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Reimagining Health--Flourishing

We learned about this cutting-edge commentary from psychology professor Richard Winett's Master Trainer health letter.

In 2016, Harvard University began a Human Flourishing Program. Now Tyler J. VandanderWeele, PhD, and two other Harvard professors have published Reimagining Health--Flourishing in JAMA (online April 1, 2019) proposing a Flourishing Scale to broaden the concept of health beyond risk factors such as blood pressure and absence of disease to include flourishing or emotional well-being: "Being happy, having meaning and purpose, being 'a good person,' and having fulfilling relationships."

This is an expansion of the Positive Psychology movement spearheaded by psychology professor Martin E. P. Seligman, PhD. (We first wrote about positive psychology in The Lean Advantage 3, published in 1994.)

Pessimists, according to Seligman, respond with helplessness; they give up. Optimists, on the other hand, persevere--and have better immune activity. A big leg-up on health.

Most of us learn to be optimists or pessimists in childhood and adolescence, and then, for good or bad, we carry this basic attitude throughout life. It doesn't have to be that way, according to Professor Seligman, a negative orientation can be changed to positive.

*  *  *

In 1965, Seligman, while a graduate student in the department of experimental psychology at the University of Pennsylvania, performed the first experiment showing that animals can be taught helplessness. One group of dogs was given escapable shock. By pushing a panel with its nose, a dog in that group could turn off the shock. The dog had control because it could escape the shock. A second group of dogs was given exactly the same shocks as the first, but no response they made had any effect. They had no control; they couldn't escape.

Once the dogs went through the experiment, each was put in a large box with two compartments, separated by a low wall. In the first compartment they received a shock, but they could easily escape the shock by jumping over the barrier into the other side of the box.

Within seconds the dogs that had been taught to control shocks discovered that they could jump over the barrier and escape. The dogs that earlier had received no shocks discovered the same thing, also in a matter of seconds. But the dogs who had found that nothing they did mattered made no effort to escape, even though they could easily see over the low barrier to the shockless zone of the box.

Those dogs just gave up and lay down, even thought they were being regularly shocked by the box. They never found that they could easily escape. Those dogs had learned that they had no control, that they were helpless.

It turns out that learned helplessness has far-reaching effects. In 1977, Madelon Visintainer, one of Seligman's graduate students, performed an experiment showing how mastery and helplessness affect health. She put three groups of rats through the same shock experiment as Seligman had with the dogs, but with an important addition. The day before the experiment she implanted a few cancer cells on each rat's flank. Under normal conditions, 50% of the rats would reject the cancer cells and live. As expected, 50% of the rats who were not shocked had died, and the other half had rejected the tumor. Of the rats who were allowed to escape the shock by pressing a bar, the rats who had learned mastery, 70% rejected the tumor. But only 27% of the helpless rats, the rats who had experienced uncontrollable shock, rejected the cancer cells.

In short Visintainer became the first person to demonstrate that the psychological state of helplessness produces a more rapid growth of cancer. She also showed that the psychological state of mastery enhances the ability to reject the tumor. And that's not all. Visintainer went on to demonstrate that the rats who had experienced mastery when young were better protected against tumors as adults.

Seligman says it works the same way in humans. Researchers at Yale found that elderly people in nursing homes were not only happier when they were given greater control over the daily happenings in their lives, but they also lived longer. As noted earlier, optimists have better immune activity than pessimists. For example, Seligman and his colleagues taught learned optimism to 40 cancer patients and produced a very sharp increase in the activity of natural killer cells, the cells that kill foreign invaders in the body, such a viruses, bacteria and tumor cells.

Fast forward to the present day.

Professor Seligman now believes that positive psychology is well-being, that the gold standard for measuring well-being is flourishing, and that the goal of positive psychology is to increase flourishing. His latest book is Flourish (Simon & Schuster, Atria Paperback, 2013). See https://www.cbass.com/FlourishOptimismHealth.htm.

I don't pretend to know the whole story, but it appears that Harvard has jumped on the band wagon, studying and advancing the concept of human flourishing.

The View From Harvard

The mission of Harvard's Human Flourishing Program is to bring together various academic fields on topics fundamental to human flourishing and to produce educational and other programs to facilitate human flourishing. The Reimagining Health commentary proposing the Flourishing Scale fits the bill, although it isn't specifically presented as a product of the program. (Dr. VandanderWeele is listed as part of the Harvard T. H. Chan School of Public Health and the Human Flourishing Program.) 

The commentary tells us that clinicians currently apply a "deficits" framework to define health. Factors such as normal blood pressure and glucose levels along with an absence of disease are seen as constituting health. 

VandanderWeele and colleagues broaden that framework to include well-being.

"A patient cares not only about physical health and test results within normal limits, but also more broadly about being happy, having meaning and purpose, being a 'good person,' and having fulfilling relationships."

In addition to those factors, their scale asks how you rate your mental and physical health, and your financial stability.

VandanderWeele and colleagues concluded:

The concept of flourishing has the potential to capture health more broadly than existing wellness measures for both patients and populations. Asking questions related to flourishing can inform and refine many complex trade-offs for patients facing treatment decisions. The concept can potentially guide clinicians in assessing their own personal well-being as well as delivering better patient-centered care. At the population level, too, attention to flourishing may present a more useful way to address policy and societal goals and current options. Such an approach could open a national conversation that reframes and reimagines traditional concepts of health. 

My Take

My life is an example of the power of positive psychology--flourishing.

"I do not believe that you should devote overly much effort to correcting your weakness," Professor Seligman wrote in Authentic Happiness (Free Press, 2002). "Rather, I believe that the highest success in living and the deepest emotional satisfaction comes from building and using your signature strengths."

While I didn't realize it until years later, that's the path I have taken. I have optimized my mental and physical strengths and skirted my weaknesses.

My early success in weight training set the stage for the rest of my life. That and winning the state championship in the Pentathlon as a junior in High School taught me that setting realistic goals and working hard gave me the power to shape the course of my life. Optimism has guided my life. See Outlook Matters--My Story: https://www.cbass.com/outlookmatters.htm

This grainy photo of me with the Pentathlon trophy appeared on our Sports page with the caption "Bass is strongest."

As indicated above, Professor Seligman has developed methods--to help pessimists become more optimistic--which may help clinicians "treat" negative ratings on the Flourishing Scale.

Hurricane at 103

The power of positive thinking was on display in Albuquerque at the 2019 National Senior Games--in the form of 103-year-old Julia "Hurricane" Hawkins. Her events are the 50 meters, 100 meters, and shot put. She holds the world record for her age group at 100 meters.

She says staying active and positive thinking keep her going strong.

She told the Albuquerque Journal she always thought it would it would be fun to run the 100 meters at 100 years old.

"Maybe I'll retire now--or maybe not," she said after winning the gold medal with a time a little over her record. "In two years I might be ready for the next one."

"As you get older you need challenges," she explained.

Like Clint Eastwood, she's not ready to let the old person in.

*  *  *

Whether or not that uplifting attitude can be taught, it seems clear that the Flourishing Scale will help clinicians go beyond the "deficits" and include well-being in the patient-care mix. Treat the whole person.

Clearly a positive step forward. 

July 1, 2019

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