A good piece and some interesting results for mental health
"
A vast scientific literature has detailed how negative emotions harm the
body. Serious, sustained stress or fear can alter biological systems in
a way that, over time, adds up to "wear and tear" and, eventually,
illnesses such as heart disease, stroke, and diabetes. Chronic anger and
anxiety can disrupt cardiac function by changing the heart's electrical
stability, hastening atherosclerosis, and increasing systemic inflammation.
Jack P. Shonkoff, Julius B. Richmond FAMRI Professor of Child Health and
Development at HSPH and at the Harvard Graduate School of Education, and
Professor of Pediatrics at Harvard Medical School, explains that early
childhood "toxic stress"—the sustained activation of the body's stress
response system resulting from such early life experiences as chronic
neglect, exposure to violence, or living alone with a parent suffering
severe mental illness—has harmful effects on the brain and other organ
systems. Among these effects is a hair-trigger physiological response to
stress, which can lead to a faster heart rate, higher blood pressure,
and a jump in stress hormones.
FOCUSING ON THE POSITIVE
"But negative emotions are only one-half of the equation," says Laura
Kubzansky, HSPH associate professor of society, human development, and
health. "It looks like there is a benefit of positive mental health that
goes beyond the fact that you're not depressed. What that is is still a
mystery. But when we understand the set of processes involved, we will
have much more insight into how health works."
Kubzansky is at the forefront of such research. In a 2007 study that
followed more than 6,000 men and women aged 25 to 74 for 20 years, for
example, she found that emotional vitality—a sense of enthusiasm, of
hopefulness, of engagement in life, and the ability to face life's
stresses with emotional balance—appears to reduce the risk of coronary
heart disease. The protective effect was distinct and measurable, even
when taking into account such wholesome behaviors as not smoking and
regular exercise.
Among dozens of published papers, Kubzansky has shown that children who
are able to stay focused on a task and have a more positive outlook at
age 7 report better general health and fewer illnesses 30 years later.
She has found that optimism cuts the risk of coronary heart disease by half.
Kubzansky's methods illustrate the creativity needed to do research at
the novel intersection of experimental psychology and public health. In
the emotional vitality study, for example, she used information that had
originally been collected in the massive National Health and Nutrition
Examination Survey, or NHANES, an ongoing program that assesses the
health and nutritional status of adults and children in the United
States. Starting with the NHANES measure known as the "General
Well-Being Schedule," Kubzansky crafted an adaptation that instead
reflected emotional vitality, and then scientifically validated her new
measure. Her research has also drawn on preexisting data from the
Veterans Administration Normative Aging Study, the National
Collaborative Perinatal Project, and other decades-long prospective studies.
In essence, Kubzansky is leveraging gold-standard epidemiological
methods to ask new public health questions. "I'm being opportunistic,"
she says. "I don't want to wait 30 years for an answer."
STATE OF MIND=STATE OF BODY
Some public health professionals contend that the apparent beneficial
effects of positive emotions do not stem from anything intrinsically
protective in upbeat mind states, but rather from the fact that positive
emotions mark the absence of negative moods and self-destructive habits.
Kubzansky and others disagree. They believe that there is more to the
phenomenon—and that scientists are only beginning to glean the possible
biological, behavioral, and cognitive mechanisms.
Previous work supports this contention. In 1979, Lisa Berkman, director
of the Harvard Center for Population and Development Studies,
co-authored a seminal study of nearly 7,000 adults in Alameda County,
California. Participants who reported fewer social ties at the beginning
of the survey were more than twice as likely to die over the nine-year
follow-up period, an effect unrelated to behaviors such as smoking,
drinking, and physical activity. Social ties included marriage, contact
with friends and relatives, organizational and church membership.
A HAPPINESS POLICY?
If scientists proved unequivocally that positive moods improve health,
would policymakers act? Some observe that, in the U.S., we define
"happiness" in economic terms—the pursuit of material goods. They
contend that even an avalanche of research showing that emotional
well-being protected health would have no traction in the policy world.
Many Americans believe, after all, that people are responsible for their
own lives.
But others see direct policy implications. "In public health, it's
important to understand how we can translate guidelines into behavior,"
notes Eric Rimm, HSPH associate professor in the Departments of
Epidemiology and Nutrition and director of the program in cardiovascular
epidemiology. "Seventy to 80 percent of heart attacks in this country
occur not because of genetics nor through some mysterious causative
factors. It's through lifestyle choices people make: diet, smoking,
exercise. Why are people choosing to do these things? Does mood come
into play?"
The toll of toxic stress goes far beyond poorer health for
individuals—population-wide, the cost of chronic diseases related to
these conditions is enormous. "Imagine if we could enact a policy that
would reduce heart disease by just 1 percent," suggests Shonkoff. "How
many billions of dollars and how many lives would that save? Now what if
we could also reduce diabetes—which is growing in epidemic
proportions—and even stroke?" The point, Shonkoff says, is that society
pays a considerable cost for treating chronic diseases in adulthood, and
reducing toxic stress early in life may actually get out in front of
these diseases to prevent them.
Kubzansky concedes that psychological states such as anxiety or
depression—or happiness and optimism—are forged by both nature and
nurture. "They are 40–50 percent heritable, which means you may be born
with the genetic predisposition. But this also suggests there is a lot
of room to maneuver." Her "dream prevention": instill emotional and
social competence in children—with the help of parents, teachers,
pediatricians, sports coaches, school counselors, mental health
professionals, and policy makers—that would help confer not only good
mental health but also physical resilience for a lifetime.
Even in adulthood, it's not too late to cultivate these qualities, she
says. While psychotherapy or meditation may work for one person, someone
else may prefer faith-based activities, sports, or simply spending time
with friends. "My guess is that many of the people who are chronically
distressed never figured out how to come back from a bad experience,
focus on something different, or change their perspective."
MAPPING HAPPINESS
Drawing on recently compiled data from a nationally representative study
of older adults, Kubzansky is beginning to map what she calls "the
social distribution of well-being." She is working with information
collected on participants' sense of meaning and purpose, life
satisfaction, and positive mood. By tracking how these measures and
health fall out across traditional demographic categories such as race
and ethnicity, education, income, gender, and other categories, she
hopes to understand in a fine-grained way what it is about certain
social environments that confers better frame of mind and better
physical health.
The last thing she wants, Kubzansky says, is for her research to be used
to blame people for not simply being happier—and therefore healthier.
Referring to one of her first major studies, which found a link between
worry and heart disease, she said: "My biggest fear was that journalists
would pick it up and the headlines would be, 'Don't worry, be happy.'
That's useless. Not everyone lives in an environment where you can turn
off worry. When you take this research out of the social context, it has
the potential to be a slippery slope for victim blaming."
BEING IN THE MOMENT
Kubzansky, who is married and has two young children, says her work has
made her think a lot more about finding balance in her own life. To that
end, she says, she recently signed up for a yoga class. She also plays
classical piano—both chamber music with friends and solo hours at the
keyboard for her own enjoyment.
"When I'm playing piano," she explains, "I'm in the moment. I'm not
worrying or thinking or trying to work out a problem. I'm just doing
this thing that takes all my attention."
That insight is also at the center of her research. "Everyone needs to
find a way to be in the moment," she says, "to find a restorative state
that allows them to put down their burdens."
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