HAPPINESS IS PREVENTIVE MEDICINE
“Happiness is not something ready made. It comes from your own actions.”
— HIS HOLINESS THE DALAI LAMA
It may seem obvious that happy, well-adjusted people are healthier. But when was the last time your doctor prescribed a program to learn optimism as a tool for preventing heart disease as effective as smoking cessation? When have you ever prescribed for yourself, as part of your preventive-medicine regimen, lifestyle modifications and practices scientifically proven to increase your happiness as a way of extending your life by seven and a half to ten years?
In modern medicine, emotional and mental health often take a back seat to biochemically rooted physical-health concerns. We tend to relegate emotional and mental health to the dark recesses of psychiatrists’ offices, focusing instead on more physical preventive-health measures, such as a healthy diet, exercise, smoking cessation, and weight management. But the scientific data linking happiness and health is shocking enough that it just might convince you that treatments aimed at increasing happiness, along with happiness’s twin sister, optimism, should take center stage when you’re interested in preventing disease.
Multiple studies show that happiness and health are inextricably linked.1 Sure, we all know that those who suffer from mental-health conditions such as depression, anxiety, or bipolar disorder are at increased risk of suicide, substance abuse, and other life-threatening conditions that directly affect the health of the body. But it might surprise you to realize you don’t have to experience full-blown mental-health disorders that meet DSM-IV criteria for generalized anxiety disorder or major depression to have your mood affect your health. Simply feeling anxious, sad, angry, helpless, frustrated, or hopeless can trigger stress responses, and who doesn’t feel that way at least some of the time?
Surveys of U.S. adults show that just over half (54 percent) rate themselves as “moderately mentally healthy” but not exactly flourishing.2 Depression affects more than 21 million Americans annually and is the leading cause of disability in the United States for individuals ages 15 to 44. It is also the principal cause of 30,000 suicides in the U.S. each year.3 Twenty-one percent of Americans will suffer from a mood disorder such as depression in their lifetime, 28 percent will suffer from an anxiety disorder, and one in five Americans takes psychiatric medications, mostly anti-depressants.4
Clearly, many people feel mentally unhealthy. But what exactly is happiness, and what does it have to do with the health of the body? Happiness researchers define happiness as “the overall appreciation of one’s life-as-a-whole.”5 Essentially, it’s a measure of how much you like the life you’re living and how much enthusiasm you feel when you wake up every day.
The data is clear that unhappy people are much more likely to get physically sick. Depression, for example, increases your cancer risk, is a major risk factor for heart disease, and is linked to a variety of pain disorders.6 Anxiety has been shown to increase cancer risk and increase carotid artery atherosclerosis, which predisposes to stroke.7
Happiness even affects life expectancy. People with higher levels of “subjective well-being” live up to ten years longer than those who don’t.8 Happiness also affects some health outcomes, including success rates of stem-cell transplantation, control of diabetes, rates of full-blown AIDS in HIV-positive patients, and recovery from stroke, heart surgery, and hip fracture.9
Studies show that positive psychological states, such as joy, happiness, and positive energy, as well as characteristics such as life satisfaction, hopefulness, optimism, and a sense of humor, result in lower mortality rates and extended longevity in both healthy and diseased populations.10 In fact, happiness and related mental states reduce the risk or limit the severity of heart disease, lung disease, diabetes, hypertension, and colds. According to a Dutch study of elderly patients, upbeat mental states reduced an individual’s risk of death by 50 percent over the study’s nine-year duration.11
The Grant Study
The link between happiness and physical health became apparent during a landmark longitudinal study called the Grant Study, which followed upstanding, exceptionally gifted Harvard sophomores from three classes who were believed to be the pinnacle of physical fitness, mental health, and hope for the future. The goal was to watch how they lived their lives; pay attention to their health, happiness, relationships, and achievements; and hopefully learn how to predict, and thereby potentially control, why some people live happy, healthy, successful lives while others don’t.
To choose just the right subjects for the Grant Study, Dr. Arlie Bock’s team combed through medical records, academic records, and personal recommendations from the dean. The 268 Harvard students, mostly from the classes of 1942, ’43, and ’44, underwent evaluation by psychologists, social workers, physiologists, doctors, and pretty much everyone else Bock could assemble to record data about who these young men were as college sophomores.
Comprehensive medical examinations noted everything from organ function to the hanging length of the scrotum to brain activity as measured by electroencephalography. Social workers recorded bed-wetting habits, how the subjects received sex ed, and the family dynamics of their youth. The young men interpreted Rorschach inkblots, got their handwriting analyzed, and submitted to extensive psychiatric evaluation. All were deemed “normal,” even “gifted.”
The young men then graduated from college, but Bock, and those who took over for him over the years, studied them for the rest of their lives. The men were followed with extensive physical checkups, periodic interviews, and questionnaires, producing a veritable gold mine of information about what makes a person healthy, happy, and successful in life.
As the young men went off to fight in the wars that followed graduation from college, many of them endured the traumas that accompany combat. In spite of the challenges they faced, though, many of the men became quite successful. Four of them ran for U. S. Senate. One was a best-selling novelist, one became the editor of the Washington Post, one was a cabinet member, and one even became president. (It was later revealed that one of the Grant Study participants was John F. Kennedy.)
But as time went on, a trend began to emerge. By 1948, 20 of the young men displayed signs of severe psychiatric illness. By the time they turned 50, a third of them were mentally ill. Turns out that beneath the promising veneer of hopeful dean’s-list sophomores lurked unexpected gremlins of the mind.
Quoted in an article in the Atlantic, Bock said, “They were normal when I picked them. It must have been the psychiatrists who screwed them up.”12
Depression in these men turned out to be strongly linked to physical health. Of those diagnosed with depression by age 50, more than 70 percent had died or were chronically ill by 63. Those who reported being extremely satisfied with their lives had one-tenth the rate of severe illness or death compared to their unhappy counterparts. These findings held up after screening out other contributing factors, such as alcohol, tobacco, obesity, and ancestral longevity.13
Are Optimists Healthier than Pessimists?
Many years later, Martin Seligman, author of Learned Optimism, who studies optimism and its effects on life and health, was seeking a way to study whether optimists live longer than pessimists. For many years, he had been researching people’s explanatory styles, how they explain unfortunate or fortunate events in their lives. As it turns out, the difference between optimists and pessimists lies in how permanent, pervasive, and personal they perceive good and bad events to be.
Because the pessimist views the bad event as permanent (“It’ll always be this bad”), pervasive (“This is going to ruin everything”), and personal (“It’s all my fault”), hopelessness ensues. When you make permanent, pervasive, and personal explanations for bad events that inevitably happen to everyone, you pave the way for chronic unhappiness and, ultimately, illness. Pessimists also believe that bad events are the result of their own failure. Good events, on the other hand, they believe to be temporary, specific, and outside of their control. Optimists, on the other hand, are a whole different breed. Optimists perceive bad events to be temporary, specific, and external, while they believe good events are permanent, pervasive, and the result of their own internal awesomeness.
Seligman and his colleagues sought out the Grant Study data to see if they could identify any correlations between explanatory style and disease risk. First, they had to determine whether optimism and pessimism are stable across a lifetime. Is it “once an optimist, always an optimist”? Or do people change?
What they found is that while optimism may change over time, the way people explain bad events tends to remain fixed throughout their lives. But that doesn’t mean you can’t convert. I’ll discuss what you can do to become more optimistic and enjoy the health benefits that accompany optimism at the end of this chapter.
Once they realized that explanatory styles related to bad events tend to stay stable over time, Seligman and his partner, Chris Peterson, took a crack at the Grant Study data. What they found was that by the age of 45, the Grant Study pessimists were already less healthy than the optimists. The pessimistic men had started to get sick younger and more severely than the optimistic men. And by the age of 60, pessimists were significantly sicker.14
Turns out optimistic patients recover better from coronary bypass surgery, enjoy healthier immune systems, and live longer. They fare better when suffering from conditions such as cancer, heart disease, and kidney failure.15 Optimists also live longer than pessimists. People with a positive outlook are 45 percent less likely to die within a specified period of time from all causes than negative thinkers (and 77 percent less likely to die from heart disease).16 A positive attitude also affects our ability to ward off infection. In one study, healthy volunteers were interviewed about attitudes and then exposed to common cold and influenza viruses. Those with sunny dispositions were more resilient than those without.17
Other studies examining optimism versus pessimism followed. Harvard psychologist Laura Kubzansky, who studies optimism, tracked 1,300 men for ten years and found that heart-disease rates among optimists were half the rates in pessimists. The difference between the two groups was as dramatic as that seen between smokers and nonsmokers.18
As it turns out, pessimists are more susceptible to depression, more likely to experience barriers to professional success, less likely to experience pleasure, more likely to endure challenges in their relationships, and more likely to get sick.19 Studies show that optimists catch fewer infectious diseases than pessimists, have stronger immune systems and lower blood pressures, live longer, and are less likely to suffer from cardiac disease.20 In one study, pessimists had twice as many infectious diseases and twice as many doctor visits as optimists.21
A sense of positive well-being has been proven to protect your heart. Patients with high levels of “emotional vitality” were 19 percent less likely to develop coronary heart disease than those with lower levels.22 And just to ice the cake, people with high self-esteem, who view themselves in a more positive light, have lower cardiovascular responses to stress, recover faster, and have lower baseline levels of the stress hormone cortisol.23
Hope Heals
When I was a medical student, I took care of a little boy named Joe, who had stage 4 cancer. Joe, who had never met his father, was in the middle of aggressive chemotherapy when he wrote a pleading letter telling his father how sick he was and begging him to fly to Florida so they could meet. Knowing the man’s whereabouts, his mother promised to send the letter, and to Joe’s delight, his father wrote back and promised to come see him in the hospital for the first time in his life.
As he waited for the visit from his father, Joe’s cancer wasn’t responding well to the treatment. His body was becoming progressively weaker. But Joe was an optimist. He believed he would recover from the cancer and have the rest of his long life to finally get to know his father, whom he had been fantasizing about for as long as he could remember.
At one point, Joe’s organs began to shut down, and we were sure the end was near. His mother called his father to tell him to come quickly, and that night, Joe got word that his father had bought his plane ticket and would be arriving in a week. By the next day, Joe’s condition had significantly improved, and he was up, walking around the ward, excitedly telling all the nurses about his father’s impending visit.
The reunion was to happen on a Saturday. Joe spent the whole week making drawings for his father, writing stories, and practicing a song on his recorder to play for him. We were amazed at how sprightly Joe suddenly appeared, in anticipation of his father’s visit.
Friday night, Joe couldn’t sleep. My attending physician finally ordered a sleeping pill so Joe wouldn’t be completely exhausted when his father arrived. Saturday morning, Joe begged us to let him out of the hospital so he could go to the airport and see his father the moment he walked off the plane. But Joe still needed his IV, and the doctor wouldn’t let him go. Instead, Joe camped out on the front patio of the hospital in a wheelchair with his IV pole, where he waited with his mother and watched for the taxi that would bring his father to the hospital.
His father’s plane was to arrive at 2:00. The airport wasn’t far. He should have been there no later than 3:30. But 3:30 came and went. Joe waited. And waited. And waited. But his father never came. His mother called, but nobody picked up. Joe left messages, but nobody ever called back.
I was working that day, and I kept checking on Joe, who insisted his father’s plane had been delayed or he was just stuck in traffic. But his mother had checked the flight. It had arrived right on schedule. Joe’s mother tried to explain to him that his father wasn’t very mature and didn’t quite know how to be a father. But Joe wasn’t buying it. He was certain his father was coming. Nothing could shake his faith.
I was on call that night, worried about Joe but running around, taking care of new admissions to the pediatric ward, when finally, at 11 P.M., eight hours after his father was supposed to arrive, Joe’s mom was able to convince him to return to his room. When I saw Joe’s wheelchair rolling through the halls and leaned in to hug him, Joe started crying and told me his father had stood him up. The whole ward—me, the nurses, Joe’s mom—got misty-eyed as we watched Joe’s thin little body shake with sobs.
Sometime around midnight, Joe finally fell asleep.
About five hours later, when I was still in the emergency room, writing up another history and physical exam as I admitted a baby with meningitis, the overhead speaker blared “Ninety-nine, Doctor Heart,” our secret code for a code blue. Someone was dying, and as the medical student on call it was my job to be there. When I called the operator to find out where the code was happening, she gave me the room number.
My own heart almost stopped when I realized it was Joe’s room.
Although he had been doing well the night before, Joe stopped breathing and our resuscitation efforts failed. Joe’s dad never came, even when Joe’s mother reluctantly invited him to the funeral.
You might say that hope had been keeping Joe alive—that’s how powerful the effect of optimism can be. But while his story of hope withdrawn has a sad ending, Maria’s story of how hope heals has a happy one. Maria was eight when she was diagnosed with a form of leukemia for which her doctors recommended toxic doses of chemotherapy, followed by a bone-marrow transplant. However, a transplant match couldn’t be found. So Maria’s parents made the radical choice to conceive a baby, hoping that the sibling would be a match.
While Maria’s mother was pregnant, Maria’s doctors treated Maria with lower doses of chemotherapy, which they believed would keep the leukemia in check but not cure her. The goal was to keep her alive until the baby was born, when cord blood collected at the time of birth could be screened and, they hoped, used for transplantation.
Maria, who had always wanted a sibling, was overjoyed that her mother was pregnant. Although the chemotherapy weakened her, her spirits stayed high, and she told all the nurses that her cancer was going away so she could be a good big sister. Not wanting to remove hope or interfere with her optimism, the nurses nodded in agreement, even though the blood tests revealed that the cancer was still there.
Maria tolerated the chemotherapy well, and a few months later, to the surprise of her doctors, her blood counts started to improve beyond what they expected with the low doses of chemotherapy they were using.
When the baby was born, Maria was in the room, outfitted with gear meant to protect her frail, susceptible body from infection. When she rocked her new sister in her arms, those present at the delivery were deeply moved.
But the cord blood collected at the time of delivery was not a close enough match for Maria. Maria’s parents were devastated, but Maria told them not to worry, that her cancer had gone away and she didn’t need the bone marrow transplant anymore. Her oncologists shook their heads. That would be impossible, they said. The doses of chemotherapy she had received were insufficient to result in cure.
But it turned out Maria was right. During her next round of tests, no trace of her cancer could be found. Although some might argue that the low doses of chemotherapy cured her, I believe hope and optimism did.
Learned Helplessness and Illness
When you work in a hospital, you often hear inspiring stories of optimism linked to disease remission and pessimism associated with disease progression. Martin Seligman claims that what differentiates the pessimists from the optimists is something he calls “learned helplessness.” When things don’t go the way we hope, we all—optimists and pessimists alike—feel temporarily helpless. When your boyfriend breaks up with you, your boss hands you your pink slip, your wife dies, your child is kidnapped, or you get slapped with a cancer diagnosis, you get the proverbial wind knocked out of you, and you’re likely to experience negative emotions like sadness, anger, worry, and fear.
When bad things happen, however, the difference between optimists and pessimists is that optimists start to recover right away. Something in them knows they’ll always land butter side up, even when they’re in the thick of it. Optimists might feel demoralized, even temporarily depressed, but they pick themselves up, brush themselves off, and get back to the business of living a happy life.
Pessimists, on the other hand, continue to feel helpless over an extended period of time, which often spirals downward into full-blown clinical depression. Studies show that when pessimists fail—in relationships, in business, in the achievement of personal goals—they feel helpless, since it feels like the negative experience will last forever, will ruin everything, and has come about as the result of internal personal failure. Over time, they learn helplessness that leaves them feeling in the dumps, often for a long, long time.24 We’ve long known that negative thoughts and stressors can make us sick, and researchers suspect that negative belief affects the body by triggering the stress response, turning off the body’s natural self-repair mechanisms and predisposing the body to disease.25
Immune Response and Helplessness
On a mission to further elucidate the mechanism of how helplessness might be linked to illness, Madelon Visintainer, a colleague of Seligman’s, performed a study on three groups of rats. The first group was given a mild, escapable shock—one the rats could avoid once they learned how. The second group was given a mild, inescapable shock, which rendered them helpless. The third group was given no shock at all.
Before setting about shocking these poor rats, Visintainer implanted a few cancer cells on each rat’s flank. The cancer was the kind that would invariably kill the rat if the rat’s immune system failed to fend it off. Visintainers carefully controlled the number of cancer cells she implanted so she could expect that, under normal conditions, about half the rats would reject the tumor and live. The other half would succumb and die.
Everything externally was perfectly controlled—the rats’ diet, how they were housed, the tumor burden. The only difference among the three groups of rats was their psychological experience. The rats experiencing escapable shocks quickly learned how to game the system, ultimately avoiding the shocks. The rats getting inescapable shocks, on the other hand, were learning helplessness. And the unshocked rats were just minding their own business, with neither the challenge of figuring something out nor the trauma of getting shocked.
As expected, within a month, 50 percent of the unshocked rats had died, while the other 50 percent of unshocked rats fought off the tumor. But curiously, the rats given escapable shocks, who learned how to master the system, rejected the tumor 70 percent of the time, giving them a survival advantage over the unshocked rats. The rats who couldn’t escape the shocks, however, wound up listless and helpless, and only 27 percent rejected the tumor.26 From these rats, we may conclude that our sense of control, ability to avoid victimhood, and feelings of hopefulness regarding our experiences, particularly the traumas we face, may affect whether we get sick or stay healthy.
Based on this data, researchers concluded that learned helplessness in rats who couldn’t escape the shocks must have suppressed the immune response known to fight off cancer cells in tumors of this sort. Further study of these helpless rats found that, indeed, inescapable shocks weaken the immune system. The T-cells of the helpless rats no longer multiplied and got down to the business of fighting off cancer cells when they came across invading outsiders. Natural killer cells, also important in fighting off cancers and other foreign invaders, lost their natural killer abilities. These studies confirmed what researchers had suspected. Psychological states can directly affect the outcome of remission from some diseases, at least those that are immune-mediated, as many cancers are.27
This may explain why optimists are healthier than pessimists. Because of their healthier explanatory styles in the face of negative life events, optimists are more likely to learn healthy adaptations in response to life’s shocks, making them immune to states of helplessness. Pessimists, on the other hand, feel like life’s shocks are inescapable, and like the listless, helpless rats, they get depressed and their immune systems weaken. Over the course of a lifetime, fewer episodes of learned helplessness may keep the immune system stronger, reduce stress responses and their negative health outcomes, and reduce the likelihood of disease.
Control as an Antidote to Helplessness
If rats can fight off cancer by exerting more control over their surroundings, is there any proof that humans respond the same way? Curious as to whether learned helplessness could be counteracted by increasing feelings of control, choice, and personal responsibility, researchers working with residents of a nursing home designed a study to evaluate the physical health of residents in response to positive changes made in the facility.
They divided the home into two groups—the first floor and the second. All residents would be able to enjoy the new benefits the home was offering—omelets versus scrambled eggs, movie night on Wednesdays or Thursdays, plants to enjoy in their own rooms if they wanted them. But in order to take advantage of these opportunities, first-floor residents were given extra choice and extra responsibility: they had to choose which eggs they wanted, sign up for Wednesdays versus Thursdays, and water their own plants.
Second-floor residents, on the other hand, were given the same opportunities, but they were offered no choices or personal responsibilities. Their schedules were set, leaving them essentially powerless. Mondays, Wednesdays, and Fridays were omelet days. Tuesdays and Thursdays were scrambled-egg days. They were assigned a movie night without being given a choice. And they didn’t have to pick out or water their own plants.
A year and a half later, researchers found that the first-floor residents, the ones with choice and personal responsibility, were more active, happier, and less likely to have died during the study period.28 As it turns out, choice, personal responsibility, and the ability to feel useful are good for your health, most likely because you feel happier, and this leaves the body better able to repair itself.
Cheerfulness Predicts Longevity
We know that unhappy people are less likely to eat well, exercise, and enjoy healthy sleep patterns. But the health consequences of unhappiness aren’t explained solely by whether or not unhappy people neglect to care for their bodies. In 1986, David Snowdon began another longitudinal study like the Grant Study, but this time, instead of studying Harvard sophomores, it studied Roman Catholic nuns.
Typically, studying what makes people live longer is fraught with bias. For example, we know that people from Utah live longer than people from Nevada. But why? Is it because the ascetic Mormon lifestyle is healthier than the rough-and-tumble boozing, gambling, and smoking culture of Las Vegas and Reno? Do the people of Utah eat more nourishing foods? Is the air in Utah cleaner? Are Utah residents less stressed?
Because these kinds of variables make longevity studies tough to interpret, it’s helpful to study populations for whom many of these variables are controlled. This is where the nun study comes in handy.
The health habits of these nuns were otherwise fairly well controlled—they ate roughly the same bland diet, they didn’t smoke or drink, they didn’t get married, have babies, or contract sexually transmitted diseases, their social and economic class was similar, and they all had the same access to good medical care. This made it easier to draw conclusions about what leads to a longer life. You’d think that such a similar population might have similar life expectancies, yet with all the typical confounding variables controlled, there was still wide variation in how long the nuns lived and how healthy they were.
Why the disparity? Upon joining the convent, new nuns were asked to write the story of their life up until that point (the average age of those who wrote these autobiographies was 22). By the time the study began, many of these nuns were already senior citizens. The autobiographies they had written many years earlier were used to assess their happiness in young life. From there on, the nuns were followed for the rest of their lifetimes.
One such sister was Cecilia O’Payne, who became a novice at the School Sisters of Notre Dame in 1932. In her autobiography, she wrote, “God started my life off well by bestowing upon me grace of inestimable value … The past year which I have spent as a candidate studying at Notre Dame College has been a very happy one. Now I look forward with eager joy to receiving the Holy Habit of Our Lady and to a life of union with Love Divine.”
By contrast, another nun taking the same vows, Marguerite Donnelly, wrote, “I was born on September 26, 1909, the eldest of seven children, five girls and two boys … My candidate year was spent in the Motherhouse, teaching chemistry and second-year Latin at Notre Dame Institute. With God’s grace, I intend to do my best for our Order, for the spread of religion and for my personal sanctification.”
Can you spot the difference between the two? Cecilia used effervescent words like “very happy” and “eager joy,” while Marguerite’s prose contained no such cheerfulness.
So what became of these young nuns? As reported in Martin Seligman’s book Authentic Happiness, at 98 years old, Cecilia O’Payne was reportedly still alive and hadn’t been sick a day in her life. Marguerite Donnelly, on the other hand, had a stroke at 59 and died soon afterward.29
When researchers investigated the life stories of the nuns, they found that 90 percent of the most cheerful nuns were still alive at age 84, compared to only 34 percent of the least cheerful. In fact, 54 percent of the most cheerful nuns were still alive and kicking it at age 94, compared to 11 percent of the least cheerful. In general, happy nuns were found to live seven and a half years longer than their unhappy counterparts.30 Other studies show that happy people live up to ten years longer than unhappy people.31 Clearly, happiness is preventive medicine, and at the end of this chapter, we’ll discuss how you can increase your happiness to assist your body’s healing process.
The Physiology of Mood
So what happens to the body when the mind is in a dark place? Emotional suffering might start in the mind, but it is ultimately an embodied experience. You don’t just experience unhappiness in your mind. You feel it in your body, as suffering cascades through your body via the stress response. When something hurts emotionally, an alarm is sounded. The stress response is triggered, even though there is no immediate bodily threat—just anger, disappointment, frustration, pessimism, heartbreak, grief, and other upsetting emotions. In this next section, we’ll discuss the physiology of how anxiety and depression negatively affect the body and how happiness can heal it.
Anxiety
The amygdala, an almond-shaped group of nuclei located in the limbic system, deep within the medial temporal lobes of the brain, is the boss when it comes to processing and storing memories of various emotions. In fact, the amygdala experiences emotions even before the conscious brain does. Repetitive triggering of the stress response makes the amygdala more reactive to apparent threats, which stimulates the stress response, thereby further triggering the amygdala, on and on and on in a vicious cycle. The amygdala serves to help form “implicit memories,” traces of past experiences that lie beneath conscious recognition. As the amygdala becomes more sensitized, it increasingly tinges those implicit memories with heightened residues of fear, causing the brain to experience ongoing anxiety that no longer has anything to do with the circumstances at hand.
At the same time, the hippocampus, which is critical for developing “explicit memories”—clear, conscious records of what really happened—gets worn down by the body’s stress response. Cortisol and other glucocorticoids weaken synapses in the brain and inhibit formation of new ones. When the hippocampus is weakened, it’s much harder to produce new neurons and thus make new memories. As a result, the painful, fearful experiences the sensitized amygdala records get programmed into implicit memory, while the weakened hippocampus fails to record new explicit memories.
When this happens, you wind up with no real memory of what set you off to begin with but with a very clear sense that something bad—something very bad—is happening. This explains why those who experience trauma can wind up triggered by situations that stimulate the unconscious mind when the conscious mind has no clue what’s going on. You wind up feeling unsafe and anxious, without having any clue why.
Depression
Depression also leads to repetitive activation of the stress response, which, in a cyclic fashion, then leads to depressed mood. With all that cortisol floating around as a result of the stress response, norepinephrine, which normally helps you feel alert and energized, gets depleted, leaving you feeling apathetic and distracted. Cortisol also lowers the production of dopamine, which is important for helping you experience pleasurable feelings.
The stress response also reduces serotonin, the most important neurotransmitter responsible for positive mood. When serotonin levels drop, norepinephrine levels drop even further, sending you into a downward spiral.
In addition to triggering the stress response, negative emotions also enhance the production of pro-inflammatory cytokines, leading to inflammation, which has been linked to certain cancers, Alzhei-mer’s disease, arthritis, osteoporosis, and cardiovascular disease. Furthermore, negative feelings can contribute to delayed wound healing and infection.32
When negative moods like pessimism, helplessness, hopelessness, anxiety, and depression prevail, the stress response flips on and stays on, leading to gastrointestinal disorders, greater vulnerability to infections and cancer, heart disease, endocrine disorders, and more.33 Happy people appear to have stronger immune systems, as demonstrated by the fact that happy people develop about 50 percent more antibodies in response to flu vaccines and mount stronger immune responses.34
When you’re unhappy, on the other hand, your immune system weakens, a finding that was confirmed by one study of grieving widowers demonstrating that T-cell multiplication slowed down during the grieving process.35 Differences in immunity were also seen in a study of optimistic versus pessimistic HIV-positive women.36
Happiness
While the neuroscience of unhappy mental states has been heavily studied, happiness is less well understood. However, the advent of functional MRI machines, along with electroencephalography, has made it easier to study the science of happiness. From examining study subjects who reportedly feel blissed out, researchers have concluded that happiness appears to be located in the left prefrontal cortex of the brain.
But what activates this part of the brain? And what can we do to get our left prefrontal cortexes more activated? Most likely, the answer has something to do with neurotransmitters like dopamine, oxytocin, endorphins, nitric oxide, and serotonin.
Researchers break down “happiness” into two types of pleasurable feelings—the anticipation of something positive and the sensory pleasure of actually experiencing it. For example, you might feel happy fantasizing about your upcoming beach vacation in Bali, planning how you’ll spend the end-of-year bonus you’ll get at work if you do a good job, or visualizing the thrill of finally kissing the object of your affection. But you might also feel happy basking in the warm sun with crystalline blue waters lapping around your body, slipping on the new cashmere sweater you just bought with your end-of-year bonus, and caressing the soft lips of your lover as your body awakens with pleasure.
When you feel happy because you’re anticipating something exciting, your brain lights up in the area of the nucleus accumbens, the pleasure center of the brain. Activation of this part of the brain is most likely related to the neurotransmitter dopamine, which mediates the transfer of positive emotions between the left prefrontal cortex and the emotional centers in the nucleus accumbens. People with sensitive dopamine receptors tend to have better moods.
Dopamine may be the primary neurotransmitter associated with the kind of happiness you get when you’re moving toward a goal and then achieve it, whereas other neurotransmitters may be responsible for other types of happiness, such as feelings of love or the sensations of physical pleasure. For example, oxytocin, the “cuddle hormone,” which plays a role in pair bonding and is released when you fall in love or snuggle your child, may explain part of how happiness affects your health. Made in the hypothalamus and secreted by the pituitary gland, oxytocin reduces inflammation by decreasing cytokines. It also indirectly inhibits release of ACTH, thereby down-regulating the HPA axis that gets triggered during the stress response. Happy people have been found to have lower levels of cortisol, most likely because happy people feel less stress, fear, anger, and other emotions known to trigger the stress response.
Oxytocin also activates serotonin receptors, lifting mood, and inhibits the amygdala, from which the fear that can trigger the stress response arises.37 Oxytocin also stimulates the release of endorphins, nature’s morphine, which reduce pain and can lead to euphoric feelings such as the “runner’s high” some get while exercising. Endorphins, which are released by the pituitary gland during exercise, love, and excitement, trigger dopamine release, which then stimulates the nucleus accumbens and leads to feelings of pleasure. Feelings of sensory pleasure also stimulate the release of nitric oxide, a potent vasodilator, which increases blood flow and is known to be important in protecting certain organs from ischemic damage, which can occur when an organ doesn’t get enough blood flow.
Most likely, happiness also affects the immune system, as demonstrated by the tumor-laden rats subjected to escapable and inescapable shocks. Learned helplessness, experienced not just by rats but by pessimists, who tend to be unhappy, makes the immune system more passive, leaving you more susceptible to infection, cancer, and other immune-mediated diseases. Optimists, who tend to be happier, are less prone to learned helplessness, which, over the course of a lifetime, may keep the immune system scrappier. The effect of fewer stress responses on the body, as well as the long-term consequences of a strong immune system, may explain the longevity differences between happy and unhappy people.
Does Happiness Cure Disease?
While copious evidence supports happiness as preventive medicine, predicting longevity in healthy populations,38 what is less clear is whether happiness can also help treat existing disease. The data is mixed. Some studies show markedly improved disease recovery rates in happy people.39 One small study, for example, evaluated 34 women suffering from a second bout of cancer at the National Cancer Institute, where they underwent extensive physical and psychological evaluations that included analysis of optimism. Because survival after a second bout of breast cancer is rare, after about a year, most of the women began to die, but a few survived. Who lived longest? The ones who were happiest.40
But while some studies suggest that a cheerful attitude and fighting spirit improve survival in sick patients, the data suggests that a positive attitude, while it may prevent disease, isn’t always enough to fight disease once it exists.41 In fact, some argue that the idea of fighting serious illness with happiness is a preposterous illusion that merely leaves the patient feeling blamed.42
Why, then, might happiness prevent disease but often fail to treat it?
It’s hard to say, but most likely it’s because the beneficial effect of happiness has more to do with the cumulative physiological effects of happiness on the body than with the ability of a happy or optimistic mood alone to cure the body once things have gone south. For example, it’s clear that feeling happy can reduce lifetime exposure to the stress response, limiting lifetime cardiovascular risk. But once the coronary arteries are already blocked with atherosclerosis, perhaps a positive mood alone just ain’t gonna hack it.
Another explanation for the disparity in data is that disease mechanisms vary, and the mechanisms of self-repair in the body also vary. Happiness, for example, has been shown to improve immune function, while learned helplessness weakens it. But for diseases unrelated to immune function, mood may have less of an impact on disease outcome. Although a person’s mental state, mood, and attitude can certainly improve quality of life, it’s likely that happiness can only take you so far with certain diseases. But since the data is mixed and happiness has other benefits, what have you got to lose by taking steps to feel happier?
Rx for Pessimism
If you’re a pessimist prone to unhappiness, don’t despair. According to happiness researchers, things like optimism and happiness can be learned, and you can enjoy the physical and mental health benefits as a result. In Learned Optimism, Martin Seligman teaches an exercise he calls the ABCs—an acronym for Adversity, Belief, and Consequences. When we encounter adversity, we think about the adverse event, and our thoughts are quickly translated into beliefs, which become habitual if we’re not mindful of them. These beliefs have consequences that can affect the way we feel and the actions we choose to take. By learning to modulate how we translate adversity into belief and how we act on those beliefs, you can convert your negative thoughts into hopeful ones.
For example, say someone zips into the parking space you were eyeing (Adversity). You get upset and think, That driver stole my place. That was a rude and selfish thing to do (Belief). You get angry, roll down your window, and shout at the other driver (Consequences).
Or your best friend hasn’t returned your phone calls (Adversity). You explain this by thinking, I’m always selfish and inconsiderate. No wonder (Belief). You feel depressed all day (Consequences).
Seligman recommends keeping an ABC diary for a few days to assess how you respond to adverse events. To do this, you have to tap into your internal dialogue and identify the beliefs that arise in the face of adversity. (Remember that beliefs are thoughts, not feelings. Feelings are actually consequences of your thoughts.) Then record the consequences—how you felt or how you acted in response to the beliefs that arose out of the adverse event. After reviewing the beliefs that arise in the face of adversity, pessimists may notice how the beliefs that arise trigger negative emotional states or behaviors, whereas optimists may notice that their beliefs help them overcome adversity quickly.
Here’s the kicker. If you naturally tend toward pessimism, you can learn to change the beliefs that arise in the face of adversity, and by changing these beliefs, you can change the consequences and improve your health. Once you are aware of your knee-jerk pessimistic beliefs, Seligman recommends two ways to deal with them: distracting yourself and thinking about something else or disputing them.
To distract yourself from a pessimistic belief, try what researchers call a “thought-stopping technique” meant to interrupt habitual thought patterns, such as slamming the palm of your hand against a wall and yelling “STOP!” You can also ring a loud bell, carry around a three-by-five card with the word STOP in large red letters, or wear a rubber band around your wrist and snap it hard to stop the ruminations. Combining such techniques with attention shifting can produce longer-lasting results. When you shout “STOP!” or snap the rubber band, consciously concentrate on something else.
If that doesn’t cut it, schedule time later in the day to ruminate on your pessimistic beliefs. Tell yourself, “Stop. I’ll think this over later.” Or write your thoughts down. Doing so breaks the rumination cycle and lessens the strength of the negative thoughts.
Even more effective than distracting yourself from your negative ruminations is disputing them. To do this, you have to learn how to argue with yourself. Review your pessimistic belief, tap into the wisdom of your wiser, loving, compassionate self, and make a case to prove yourself wrong. For example, if your best friend doesn’t return your calls and your first thought is, She hates me because I’m a terrible friend, dispute the thought. Argue that she might be busy, that someone else might not have relayed the messages you left on her machine, that she probably meant to call but got distracted, that really she loves you and you’re a good friend. In other words, the problem isn’t permanent, pervasive, and personal; it’s temporary, specific, and external. Based on this new optimistic belief, you can choose new consequences and abort the downward spiral that pessimistic beliefs trigger.
The keys to successfully disputing your negative beliefs include trying to find evidence that your negative belief is false (if it is), considering alternative interpretations of the adverse event other than the pessimistic explanations you’ve imagined, determining what payoff you may be gaining from such a negative belief, and if the belief really is true, thinking through the implications of such a belief. Let’s return to the best friend who hasn’t called you back. After thinking of alternative explanations for why she didn’t call, examine why your mind might race straight to negative assumptions. Perhaps you’re getting something out of feeling like a neglected victim. Perhaps you cling to your righteous anger when she doesn’t call you back, and your payoff is that you get to feel superior.
If the real reason she didn’t call you back is that she hates you because you’re a terrible friend, what can you learn from this belief? How can you use this belief to learn to be a better friend? You’ll ultimately realize that, if this friendship isn’t destined to last, you can probably learn something about yourself from the relationship, and chances are good that there’s someone else out there just itching for the title of your new BFF.
In other words, try to talk yourself out of your negative belief, and if you can’t, let yourself think things through to the worst possible scenario so you realize that, even if it’s true, the implications probably aren’t the end of the world.
Seligman also recommends distancing yourself from your pessimistic beliefs, realizing that they are just that—beliefs, not facts—and concluding your inner dialogue with an energizing thought, one that lifts you up rather than dragging you down.
Are you a pessimist ready to argue with yourself and get happier? Your body will thank you if you do.
Rx for Unhappiness
Becoming happier and healthier requires more than simply shifting from pessimistic to optimistic explanations for adverse events. This is good news, because, according to the research of Sonja Lyubomirsky, 40 percent of our happiness is easily within our control.
Yes, it’s true that 50 percent of happiness is dictated by a predetermined genetic set point. Happiness is related to activity in the left prefrontal cortex of the brain, and some of us just naturally have more active left prefrontal cortexes. Studies of twins have shown us that we’re all predisposed to have a certain type of temperament. Some of us are naturally sunny, while others are inherently melancholy. While we can’t change the genetic part of our personal happiness equation, we can make changes to our overall happiness, and the secret to happiness is probably not what you think.
Although you may think changing your life circumstances will make your happier—when you finally meet “the one,” get the perfect job, score the deal, hit the bestseller list, get pregnant, or whatever else your heart desires—the research suggests that life circumstances only account for 10 percent of our happiness. Whether we’re healthy or unhealthy, privileged or poor, beautiful or homely, married or single, or facing some sort of life transition or trauma, does affect us—but not as much as you might think.
Why don’t life circumstances account for more of our happiness? Because of a powerful force psychologists call “hedonistic adaptation.” When you finally attain something you want—the object of your affection, more money, higher status, greater beauty, or some material possession—it makes you happier for a short while. But you quickly return to your set point. When good things happen, we get a happiness boost, but it isn’t sustainable. For example, newlyweds feel happier, usually for about two years, and then they return to their happiness set point.43
But here’s the really good news! Forty percent of our happiness is unrelated to our genetic happiness set point and not subject to hedonistic adaptation. Scientific studies show that influencing this 40 percent can be as easy as keeping a gratitude journal every night.44
As described in Authentic Happiness, Martin Seligman conducted a study and taught a single happiness-inducing strategy to a group of severely depressed individuals. Although these people were so abysmally depressed they could barely climb out of bed, they were instructed to do one simple task every day: go to a website and write down three good things that happened to them that day. Within 15 days, their depression improved from “severely depressed” to “mildly to moderately depressed.” Ninety-four percent of them reported feeling better!
In The How of Happiness, Sonja Lyubomirsky shares her findings from a study examining happy people. What she found was that the happiest people were not the richest, most beautiful, or most successful. Instead, as it turns out, the golden ticket to happiness lies not so much in changing our natural tendencies or even our life circumstances but in adopting certain behaviors that have been scientifically proven to increase happiness. In her study, happy people shared similar traits. They devoted a lot of time to nurturing their relationships with family and friends, were comfortable expressing gratitude for what they had, were the first to lend a helping hand, practiced optimism when imagining their futures, savored life’s pleasures and tried to live in the moment, exercised frequently, were deeply committed to lifelong goals and ambitions, and showed poise and strength when facing life’s inevitable challenges.
She also found that you can be happier by avoiding overthinking, cutting yourself loose from ruminating thoughts, eliminating social comparisons, taking action to solve problems right when they arise, seeking meaning amid stress, loss or trauma, practicing forgiveness, engaging in activities that get you “in the flow,” smiling more, and making efforts to take care of your body.
I believe that living in alignment with your truth is also vital to happiness, and studies confirm this. Steve Cole and his colleagues at UCLA investigated HIV-positive gay men to determine whether how “out” or “closeted” they were with their homosexuality affected their disease progression. Study participants were asked to rate themselves as “definitely in the closet,” “in the closet most of the time,” “half in and half out,” “out most of the time,” or “completely out of the closet.”
Researchers then followed the course of their disease. What did they find? On all counts, HIV infection advanced more quickly in direct proportion to how “in the closet” the patients were. The more they lived in alignment with their truth, the healthier they were. And the results weren’t subtle. Those who were mostly or all the way in the closet hit critically low CD4 counts 40 percent faster than those who were mostly or all the way out, and they died 21 percent faster.45
When you make efforts to increase your happiness, the health of the body tends to follow.
