Up: How Positive Outlook Can Transform Our Health and Aging - Couverture rigide

Couverture rigide

ISBN 10 : 1410463060 ISBN 13 : 9781410463067

Synopsis

An NIH-funded researcher and practicing physician draws on research and clinical experience to demonstrate how one's life outlook can significantly impact the aging experience, revealing how to make key adjustments in attitude and perspective to promote health. (health & fitness).

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1

How Our Outlook Drives Our Health and Aging

“I wonder how many times you almost died?” my father asked me while we waited for our food at the Greek diner Salonica on Fifty-seventh Street, at the edge of the University of Chicago campus. In my third year of college, a previously undiagnosed congenital heart condition came crashing into my life and set me on a path to explore the attitudes that I now view as some of the most basic building blocks of health and disease. The gravity of my condition crystallized during the first week after successful cardiac surgery, and my father finally felt safe enough to pose this obvious question. There had been several times during my childhood when I had come close to collapsing, but every one of these mishaps had followed episodes of intense exertion, like running a three-hundred yard dash in grade school or climbing out of the Grand Canyon as a high school student. Consequently, I had always passed them off as “overdoing it,” and sometimes didn’t even mention them to anyone. My dad and I reflected on the events of the past few months: The previous summer, my energy level had inexplicably taken a dive. One Sunday morning while having dim sum with friends in Chinatown, I had dropped a full glass of water—completely forgetting that my hand was supposed to be holding it—sending it clanking over the porcelain dishes and dumplings and shattering on the floor. I had even fallen asleep during my medical school entrance exams, waking up drooling over the biology section.

Having scarcely completed adolescence, it did not even occur to me that there could be something really wrong. But after several weeks involving similar incidents, I thought I may have mononucleosis and finally made an appointment at the student health center. After hearing my story, the internist detected a loud heart murmur and immediately shipped me off to get a cardiac ultrasound. In the dark, quiet viewing rooms of the echocardiography suite, there were raised eyebrows as successively senior cardiologists were called in to help interpret the results. I looked at the shadowy pictures of my beating chambers with suspense and intrigue, as if they were part of an exciting movie. Not until years later would I realize that my state of general wonder throughout this process—peppered though it was with fear and doubt—would help preserve my sanity through the events that followed. I did not yet know how to read an echocardiogram, and could not discern the mass of tissue in the middle of the heart chamber called the left ventricle. The mass was partially attached to the mitral valve—the valve bisecting the left atrium (top chamber) and the left ventricle (bottom chamber). The walls of the left ventricle had become hypertrophied, or thickened, because of the very high pressure required to pump blood through the mass and out to the rest of my body. My heart had reached a point where it was simply no longer able to perform. I needed major surgery as soon as possible.

After the initial shock and uncertainty, I became “the little patient that could.” I put the surgery date on my calendar and told my relatives, friends, professors, and classmates. I met with my cardiac surgeon, the late Dr. Robert Karp, and asked him a list of twenty-two questions I had typed out on my PC, everything from how long the surgery would take (two to three hours) to the likelihood of dying on the table (5 percent or less). My final question—“Is there anything that I can do as a patient to make your job as a doctor easier?”—produced the first grin I’d seen on him yet. “You already have,” he told me. I didn’t catch his meaning then, but now as a practicing physician I know what it’s like to work with a genuinely motivated patient, and I understand why he smiled at me. My upbeat attitude made me an easier patient to treat, someone willing to adhere to his medical advice and to do my part to attain the best possible outcome. That didn’t mean I wasn’t afraid. In fact, my concern about dying on the table prompted a couple of urgent visits to student mental health services: I didn’t want to go to my grave with too much unfinished business. Within a couple of weeks I was on the operating table while Dr. Karp cut open my left atrium, reached across my mitral valve, and sliced away the offending blob.

After a brief ICU stay and four more days on the cardiac floor, I walked out of the hospital into a sharp Chicago December wind, leaning half of my body weight on each of my parents. Now on the mend, with a fresh scar traversing my chest, I basked in the warmth of my circumstances—hot Greek food, the love of my mom and dad, support of friends and professors, and the impeccable skill of my surgeon and his team, all culminating in the miracle of my being able to sit up without assistance. I had been given a second chance, and I was ecstatic to be alive.

The very experience of having felt so weak after surgery, in which it took real effort on some mornings to even hold my head up, allowed me a glimpse of frailty that most twenty-year-olds never get. Ironically, feeling close to my own mortality provided a rare and valuable reference point that only bolstered my hopefulness. During open heart surgery, my heart stopped beating for two hours on bypass, but I woke up—knowing that every day is a gift and that it is possible to overcome the most dire of situations. Looking back twenty years later from the vantage point of an NIH-funded academic physician, wife, and mother, I realize now it was the first time a serious situation had forced my “outlook” hand, and, instinctively, I played the hope card. This somewhat unconscious act, as well as the positive outcome itself—a 360-degree spin from healthy young woman to invalid and back again—began the evolution of the can-do attitude that often becomes my default. This outlook kicks in at two a.m., overriding all circadian rhythms, when I’m on call and paged to the bedside of a patient who has just gone into cardiac arrest. It helps me visualize an ill person becoming well again, even before he heals, because having witnessed the “other side,” I know what proper care and tending can do for the human body. Above all, it fans the voice inside my head that declares things will eventually change, often for the better, even when the specifics remain uncertain.

Our outlook—a term I have chosen to describe our unique patterns of thinking, feeling, and interacting with ourselves and with the world—fundamentally impacts our health and aging. Outlook encompasses our personality, character traits, general disposition, and attitudes, all of which are words used by researchers and clinicians to describe our psychological makeup. While I use many of these terms interchangeably, I decided on the umbrella term outlook for several reasons. First, we can relate to it on a gut level: Our outlook is the lens through which we view the world. Unlike other terms, which carry connotations of permanence, outlook allows for the possibility of something new—as in “gain a new outlook on life.” This is key, because Up is not an academic discussion of the psychological underpinnings of aging, although I do include as much of the research as I can fit in. Up invites you to take a personal inventory—and, if necessary, to make changes geared toward maximizing your health at any age.

When we deconstruct our outlook into its nuts and bolts—the unique patterns of thinking and feeling that drive so much of our lives—we begin to see it from a different perspective. We begin to see not only why our outlook may lead us to decisions and behaviors but also where we may want to tweak it in the service of our own healthy aging, and how to undertake this change. Our outlook, research shows, has the potential to influence every facet of our health, from how quickly we recover from an illness or surgery to whether we become depressed, develop cardiovascular risk factors, or suffer a heart attack, stroke, or cancer, and even how well we care for ourselves when our health begins to break down.

Aspects of outlook—such as the character trait of optimism, defined by research psychologists as the general expectation of good things to come—have also been linked to longevity. Results from a study my colleagues and I published in the journal Circulation (August 2009) on almost one hundred thousand American women showed that middle-aged and older female optimists, compared with pessimists (people who have a generally negative expectation of the future), were less likely to smoke or have diabetes, high cholesterol, high blood pressure, symptoms of depression, and obesity; they were also more physically active. Optimists lived healthier and longer lives than pessimists, exhibiting a 16 percent lower risk of a first heart attack and a 30 percent lower risk of death from heart disease by the end of the study. In these same women we studied another character trait, called cynical hostility, which is a type of anger involving a deep mistrust of other people. This mistrust stems from the belief that most people are selfish, dishonest, and unworthy. Women who had the highest levels of cynical hostility, compared with those with the lowest levels, were 16 percent more likely to die over eight years of study follow-up.

My research joins the growing ranks of findings from around the world that point in the same direction: A positive outlook is good medicine. Two decades of clinical practice as an internist have brought me to the same conclusion, demonstrating repeatedly how outlook provides some people with the gumption to seize opportunities, and in other cases seems to sabotage any hope of healing. In fact, very soon after I began my formal research training, I realized that the body of evidence was pointing to something bigger than any one disease or any one subgroup of patients. Everyone owns an outlook. And the truth is, we may have more control over our outlook than anything else. My clinical practice and early research

spurred me to ask some pivotal questions that hold the promise of an exciting new reason to look up: If our outlook is associated with a higher risk of aging-related diseases such as heart attack, stroke, cancer, and death itself, is it associated with aging, period? Does an unhealthy outlook make us older faster? And does a healthy outlook actually keep us physiologically younger?

The Science of Outlook and Aging

Aging has become a loaded term these days—walk into any mall or search the Internet and you’ll be greeted with a dizzying array of antiaging products purporting to turn back the clock and make you look and feel younger. But in strictly medical terms, healthy aging is defined as growing older while steering clear of mental and physical disability, and the field has become a major medical frontier. In fact, aging experts now have a term for living healthily to a ripe old age: compression of morbidity. What it means is that, ideally, we “compress” as much of our disease and disability as possible into the very last little bit of our life, so that we remain lucid and able-bodied enough to enjoy as much time as we can prior to our demise. Or as my colleagues who are aging experts say, “Live a long and healthy life—then fall off the cliff.” Following this advice means paying as much attention, if not more, to our health span as to our life span.

So aging is much broader than the white-haired, wrinkled, cane-toting physical and mental debility most people associate with “getting old.” The process actually takes place on multiple levels, every second of every day. For simplicity’s sake, we can divide aging into three main categories: visible outward changes such as wrinkles and stooped posture; telltale variations in our organs such as atrophy of the brain, meaning loss of neurons; and microscopic changes within the cells that comprise each of our organs. Keep in mind that the full scope of aging is a more complex process that scientists still don’t fully understand, although breakthroughs are happening every day. These levels are all related: Our cellular age influences the age of our organs, which in turn influences our overall biological age. And here’s the rub: Research links our outlook to all levels of aging—from cells to organs to the whole person. What’s more, we see these connections across all age groups, from children to older adults.

In addition to my own work showing that optimists have fewer heart attacks and live longer—and that cynical women die sooner— other researchers have found that a high degree of anger also predicts early heart disease. Many of these studies, including mine, have been able to observe people for five to ten or more years, while others, such as The Longevity Project: Surprising Discoveries for Health and Long Life from the Landmark Eight-Decade Study, coauthored by Drs. Howard Friedman and Leslie Martin, followed people from early childhood over their lifetime. The most exciting finding of that study was that conscientious kids, defined as those who are dependable and goal oriented, live longer than kids who are less conscientious, corroborating similar results from other populations.

Outlook is even associated with preclinical changes in our cardiovascular system, meaning changes that are evident on testing even before we have symptoms or a major clinical event, such as a heart attack. One of my colleagues and mentors, Dr. Karen Matthews, Distinguished Professor of Psychiatry at the University of Pittsburgh, has helped shape our current understanding of how aspects of outlook, including cynical hostility, influence our risk of cardiovascular disease in adulthood, even while we are still relatively young adults. For example, in one large study of healthy men and women who were between eighteen and thirty years old when they joined, Dr. Matthews and other researchers found that people with a high degree of cynical hostility had greater coronary artery calcification, a sign of atherosclerosis—pathological narrowing of blood vessels—and a harbinger of risk for future heart attack. In a related study, young adults with a higher degree of cynical hostility were more likely than less hostile people to develop high blood pressure in the first place, indicating that unwanted cardiovascular changes were happening earlier in their bodies.

Facets of outlook also predict the development of other major physical and mental health conditions, including dementia. I worked with Dr. Ben Chapman, Dr. Paul Duberstein, and colleagues to show that older adults who are highly conscientious are less likely to develop memory problems and dementia as they age, while neurotic individuals—those who have high levels of emotional distress—are more likely than their less neurotic counterparts to suffer dementia. To look more closely at outlook and brain health, I am currently leading a study (forthcoming this year) analyzing the brains of more than fourteen hundred postmenopausal women who have undergone structural magnetic resonance imaging (MRI). Because optimists tend to have healthier physical and mental health profiles, we expect to find that they will have larger frontal gray matter than the pessimists. ...

Revue de presse

"The latest scientific research confirms that developing a sense that you can make things better in the future is a key first step to improved health. The trick is how to do this. Up is Dr. Hilary Tindle's excellent guide to making the turn to that important new direction. It's a path not only to better health but to a happier life."—Howard S. Friedman, author of The Longevity Project
 
"A wonderfully written, wise, and ultimately practical book for helping people age in a meaningful and healthy manner.  Full of personal examples, exercises, and easy-to-digest research findings, Up will help you understand how powerfully a positive and accepting attitude can impact your body and mind."—Kristin Neff, PhD, author of Self-Compassion
 
“In this groundbreaking book, Dr. Hilary Tindle takes us on a fascinating journey to a hidden spring of health and longevity—our attitude or outlook. Up reveals that we have the power to change our outlook to become more positive (and realistic!). Dr. Tindle makes the case with compelling scientific evidence and delightful stories, and offers practical strategies for moving ourselves in the right direction. This intelligent, warmhearted book will help you gently take back control of your own health and wellbeing.”—Christopher Germer, PhD, author of The Mindful Path to Self-Compassion
 
“Up is as hopeful as it is helpful...Dr. Tindle reminds us that the power to substantially improve our health and longevity is in our own hands...Even if you think you are already an optimist, read this book: you may discover that you’re struggling at maintaining your mindset and learn what to do about it. If you’re feeling pessimistic, it will certainly uplift your mind and body. Skeptics too will learn from Up’s incisive arguments about how your thinking can transform your well-being.”—Michael V. Pantalon, author of Instant Influence
 
“Up is a timely and fascinating book that teaches everyone about how crucial optimism is and how to create it in your own brain and your own life...This book is essential for everyone, optimists and pessimists alike.”—Andrew Newberg, author of Words Can Change Your Brain
 
"A must-read for anyone interested in how our attitudes and world view can impact our health. Dr. Tindle's style is very engaging, and the book is rich with examples from her own practice while staying true to the underlying science. I highly recommend it."—Michael F. Scheier, Professor and Head, Department of Psychology, Carnegie Mellon University

Détails de l'édition

• Langue: anglais
• ISBN 10: 1410463060
• ISBN 13: 9781410463067
• Reliure: Relié
• Nombre de pages: 411
• Coordonnées du fabricant: non disponible
• Personne responsable: non disponible