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The Optimism Revolution

Optimism as you know it isn't always the best medicine. In the new view, behavior trumps positive outlook. Why a healthy mentality paints the world in light and shadow.

The pain was blinding," recalls Larry Dossey of the afternoon last August when he was thrown by two different horses—within a mere two hours. Dossey, his wife, and another married couple had just spent two weeks camping and fly-fishing in the Wind River Mountains of Wyoming—a place so beautiful, he says, that it makes him feel like he's "in touch with the gods."

Dossey, a doctor as well as an early champion of mind-body medicine, cracked his ribs when the first horse spooked; but he allowed the wranglers to mount him on a second horse—their most experienced one—with the hopes of reaching civilization soon. The second horse bolted up the mountain, lunged over an embankment, and sent Dossey flying. He fractured his spine, though he didn't know that at the time.

After testing his ability to wiggle his toes and turn his head, Dossey concluded his best chance for survival was to walk out of the wilderness. "I realized that this was an extraordinarily serious situation with no good solution that I nonetheless had to overcome," he recalls. "And somehow I knew I could overcome it with sufficient courage and resolve." So he suggested that the women, wranglers, and pack horses ride ahead, and that his friend accompany him by foot. Night fell. For 10 hours he walked, in pain "with every step, one flashlight between us, across some of the most rugged territory I've ever seen," says Dossey. "How do you eat an elephant? One bite at a time. I focused on the act of putting one foot in front of the other. I put my consciousness down in my feet. I stopped every 15 minutes to get on top of the pain."

At about 4 in the morning, they reached the wranglers' base camp, and from there his wife drove him to the small town of Lander, Wyoming, an hour away. But his back pain only worsened, so that he could hardly stand. Two days later they located a spinal specialist in Bozeman, Montana, who diagnosed the fractured vertebra and hospitalized Dossey, putting him on intravenous morphine. For months he wore a body brace , encased in plastic from chin to hips. He now wears a lighter brace and suffers from daily back pain. His conclusion: "I'm absolutely grateful I didn't land on my head or neck. I came within just a whisper of being a quadriplegic. I reflect on this every day."

That's an optimistic appraisal if there ever was one, but Dossey's background as an experienced physician—he's knowledgeable about both trauma and the impact of attitude on health—helped prepare him for what he calls "grounded optimism." So did his experience as a seasoned outdoorsman who'd made annual treks into wild country for three decades, and the fact that he'd served as a battalion surgeon in Vietnam, where he'd often observed the limits of human endurance. As he puts it: "Characterizing optimists as smiley-faced romantics is unfair. Optimists are actually realists who take steps to solve problems"—for instance, the literal steps Dossey took for 10 hours. According to this definition, Dossey and other true optimists are flexible, and anchored in reality. And most important, they get things done.

Optimism: The New View

Optimism has long been considered a straightforward asset when battling illness or adversity. And, broadly speaking, it is. Harvard graduates who were optimists at age 25 had better health outcomes for the next three decades. As Dossey explains, "Optimists have more stable cardiovascular systems, more responsive immune systems, and less of a hormonal response to stress compared to pessimists. They have a stronger sense of self-efficacy, so they're more likely to invoke healthier behaviors because they think it can make a difference."

Of course, to be considered optimistic you have to have a positive long-term outlook and some degree of hope for the future. But a new view of optimism holds that to have a real impact on health, outlook is less important than behavior. By this definition, it is the act of engaging with the world, of taking concrete steps toward goals, that improves health. But there's a wrinkle: Under trying circumstances, optimism can actually lead to fatigue and temporary immune suppression. That finding has helped researchers rethink optimism and how it really works.

It turns out that our standard view of optimism is simplistic, and it is only by observing the nuanced impact of "optimistic" behaviors on the immune system that we can get a more complete picture of this coping style. Grounded optimism gives the brain a built-in action potential: It replaces emotion with motion.

In the end, the hidden key to optimists' better health outcomes may be their propensity to engage with the world and to persist in the face of difficulty, whether it's a night of agonized walking through the wilderness or the willingness to seek out second and third opinions for a medical condition. "Here's the really important piece to understand," says Suzanne Segerstrom, a University of Kentucky psychologist and author of Breaking Murphy's Law: How Optimists Get What They Want from Life—and Pessimists Can Too. "If you're an optimist and working harder at a task, your stress hormones may go up. Your immune function may dip a bit. But it's like doing crunches at the gym. Short-term, more crunches hurt. Long-term, you get a big payback in terms of health and fitness. Optimism leads to increased well-being because it leads you to engage actively in life, not because of a miracle happy juice that optimists have and pessimists don't."

Segerstrom herself embodies this principle: She suffered an injury (also involving a horse) that led to unexpected complications, including bursitis and sciatica. "My attitude was, well, somebody has to fix this. So when one doctor couldn't help me, I found another. And I made progress."

Her conclusion? "The more I work on optimism, pessimism, and health, the more I believe optimism's benefits have less to do with mood and much more to do with persistence. The kind of optimism I study is based on a very simple concept: Do you think the future will be mostly good or mostly bad?" If you believe it will be mostly good, says Segerstrom, you'll be motivated to persist through tough times, whether you are naturally cheerful, a worrier, a grump, easygoing, or a bit neurotic.

Optimists' persistence is evident in a study conducted by Lise Solberg Nes, one of Segerstrom's graduate students. Subjects were given a series of anagrams to unscramble. One was impossible and the other 10 were difficult. Pessimists worked on the difficult anagrams an average of 9½ minutes, while optimists worked for an average of 11½ minutes. For the impossible anagram, pessimists worked an average of one minute, while optimists worked twice as long—two minutes.

Faced with a health challenge instead of an anagram, the active, problem-solving approach stands people in good stead. Carol Farran, a professor of nursing at Rush University Medical Center and author of Hope and Hopelessness, was diagnosed with breast cancer 20 years ago at age 42, when her children were in junior high school. Farran had already been conscientious in dealing with two other chronic health problems: endometriosis and fibromyalgia. "For fibromyalgia, I use low doses of antidepressants, massage, and yoga, and I say to myself each day, 'Well, Carol, you can choose to sit around and mope or you can live an active life anyway.' To me, that decision is the axis around which optimism truly turns."

Farran's proactive outlook may have saved her life—it was she who discovered a lentil-size node in her breast. When it turned out to be breast cancer, Farran first suffered crying jags and panic attacks. Shortly after surgery, "I was out with my kids and panicking. We went to a music store, and I got a metronome. Symbolically it was very important. I could set the metronome to whatever speed I wanted, and it reminded me that I could set my life to my own time, fast or slow." Whenever she listened to the metronome, she remembered that it was her choice to reframe and reappraise her life. "It gave a certain meaning to my struggle," she concludes, and it is meaning that helps us regain a sense of control and mastery over our own lives. "You make new choices in life," says Farran. When one goal becomes impossible, the dispositional optimist will find another goal to work toward and bring satisfaction instead.

That ability to reframe life, to find new meaning, is part of an optimistic strategy. "When a crisis strikes," says University of Virginia psychologist Jonathan Haidt, author of The Happiness Hypothesis, "optimists tend to alternate between active coping and reappraisal. If active coping fails to fix the problem, they reappraise the situation, looking for hidden benefits, and, invested with flexibility, write a new chapter for their life." For instance, optimistic patients who received bone-marrow transplants for cancer were able to sustain relationships and re-enter the world more readily than their pessimistic counterparts, largely because they used emotional coping and tried to gain something positive from a generally negative experience. Optimism also predicts whether people will remain actively engaged with life after falling ill. In a study of 250 adults with chronic illnesses such as arthritis and cancer, Farran found that 85 percent had to give up meaningful activities (exercise, gardening, traveling). But the hopeful among them replaced lost activities with new and meaningful ones (playing music, writing, socializing) to remain fulfilled.

The Limits of Optimism

It isn't that optimism stirs up some neurochemical elixir that enhances health. Rather, it mobilizes personal power: Exercising, staying compliant with treatment, getting regular checkups, regrouping to overcome roadblocks—these are the pragmatic things that help keep us well.

Optimism is not a panacea. It can't overcome overwhelming odds—it cannot cure end-stage cancer, or brain diseases like Alzheimer's, or autoimmune diseases like lupus. One telling study looked at lung cancer, which has a high mortality rate because it is often discovered late. More optimists were alive after one year (75 percent of very optimistic folks, compared to only 60 percent of moderately optimistic or pessimistic folks) but by the third year the grim reaper had completely evened out the score, and only 20 to 25 percent of all sufferers were still alive. Similarly, HIV studies are mixed: In one study, optimism did not slow down the decline of special immune cells, while in another, it did and lowered viral load. "The places where we see mixed or no effect in optimism tend to be in populations like those with cancer, HIV, or the elderly," says Segerstrom.

Not only is optimism inadequate to change the course of a lethal illness, but it may, in some situations, be a source of stress. For instance, Segerstrom found that when optimists were exposed to loud noises they couldn't control or were asked to perform tasks that became increasingly difficult, their immune systems became temporarily suppressed in ways that would impair their ability to fight infection. This is due to the conscientious nature of optimists, who try to meet multiple goals, she says.

Why might optimism fail in these challenging circumstances? Perhaps optimists just can't face failure. Some experts argue that although optimists are typically less distressed than pessimists, they might get especially anxious and demoralized when their expectations are dashed and their efforts fail. By this rationale their disappointment leads to negative affect that subsequently decreases immunity.

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.