Sadly, I have recently found myself counseling optimism to friends who were facing terrible odds in their fight against cancer. Such occasions never fail to evoke in me an image of a young medical student (that’s me) trailing his widely admired and beloved chairman of the department of surgery, Professor John Dunphy, on evening rounds. He would make a point of visiting his patients scheduled for surgery the next day and engage them in conversation about their upcoming surgery.
He would ask about their families and their outlook on life in general. After, he would go to the nurses’ station and strike off the next morning’s list of patients who were pessimistic about their odds of a successful procedure. “In my experience,” he told me, “their odds of surviving a difficult procedure or post-op period are pretty slim.” I was incredulous, although, skeptical—in those days, surgeons justified anything they did with the phrase, “in my experience.”
Pessimism and health
So, a recent article by Pauline Chen, MD, in which she describes an episode from her practice, caught my attention. The patient, a diabetic, had been hospitalized for a toe infection that should have responded to a simple course of IV antibiotics. But, in this case, it did not. Instead, the patient required a series of amputations—each one higher up the foot—in an attempt to stem the infection. He started losing weight and eventually required nutritional support. Then, one day, his heart stopped. Dr. Chen wondered if he was depressed? “He’s not,” a consulting psychiatrist told her, “it’s just the way he is.” In other words, he was a pessimist by nature.
These are interesting anecdotes, you might be thinking, but is there any evidence that optimism or pessimism can impact health outcomes?
The scientific evidence
There is real scientific evidence, accruing at an accelerating rate, that optimistic disposition leads to better health; the converse is true for pessimism. Here are but a few findings, out of dozens of articles on the subject:
- Optimists are twice as likely to be in ideal cardiovascular health, according to a new study led by Rosalba Hernandez, a professor of social work at the University of Illinois. Further, optimistic individuals recover more quickly following cardiac-related events, such as coronary artery bypass surgery and myocardial infarction, with a more rapid return to a normal lifestyle and a better-reported quality of life.
- Optimism also appears to be associated with lower levels of distress, slower disease progression, and improved survival rates in patients with HIV.
- Numerous studies, reviewed by Smith and Mckenzie of the University of Illinois, show that subjective well-being is associated with improved longevity compared to individuals who maintain a negative disposition regarding their health, their relationships, or their prospects for the future.
All these are association studies and are, therefore, subject to the dilemma of cause and effect. For instance, optimistic people are more likely to have a healthier lifestyle, including eating better diets, avoidance of drug or excessive alcohol, and exercising more. Could that be the reason for better health and longer longevity rather than their optimistic outlook?
The biochemistry of optimism & pessimism
Stick with me. I am going to make this simple. The direct evidence of the impact of optimism on health reaches down to the molecular level. People with optimistic attitude have lower levels of Interleukin 6 (IL6), a peptide hormone that is responsible for much of the damage caused by inflammation.
Now, inflammation per se is not all bad. It protects us from infection, for instance. But it’s a two-edged sword. For example, it is the underlying mechanism of vascular plaque formation, atherosclerosis, and cardiac disease.
On the other hand, certain types of lymphocytes—cells involved in the inflammatory process—protect us from cancer. Stress hormones simultaneously suppress lymphocytes and increase inflammatory mediators such as IL6 and TNF (tumor necrosis factor)—a double whammy. Edna Maria Vissoci Reiche and colleagues have found that pessimists are prone to higher levels of stress hormones, lowered immune response, and increased levels of cancer.
Do optimists live longer?
The good news is that there are several studies showing just that. For instance, a study from the University of Illinois shows that subjective well-being is associated with longer longevity as compared to individuals who maintain a negative disposition regarding their health, their relationships, or their prospects for the future.
In order to ascertain if optimistic people have longer life spans than their pessimistic counterparts, a team of researchers from the Netherlands interviewed approximately 1,000 men and women between the ages of 65 and 85 about health, self-respect, morale, optimism and contacts, and relationships. The study, which was led by Erik Giltay, MD, Ph.D, of Psychiatric Center GGZ Delfland, Delft, the Netherlands, included two key questions regarding optimism: “Do you often feel like life is full of promise,” and “Do you still have many goals to strive for?” Answering yes to these questions revealed a sense of optimism.
During the nine-year follow-up period, Dr. Giltay and his colleagues found that those participants who reported higher levels of optimism were 55% less likely to die from any cause and 23% less likely to die from a heart-related illness as compared to the pessimistic group.
Another study, led by Dr. Hilary Tindle of the University of Pittsburgh, found similar results. The researchers used data from the Women’s Health Initiative, an ongoing government study of more than 100,000 women over age 50 that began in 1994. Participants completed a standard questionnaire that measured optimistic tendencies based on their responses to statements like, “In uncertain times, I expect the worst.”
Their results showed that eight years into the study, women who scored the highest in optimism were 14% more likely to be alive than those with the lowest, most pessimistic scores. The pessimists were more likely to have died from any cause, including heart disease and cancer. Drilling down, they found that pessimistic black women were 33% more likely to have died after eight years than optimistic black women, whereas white pessimists were only 13% more likely to have died than their optimistic counterparts.
As Dr. Tindle notes, pessimistic women tended to agree with statements like, “I’ve often had to take orders from someone who didn’t know as much as I did” or “It’s safest to trust nobody.” She accounted for confounding factors such as income, education, health behaviors like controlling blood pressure, degree of physical activity, drinking, and smoking and still found that optimists had a decreased risk of death compared to pessimists.
But is it only pessimism that accounts for the increased mortality? The title of the Tindle’s article is revealing: “Optimism, cynical hostility, and incident coronary heart disease and mortality in the Women’s Health Initiative.” Note that the counter to optimism is not pessimism, rather, it is cynical hostility. In other words, the class of “non-optimists” is not limited to the woe-is-me individual. It includes people who may feel optimistic about their own prospects, but are cynical and hostile to others.
So, the underlying factors that govern our health and longevity are not merely cheerfulness versus moroseness, they are positive versus negative attitudes, compassion versus hostility, love versus hate. Dr. Tindle expands on this profound, and uplifting theme in her aptly named book: “Up: How Positive Outlook Can Transform Our Health and Aging“. Highly recommended.