion with the greatest weight of scientific evidence connecting it to the onset of sickness and course of recovery. Yale psychologist Bruce McEwen noted a broad spectrum of effects: compromising immune functions to the point that it can speed the metastasis of cancer; increasing vulnerability to viral infections; exacerbating plaque formation leading to atherosclerosis and blood clotting leading to myocardial infarction; accelerating the onset of Type 1 diabetes and the course of Type II diabetes; and worsening or triggering an asthma attack. Stress can also lead to ulceration of the gastrointestinal tract, triggering symptoms in ulcerative colitis and in inflammatory bowel disease. The brain itself is susceptible to the long-term effects of sustained stress, including damage to the hippocampus, and so to memory.

There are also medical costs of depression. In patients with chronic kidney failures who were receiving dialysis, those who were diagnosed with major depression were most likely to die within the following two years; depression was a stronger predictor of death than any medical sign.

Heart disease is also exacerbated by depression. A study of 2832 middle-aged men and women tracked for twelve years, those who felt a sense of nagging despair and hopelessness had a heightened rate of death from heart disease. For the 3% who were most severely depressed, the death rate from heart disease compared to those with no feelings of depression was four times greater.

As there are medical costs to pessimism, there are medical advantages to optimism. For example, 122 men who had their first heart attack were evaluated on their degree of optimism or pessimism. Eight years later, of the 25 most pessimistic men, 21 had died; of the 25 most optimistic, just 6 had died.

There is medical value from relationships. Two decades of research involving more than 37,000 people show that social isolation, the sense that you have nobody with whom you can share your private feelings or have close contact—doubles the chance of sickness or death. A 1987 report in “Science” concluded that isolation is as significant to mortality rates as smoking, high blood pressure, high cholesterol, obesity, and and lack of physical exercise. Goleman takes care to note that solitude is not the same as isolation; many people who live on their own or see few friends are content and healthy. Rather, it is the subjective sense of being cut of from people and having no one to turn to that is a medical risk.

Goleman argues that for medicine to enlarge its vision to embrace the impact of emotions, two large implications of the scientific findings must be taken to heart:

HELPING PEOPLE BETTER MANAGE THEIR UPSETTING FEELINGS—ANGER, ANXIETY, DEPRESSION, PESSIMISM, AND LONELINESS IS A FORM OF DISEASE PREVENTION. The data show that the toxicity of these emotions, when chronic, is on a par with smoking cigarettes, helping people handle them better could potentially have a medical payoff as great as getting heavy smokers to quit. One way to do this that could have broad public-health effects would be to impart most basic emotional intelligence skills to children, so that they become lifelong habits. Another high-payoff preventive strategy would be to teach emotion management to people reaching retirement age, since emotional well-being is one factor that determines whether an older person declines rapidly or thrives. A third target group might be so-called at-risk populations—the very poor, single working mothers, residents of high-crime neighborhoods, and the like—who live under extraordinary pressure day in and day out, and so might do better medically with help in handing the emotional toll of these stresses.
MANY PATIENTS CAN BENEFIT MEASURABLY WHEN THEIR PSYCHOLOGICAL NEEDS ARE ATTENDED TO ALONG WITH THEIR PURELY MEDICAL ONES. While it is a step toward more humane care when a physician or nurse offers a distressed patient comfort and consolation, more can be done. But emotional care is an opportunity too often out of the way medicine is practiced today; it is a blind spot for medicine. Despite mounting data on the medical usefulness of attending to emotional needs, as well as supporting evidence for connecting between the brain’s emotional center and the immune system, many physicians remain skeptical that their patients’ emotions matter clinically, dismissing the evidence of this as trivial and anecdotal, as “fringe, or worse as the exaggerations of a self-promoting few.

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Improving Your Outlook

April 29, 2012

If you have not already read the Healthymemory Blog Post, “Outlook,” it is recommended that you read it prior to reading the current post. You should remember that you can be too optimistic or too pessimistic, so you should first assess where you are on this outlook dimension before deciding how it might be improved. Dr. Davidson provides suggestions1 to make yourself more optimistic or less optimistic.

To increase your level of optimism, Dr. Davidson suggests the following:

Every day for a week, do these three exercises:

      1. Write down one positive characteristic of yourself and one positive characteristic of someone with whom you regularly interact. Do this three times a day. Ideally write down a different trait each time.

      2. Express gratitude regularly. Pay attention to times you say thank you and look directly into the eyes of the person you are thanking and display genuine gratitude. Keep a journal and note the specific times you felt a genuine, however brief, connection with this person to whom you expressed gratitude.

      3. Complement others regularly for such things as a job well done, a well kept yard, or something they are wearing, even if they are a stranger. Again, look directly into the eyes of the person you are complementing and record your feelings in your journal.

At the end of the week reassess your level of optimism. If you are where you think you should be, continue to monitor your optimism and repeat the above exercises if you feel you have regressed. If you think you have become too optimistic, you can try some of the suggestions for people who feel they are too optimistic.

Envision negative outcomes. Try to imagine how things could go wrong. If you are considering a purchase, be sure to consider all the negative consequences that do or could result from the purchase. To build your negativity, work at it until you think you are at the right dimension along the optimistic pessimistic outlook dimension. I would also recommend making a practice of regularly watching and reading the news.

You can also adjust your environment. To move to the positive end of the dimension fill your workspace and home with upbeat, optimistic gratifying times, and people who bring meaning to your life. Try to change pictures often so that you do not become habituated to them.

To move to the negative end of the dimension, fill your home and workspace with reminders of threats to your well being, such a pictures of disasters, and newspapers, magazines, and books dealing with all the problems facing the world.

If you feel you have moved too far in either direction, rearrange your environment accordingly.

1Davidson, R.J., & Begley, S. (2012). The Emotional Life of Your Brain. New York: Hudson Street Press.

Can Optimism Be Bad?

May 22, 2011

Optimism and positive thinking are heavily advocated as means to not only happiness, but also to better physical and mental health. A recent article1 calls these beliefs into question. According to the authors, “…positivity is not all it is cracked up to be. Although having an upbeat attitude undoubtedly has its benefits, gains such as better health and wealth from high spirits remain largely undemonstrated. What is more, research suggests that optimism can be detrimental under certain circumstances.”

It should be appreciated that it is difficult to conduct research that does provide hard evidence that a positive attitude is beneficial. Most of the research is correlational and that can make it difficult to distinguish cause from effect. Obviously if you question a group that is healthier, happier, or more successful and rate their optimism or positivity scores against a group lacking in any of these attributes, it should not be surprising that the former group has higher ratings than the latter. It is also difficult to conduct controlled experiments on this topic. Suppose one group is given training on optimism and positive thinking and another group is not given this training and serves as a control. If the group given the training does score significantly than the control group, it could be the due to their being given special treatment, rather than the treatment it, oneself. This artifactual result is known as the Hawthorne Effect.

I think it is useful to make a distinction between the optimism/pessimism dimension, and the positive/negative thinking dimension. I think that the optimism/pessimism dimension is best regarded as a personality trait. That is, whether people see the glass as half empty or half full is basically determined by a personality trait. I tell people that I am a congenital pessimist. I definitely have a tendency to see the downside. There are benefits to being a pessimist, however. For example, pessimists have been found to be less prone to depression than were optimists after experiencing negative events such as a friend’s death. Although I need not extol the benefits of being an optimist, one obvious benefit is that optimists are more likely to persevere. It seems like most successful people have typically undergone failures, sometimes many failures, be before achieving success. Pessimists, however, having given up early, rarely achieve success.

Regardless of one’s innate disposition with respect to the optimism/pessimism dimension, I think it is important that everyone engages in both positive and negative thinking. Pessimists need to engage in positive thinking so that they will not overlook possible opportunities and will not give up prematurely in the pursuit of opportunities. If they like being miserable, fine, but positive thinking can make one happier and be more pleasant. The important point for pessimists is that they also activate the positive circuits in their brains (and if there aren’t any, to build some).

Optimists need to engage in negative thinking to keep them from pursuing foolish or unrealistic events. I remember reading about a married couple who were so energized after seeing the movie Rocky (the original, not one of the numerous sequels) that they put their entire wealth on a lottery tickets. Admittedly, this is an extreme example, but I think you get the idea, to be sure to activate the negative circuits of your brain (and if there aren’t any, to build some).

Unfortunately, positivism is oversold. I become angry when I hear someone tell a child that they can be anything they want provided they put their mind to it. While it is true that most people can probably achieve more than they think they can, a substantial contributor to success is opportunity, If opportunities are not available at the appropriate times, success is likely to be stunted. For example, the famed football coach, Vince Lombardi spent many years as an assistant coach before finally being offered the head coaching job with the Green Bay Packers. If memory serves me correctly, I believe I saw a movie2 in which Lombardi was ready to quit coaching before being offered the Packers’ job. As a result of this opportunity, he went on to become one of the most famous coaches of all time and had the Super Bowl Trophy named after him. This is a conjecture on my part, but believe that there were many potential Lombardi’s in the NFL assistant coaching ranks who never got the chance. Similarly, I think that there were potential Hall of Famers at the quarterback position, who either never were drafted, or who never got a chance at a starting position. There is nothing special about professional football. I think you can find examples in any endeavor you choose. Although you can and should prepare yourself for opportunity, you might need to realize that the opportunity might not come. And if it does not come, you should not view yourself as a failure, but rather as someone who did fulfill their existing potential.

1Lilienfeld, S.O., & Arkowitz, H. (2011). Can Positive Thinking Be Negative? Scientific American Mind, May/June, 64-65.

2I understand another movie is scheduled to come out in February 2012 with Robert DeNiro playing the role of Lombardi.

© Douglas Griffith and healthymemory.wordpress.com, 2011. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Douglas Griffith and healthymemory.wordpress.com with appropriate and specific direction to the original content.