Segerstrom sees it differently. She suggests that, regardless of their expectations, optimists don't give up because they're conscientious. In the face of difficulty, they redouble their efforts. Increased effort is beneficial overall, because as you persist in working toward long-term goals (marriage, career advancement, financial and social capital) you create a resource-rich life, one that increases well-being across the board. If you get sick, you invest energy in the effort to get well. But in the short-term, there is a fatigue factor.
Does immune suppression measured in the lab play out in the real world? Segerstrom is studying law students to see if the immune system shows signs of stress when the optimists among them are overtaxed. She has collected more than 7,000 saliva samples from 150 law students to measure levels of the stress hormone cortisol. If the immune system is temporarily suppressed by energetic goal pursuits, it should be reflected in stress hormones," she says.
But even if pursuing goals stresses the immune system, Segerstrom isn't convinced there will be any long-term health consequences. She would, she adds, prefer to go through a temporary decrease in immunity if it meant she could accomplish her important life goals.
The Power of Proxy
There are limits to the attitude and stamina of even the staunchest optimists—not surprising when you consider that we've evolved to conserve physical and mental energy in most situations.
Psychologists Patrick Carroll of Ohio State University and Kate Sweeny and James Shepperd of the University of Florida found that even optimists will temporarily revise their forecasts "downward" as a moment of truth approaches. "Shifts from optimism occur in response to the possibility that things may not turn out as hoped," explains Sweeny. "It makes sense to be optimistic when a goal is far away, and more realistic when it's close at hand. That allows us to prepare for an unexpected setback."
Farran points out that when faced with certain health problems, the best thing some patients can do is lie low while the immune system regains its footing without optimism's suppressive effect. Simple rest is sometimes good medicine. Many times such patients do best when they have a health proxy, she adds, someone to "carry the hope for them" by getting them to doctor appointments and giving them the medication they might be too depressed to take themselves.
Besides, even as a person rests, he or she can quietly persist. That's what Sarah Elizabeth Olson, a mother of two in Aptos, California, did while bedridden with a terrible case of long-term Lyme disease. Both she and her toddler came down with the infection when she was 29. A course of antibiotics did not treat the disease completely, and her health declined over the next year. "By the end I could no longer walk, began to choke when eating, and could not write. I had to be helped to bathe. I slept 22 hours a day," she recalls. Olson took out a second mortgage to pay for long-term intravenous antibiotics, yet for the first six months she didn't improve at all. "I was in chronic pain. I would go into the laundry room and lay my head against the cool metal of the washing machine and tears would stream down my face," she says.
Despite her lack of response, she still went through the exhausting act of infusing the antibiotic each day because her doctor encouraged her and because she wanted to get well. Then, in the seventh month, improvement came. "I got better and better," she says. Today a stay-at-home mom with two healthy daughters, she runs a support group for Lyme patients and, like a true optimist, has found meaning in her experience. "When I had terrible arthritis I told myself, 'If I ever get my hands back I am going to learn to crochet!' I have crocheted hundreds of hats. I can close my hand, and the simplicity of that, which I could not do when sick, makes me happy instantly."
Are Your Expectations Realistic?
Even the most positive outlook may do little good without realism, flexibility, and the action-oriented approach required to effect change. Where do you fall on the spectrum of expectant emotions?
Wishing. You can wish on a star or someone can wish you luck, but just longing for something isn't likely to put it within reach. Some older women interviewed by Farran, for instance, wished to get married but did not discuss the huge adjustment a marriage would entail, nor did they have prospective spouses. This kind of outlook, lacking in reality or an action plan, won't benefit health. It's comparable to receiving a positive biopsy, and dismissing it with the statement, "This result is just plain wrong."
Blind Optimism, or what Dossey calls "smiley-faced optimism." For some, this Pollyanna-ish sentiment holds that no matter how black things seem, everything will be just fine. The blind optimist expects the best possible outcome and sees only the positive aspects of a situation. In his unwavering belief that good triumphs over evil, he may be inflexible in altering his goals when things don't work out. The blind optimist accepts a positive biopsy as accurate, but assumes a cure without researching the best treatments or doing anything extra at all.
Realistic Optimism or Hope, has the ability to be fluid and flexible while continuing to reinvent its end goal. This person hopes for a good outcome but also works hard to accomplish it. Through sheer persistence and attention to detail, the realistic optimist is more likely to overcome illness and positively impact his or her health.
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