THE MEDICAL BENEFITS OF POSITIVE FEELINGS
The cumulative evidence for adverse medical effects from anger, anxiety, and depression, then, is compelling. Both anger and anxiety, when chronic, can make people more susceptible to a range of disease. And while depression may not make people more vulnerable to becoming ill, it does seem to impede medical recovery and heighten the risk of death, especially with more frail patients with severe conditions.
But if chronic emotional distress in its many forms is toxic, the opposite range of emotion can be tonic—to a degree. This by no means says that positive emotion is curative, or that laughter or happiness alone will turn the course of a serious disease. The edge positive emotions offer seems subtle, but, by using studies with large numbers of people, can be teased out of the mass of complex variables that affect the course of disease.
The Price of Pessimism—and Advantages of Optimism
As with depression, there are medical costs to pessimism—and corresponding benefits from 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. Their mental outlook proved a better predictor of survival than any medical risk factor, including the amount of damage to the heart in the first attack, artery blockage, cholesterol level, or blood pressure. And in other research, patients going into artery bypass surgery who were more optimistic had a much faster recovery and fewer medical complications during and after surgery than did more pessimistic patients.35
Like its near cousin optimism, hope has healing power. People who have a great deal of hopefulness are, understandably, better able to bear up under trying circumstances, including medical difficulties. In a study of people paralyzed from spinal injuries, those who had more hope were able to gain greater levels of physical mobility compared to other patients with similar degrees of injury, but who felt less hopeful. Hope is especially telling in paralysis from spinal injury, since this medical tragedy typically involves a man who is paralyzed in his twenties by an accident and will remain so for the rest of his life. How he reacts emotionally will have broad consequences for the degree to which he will make the efforts that might bring him greater physical and social functioning.36
Just why an optimistic or pessimistic outlook should have health consequences is open to any of several explanations. One theory proposes that pessimism leads to depression, which in turn interferes with the resistance of the immune system to tumors and infection—an unproven speculation at present. Or it may be that pessimists neglect themselves—some studies have found that pessimists smoke and drink more, and exercise less, than optimists, and are generally much more careless about their health habits. Or it may one day turn out that the physiology of hopefulness is itself somehow helpful biologically to the body's fight against disease.
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With a Little Help From My Friends:
The Medical Value of Relationships
Add the sounds of silence to the list of emotional risks to health—and close emotional ties to the list of protective factors. Studies done over two decades involving more than thirty-seven thousand 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 chances of sickness or death.37 Isolation itself, a 1987 report in Science concluded, "is as significant to mortality rates as smoking, high blood pressure, high cholesterol, obesity, and lack of physical exercise." Indeed, smoking increases mortality risk by a factor of just 1.6, while social isolation does so by a factor of 2.0, making it a greater health risk.38
Isolation is harder on men than on women. Isolated men were two to three times more likely to die as were men with close social ties; for isolated women, the risk was one and a half times greater than for more socially connected women. The difference between men and women in the impact of isolation may be because women's relationships tend to be emotionally closer than men's; a few strands of such social ties for a woman may be more comforting than the same small number of friendships for a man.
Of course, 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 off from people and having no one to turn to that is the medical risk. This finding is ominous in light of the increasing isolation bred by solitary TV-watching and the falling away of social habits such as clubs and visits in modern urban societies, and suggests an added value to self-help groups such as Alcoholics Anonymous as surrogate communities.
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The power of isolation as a mortality risk factor—and the healing power of close ties—can be seen in the study of one hundred bone marrow transplant patients.39 Among patients who felt they had strong emotional support from their spouse, family, or friends, 54 percent survived the transplants after two years, versus just 20 percent among those who reported little such support. Similarly, elderly people who suffer heart attacks, but have two or more people in their lives they can rely on for emotional support, are more than twice as likely to survive longer than a year after an attack than are those people with no such support.40
Perhaps the most telling testimony to the healing potency of emotional ties is a Swedish study published in 1993.41 All the men living in the Swedish city of Goteborg who were born in 1933 were offered a free medical exam; seven years later the 752 men who had come for the exam were contacted again. Of these, 41 had died in the intervening years.
Men who had originally reported being under intense emotional stress had a death rate three times greater than those who said their lives were calm and placid. The emotional distress was due to events such as serious financial trouble, feeling insecure at work or being forced out of a job, being the object of a legal action, or going through a divorce. Having had three or more of these troubles within the year before the exam was a stronger predictor of dying within the ensuing seven years than were medical indicators such as high blood pressure, high concentrations of blood triglycerides, or high serum cholesterol levels.
Yet among men who said they had a dependable web of intimacy—a wife, close friends, and the like—there was no relationship whatever between high stress levels and death rate. Having people to turn to and talk with, people who could offer solace, help, and suggestions, protected them from the deadly impact of life's rigors and trauma.
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The quality of relationships as well as their sheer number seems key to buffering stress. Negative relationships take their own toll. Marital arguments, for example, have a negative impact on the immune system.42 One study of college roommates found that the more they disliked each other, the more susceptible they were to colds and the flu, and the more frequently they went to doctors. John Cacioppo, the Ohio State University psychologist who did the roommate study, told me, "It's the most important relationships in your life, the people you see day in and day out, that seem to be crucial for your health. And the more significant the relationship is in your life, the more it matters for your health."43
The Healing Power of Emotional Support
In The Merry Adventures of Robin Hood, Robin advises a young follower: "Tell us thy troubles and speak freely. A flow of words doth ever ease the heart of sorrows; it is like opening the waste where the mill dam is overfull." This bit of folk wisdom has great merit; unburdening a troubled heart appears to be good medicine. The scientific corroboration of Robin's advice comes from James Pennebaker, a Southern Methodist University psychologist, who has shown in a series of experiments that getting people to talk about the thoughts that trouble them most has a beneficial medical effect.44 His method is remarkably simple: he asks people to write, for fifteen to twenty minutes a day over five or so days, about, for example, "the most traumatic experience of your entire life," or some pressing worry of the moment. What people write can be kept entirely to themselves if they like.
The net effect of this confessional is striking: enhanced immune function, significant drops in health-center visits in the following six months, fewer days missed from work, and even improved liver enzyme function. Moreover, those whose writing showed most evidence of turbulent feelings had the greatest improvements in their immune function. A specific pattern emerged as the "healthiest" way to ventilate troubling feelings: at first expressing a high level of sadness, anxiety, anger—whatever troubling feelings the topic brought up; then, over the course of the next several days weaving a narrative, finding some meaning in the trauma or travail.
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That process, of course, seems akin to what happens when people explore such troubles in psychotherapy. Indeed, Pennebaker's findings suggest one reason why other studies show medical patients given psychotherapy in addition to surgery or medical treatment often fare better medically than do those who receive medical treatment alone.45
Perhaps the most powerful demonstration of the clinical power of emotional support was in groups at Stanford University Medical School for women with advanced metastatic breast cancer. After an initial treatment, often including surgery, these women's cancer had returned and was spreading through their bodies. It was only a matter of time, clinically speaking, until the spreading cancer killed them. Dr. David Spiegel, who conducted the study, was himself stunned by the findings, as was the medical community: women with advanced breast cancer who went to weekly meetings with others survived twice as long as did women with the same disease who faced it on their own.46
All the women received standard medical care; the only difference was that some also went to the groups, where they were able to unburden themselves with others who understood what they faced and were willing to listen to their fears, their pain, and their anger. Often this was the only place where the women could be open about these emotions, because other people in their lives dreaded talking with them about the cancer and their imminent death. Women who attended the groups lived for thirty-seven additional months, on average, while those with the disease who did not go to the groups died, on average, in nineteen months—a gain in life expectancy for such patients beyond the reach of any medication or other medical treatment. As Dr. Jimmie Holland, the chief psychiatric oncologist at Sloan-Kettering Memorial Hospital, a cancer treatment center in New York City, put it to me, "Every cancer patient should be in a group like this." Indeed, if it had been a new drug that produced the extended life expectancy, pharmaceutical companies would be battling to produce it.
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