As if I needed another reason to love Barbara Ehrenreich

Writing for HuffPo, Charlottesville's own Barbara Ehrenreich takes on positive psychology. I have to remember to drop by sometime with a cake and welcome her to the city, even if it is a year too late.

She addresses something very annoying about the belief that positive thinking is a universal good (and provides a backhanded slap to Depeak Chopra and "the Secret"), that there isn't much proof that it really works - at least not in situations of ongoing stress. Further, a more insidious aspect of the emphasis on positive thinking is a blame-the-victim mentality inherent in its proponents.

The perennial temptation to blame disease on sin or at least some grave moral failing just took another hit. A major new study shows that women on a virtuous low fat diet with an extraordinary abundance of fruits and veggies were no less likely to die of breast cancer than women who grazed more freely. Media around the world have picked up on the finding, cautioning, prudishly, that you can't beat breast cancer with cheeseburgers and beer.

Another "null result" in cancer studies -- i.e., one showing that a suspected correlation isn't there -- has received a lot less attention. In the May issue of Psychological Bulletin, James Coyne and his colleagues at the University of Pennsylvania reported that "there is no compelling evidence linking psychotherapy or support groups with survival among cancer patients." This flies in the face of the received wisdom that any sufficiently sunny-tempered person can beat cancer simply with a "positive attitude."

Then, Chopra gets a snub:

So far no one appears to have read Coyne's study. On June 30, a month after its publication, all-purpose guru Deepak Chopra assured Sanjay Gupta on CNN that the mind can control the body: "...You know, of course, the ... study where women who supported each other in a loving environment with breast cancer the survival doubled." Gupta, last sighted seeking to discredit Michael Moore's SiCKO with his "fact-checking," simply nodded, although the study Chopra was referring to was discredited years before Coyne's research came out.

For the last decade or so, adherents of the new discipline of "positive psychology" have been insisting that not just cancer, but almost any health setback, can be conquered with optimism or a "positive attitude." But as Coyne and other critics point out, the science here is shaky at best. Even the theoretical linch-pin of the supposed happy-mind-healthy-body connection -- that a positive outlook strengthens the immune system -- took a kick in the teeth two years ago when Suzanne Segerstrom at the University of Kentucky found, to her own apparent surprise, that optimism can have a negative effect on the immune system when the stressors are intense, as in the case of serious disease.

Quite true. Segerstrom's review on the topic is interesting. It suggests mixed benefits to optimism, in some situations it helps, sometimes it appears to be detrimental. In particular, optimists seem to do well with temporary stresses, lasting a week, but if a stress is prolonged, they do worse - possibly due to circumstances creating a big conflict with their personality. Segerstrom's "engagement" hypothesis is that in the face of an ongoing stressor, the optimist doesn't give up early enough, which would allow to accept their fate and decrease engagement with stressors. I recommend reading the paper if you've got a subscription, it's really very interesting.

The only point on which I disagree with Ehrenreich's is her characterization of HRT being "pushed" as something negative. One of the problems with science is that you work with the data that you have. HRT did have many positive and beneficial effects and earlier studies didn't show the breast cancer risk.

TheWomen's Health Initiative study came along and showed that along with those benefits came a small but significant increased risk of breast cancer and stroke with one type of HRT (with reductions in risks of some other diseases and no difference in overall mortality). I'd say there is still room for debate over the positive and negative aspects of HRT and there always is the possibility one day we'll develop a specific estrogen that has the benefits of HRT without increasing other risk factors. Also, there is a benefit for certain women for whom the relative risks don't outweigh the benefits. The Relative Risk was 1.26, or and incidence of breast cancer 26% more than one would expect, another example of a RR less than 2 that is important because of the power of the study.

Anyway, back to the point. Barbara Ehrenreich rocks.

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Aaarrgh! I just wrote a long post, and then the electronic gremlins ate it.

Short version: The 'optimism' ideology that dominates much of psych is a crock of unrealistic sh*t, and is little more than a blame-the-patient, get-out-of-jail-free card for psychs' failure to deliver a solid result. 'Optimism' studies are methodologically weak, stuffed full of untested abitrary assumptions, and of little practical clinical benefit. No respect for it at all.

Bah, humbug.

Thanks to MarkH for putting up your post. This is an issue that has to be more critically and widely discussed.

By Obdulantist (not verified) on 20 Jul 2007 #permalink

This is an excellent post. I agree this issue does need to be more critically and widely discussed.

The reason that optimism is sometimes helpful is due to the placebo effect, which I have written a blog about.

http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

During an acute episode of stress, be that disease, danger, toxin exposure, or trauma, the body responds in characteristic ways that are called "stress responses". Those are adaptive responses that allow one to better cope with what ever "stress" is occuring. However, all of those stress responses have long term adverse effects (if they didn't, then organisms would evolve to be in those states continuously). Optimum health requires invoking those stress responses quickly and appropriately, and then de-invoking them when the stressor has passed.

That is what the placebo effect is, a neurogenic mechanism for de-invoking the stress response(s). If you don't invoke the stress response, or de-invoke it too quickly, you do not respond as effectively to the stressor.

A major stress response is the shifting of metabolic resources away from normal cellular repair funtions and into immediate "fight or flight" activities, the "running from a bear" example I use. Shutting down the immune system while running from a bear gives you a few more molecules of ATP, and if that is enough to save you from the bear, it is worth it, even if it increases the risk of infection or cancer later. But what ever systems do get shut down in an emergency need to be brought back online ASAP afterward.

In one of the examples I give, a nocebo, (a pharmacologically inactive substance thought to produce a worsening of a symptom) can actually make that symptom better. In the case of nausea, a nocebo (something said to make the nausea worse) actually makes it better, where a placebo (something said to make it better) actually makes it worse. I attribute this to nitric oxide physiology, and the placebo/nocebo effects being mediated by high/low nitric oxide levels respectively. The enteric nervous system is nitrergic, and so more NO makes it more active exacerbating nausea.

Inapropriate optimistism keeps one from responding appropriately. If your physiology is not responding appropriately, you are not going to be as healthy as if it is. There is no secret about that.

And that's why I've not given any credence to anything Sanjay Gupta says for years now. I wanted to like him. He's got a cool name and every time I see him I think of Oscar Nuñez.

But, Sanjay Gupta is just a crappy journalist.

According to Wikipedia, Mike (Hi!), it's cell biology, 1968, Rockefeller University. I didn't know that, so now I admire her all the more.

Y-ellow fellow mutating life forms.
I feel thoroughly vindicated in starting my cult all those years ago. It's called "The cult of not giving a shit." (I could probably think of a better name but I couldn't give a shit.) After experiencing years of radical, painful and even experimental medical trauma, I simply stopped giving a shit. And it works. Guaranteed or triple your money back. Hey. I'm still here aren't I? Or am I just being existential? But anyway, now I have the scientific data to back it up.

Wasn't there a study recently that showed that negative thinking had better over all outcomes than positive thinking? As I recall it went something like.

"Look out for that bus!"
"What bus?"
SPLAT!

IE: IF a positive thinker sees a bear, maybe it won't attack them. Maybe it's friendly? Maybe it just wants a hug? If a negative thinker sees a bear, maybe it will tear them apart and the art of scampering up the nearest vertical cliff face might be a real good idea. Survivability then becomes a contest between the ability to hug wild animals and the ability to ascend vertical cliff faces. I know which one I'd put my research dollar on.

The study suggested that in evolutionary terms that negative thinking was a far better survival trate. Those who thought negatively were more likely to see a threat and reason it's outcome before the rest of the "group" and thus be an early warning system.

If someone remembers what this study was I'd be most interested.

On the other hand, I've had limited success with positive thinking. Only the other day I grew an extra testicle. There IS however, a downside to this so I thought about growing an extra penis next. But then I thought, why not go all the way and grow a vagina? So if you'd all like to prey for me, it would be a great help.

Now I'm late for my walking on water practice.

Be absolutely Icebox.
Batz.

Waitaminnit! After more than a century of entirely defining psychology in terms of disease with no corresponding theory of psychological health, there is actually a (rather young-ish) scientific approach to understanding healthy psychological functioning which goes by the name of "positive psychology." Why are the woo-peddlars being allowed to co-opt the name and obscure the work of respectable researches trying to correct a major problem in the underpinnings of clinical psychology.

Don't believe it's a real problem? Consider medical diagnostics: It isn't just a series of abstract tests which determine an average blood pressure, white blood cell count, internal body temperature, etc. and define illnesses simply by whether and how a person deviates from that consistently measurable (but not truly understood) average. There are rich explanations for why a given blood pressure or WBC is within the healthy range for a person of a given gender/size/age - an explanatory, coherent theory of healthy functioning, of homeostasis - accompanied by accounts of how various sorts of pathogens or diseases disrupt those balances.

Then look a the DSM, any version. Compare and contrast.

'Nuff said.