August 29, 2008

The Power of Positive Thinking: Truth or Myth?

You might call Maarten van der Weijden the anti-Lance Armstrong.
Last week, the Dutch Olympic long-distance swimming champion and cancer
survivor told the British newspaper The Telegraph that he didn't want to be compared to the American cycling star.

"Armstrong says that positive thinking and doing a lot of sports can
save you. I don't agree," said van der Weijden. "I even think it's
dangerous because it implies that if you are not a positive thinker all
the time you lose ... The doctors saved me. I am just lucky."

Van der Weijden's comments cut to the heart of an ongoing debate in the medical community. Can patients really improve their chances of survival
by staying upbeat and happy? Experts say the American public has
largely accepted this as fact. But, scientifically speaking, questions
remain regarding whether this works, how it would work, and what such a
connection would mean for patients who don't get better.

Appeal and promise

There certainly is an appeal to believing that you have some level
of control over a debilitating illness. "I think it's part of the
American spirit," said James Coyne, director of the behavioral oncology
program at the Abramson Cancer Center and professor of psychology at
the University of Pennsylvania School of Medicine. "There's this idea
that you can succeed and conquer anything, even illness, on the basis
of your character."

And studies showing a possible connection between positive thinking
and health are frequently in the news. For instance, work by
researchers at Ben-Gurion University in Israel suggested that women
who've faced several life challenges, such as a death in the family or
divorce, are more likely to be diagnosed with breast cancer than peers
who've had more stable, happy lives. The results were detailed in the
Aug. 21 issue of the journal BMC Cancer.

The same study also found that women with cancer
were more likely to report that, prior to diagnosis, they had been
anxious or depressed and that bad things had happened in their lives.

Ronit Peled, one of the Ben-Gurion University researchers, said this
was evidence for a relationship between emotional well-being and the
risk of contracting cancer. "The main message from my point of view is
that young women who have severe life events at a young age should be
considered a risk group for breast cancer and treated accordingly," she
said. "But general feelings of happiness and optimism in one's life can
play a protective role."

Coyne said the public often takes news like this to mean that
positive thinking has been unequivocally proven to be good for your

But the truth is a little more complicated.

How do you feel?

In reality, there is no clear-cut answer yet on whether being upbeat
can keep you healthy or cure anything, Peled and Coyne both said.
Research on the subject is divided between studies like Peled's and
studies like the one Coyne did, detailed in December 2007 in the
journal Cancer, which found that emotional well-being wasn't
an accurate predictor of whether or not patients with neck and head
cancer survived.

Coyne is particularly skeptical of positive thinking's power over
cancer. "The problem with cancer is that it's so complex. By the time
you're diagnosed it may have been building for decades," he said.

For other diseases, though, the scientific outlook is sunnier. Coyne
said there's evidence that mood can predict whether someone who has had
one heart attack will have another. And he said there is a biological
explanation for why this might be possible.

Little research has been done on the biological basis of positive
thinking as a therapeutic treatment for illness, but Coyne said
scientists know the brain and the immune system communicate. Given that
scientists also know the immune system plays a role in inflammation of
the arteries, which can play a role in heart attack, it's reasonable to
think that heart attacks could be tied back to things going on in the

Good, bad

However, when Coyne and other researchers tried to intercede and treat depression among heart attack
patients, they found the patient's moods improved, but the rates of
second heart attack didn't. Ironically, Coyne said, the most evidence
for emotion affecting health actually favors negative emotions, not
positive ones. For instance, he said, we know anger and depression are
correlated with having a second heart attack, however, what's unproven
is whether being positive can reduce the risk.

Another way emotion could affect health, even for complicated
illnesses such as cancer, is by affecting the patient's willingness to
stick to the treatment plan. "It could be an indirect effect," said
Anne Harrington, chair of Harvard University's history of science
program and author of "The Cure Within: A History of Mind-Body
Medicine" (W.W. Norton, 2008). "If a person is positive, he or she is
more likely to show up for all the treatments to have a better diet to
exercise. And if you're deeply depressed you sleep badly and that's bad
for your health."

But Harrington and Coyne echoed the concerns of Maarten van der
Weijden, saying that findings about emotions and health shouldn't be
used to pressure patients into feeling a certain way.

In fact, Harrington said, that could hurt the patient more than if
they'd been left alone. "Misinterpretations of this research can make
people afraid to have the feelings they have," she said. "I have a
colleague who's studied this and it's very clear from his work that
it's just as stressful to keep up a performance of positivity as it is
to [keep up] a bad mood. It's very stressful to be inauthentically
upbeat all the time."