Is Your Life’s Wine Bottle Half-Full or Half-Empty?

Abstract & commentary

Synopsis: Maruta and colleagues conclude that a pessimistic explanatory style, as measured by the Optimism-Pessimism scale of the MMPI, was significantly associated with increased mortality.

Source: Maruta T, et al. Mayo Clin Proc 2000;75:140-143.

It has been known for many years that animals subjected to unpleasant events that were out their control often demonstrated diminished immune function and an inability to reject implanted tumors.1,2 Anecdotal reports regarding helplessness associated with mortality in humans led researchers to study traits that turned out to be major contributors to helplessness, that is, pessimism and optimism. It was rapidly discovered that pessimistic individuals, that is, those individuals who interpret bad events as permanent and pervasive, became relatively helpless and depressed more easily than did optimists, who would look upon bad events as temporary, controllable, and regionally well defined.

Over the past 25 years, multiple studies have revealed that individuals who are pessimistic regarding life’s events frequently are afflicted with poor physical health,5,6 are prone to depression,7 and are frequent users of both mental health care and medical delivery systems.8 Maruta and colleagues from the Mayo Clinic studied 1145 consecutive patients self-referred to the Mayo Clinic Division of Community Internal Medicine between 1962 and 1965. Each patient was scored using the Optimism-Pessimism (PSM) scale of the Minnesota Multiphasic Personality Inventory (MMPI) and 30 years later the vital status of each of these patients was ascertained in order to determine if pessimism was a risk factor for mortality. Of the 839 patients studied, 124 were classified as optimistic, 518 as mixed, and 197 as pessimistic; at the end of 29 years, 723 were successfully contacted. After adjusting for sex, age, and expected survival, a PSM scale score that was higher by only 10 points (i.e., indicating the individual to be more pessimistic) was associated with a 19% increase in the risk of death. Maruta et al concluded that a pessimistic explanatory style, as measured by the PSM scale of the MMPI, was significantly associated with increased mortality.

COMMENT by Harold L. Karpman, MD, FACC, FACP

The link between mind, body, and mortality has been postulated and supported by philosophers, physicians, and life observers since the time of Plato, who claimed that mind and body are one and indivisible. Even though the exact nature of how the mind influences the body and its functions has not been clearly determined, numerous studies have suggested that the manner in which people attempt to understand or explain the causes of stressful or adverse life events, in particular, if they are subject to a pessimistic explanatory style, can significantly undermine their psychologic and physiologic functioning; in fact, a pessimistic outlook has been clearly demonstrated to adversely affect the course of many illnesses.9 This study is extremely important since Maruta et al were successful in creating a subscale with which they were able to test the long-term effects of pessimism on physical illness and mortality.10 Equally important, they were able to test this subscale analytic technique in a large number of patients who had taken the MMPI at least 29 years earlier. Two hundred deaths occurred among the 723 patients who were able to be contacted and, in this group, there seems to be little question that the mortality rates were significantly increased in the more pessimistic individuals.

Additional long-term studies may be necessary to confirm the findings of Maruta et al; however, even if we assume the data to be accurate, we still have no explanation as to exactly how a pessimistic explanatory mechanism acts as a risk factor for early mortality. Optimists who are less likely to develop depression and learned helplessness have less tendency to self-blame and catastrophic thinking and appear to be more positive in seeking and receiving medical care. It is quite possible that the negative effects of pessimism may increase mortality by decreasing the responsiveness of the immune system. Regardless, if the half-empty bottle manifested by pessimism shortens life and the half-full bottle of optimism prolongs life, it certainly would seem appropriate to attempt to identify pessimistic individuals early on in their lives since aggressive behavioral intervention may be helpful in creating lasting changes in their explanatory style, that is, such intervention may make them less pessimistic. In other words, it may be possible to direct pessimistic individuals into behavioral treatment programs early in their school years since appropriate clinical interventions in the early years may help to move an explanatory style more toward the optimistic pole10,11 and therefore reduce overall mortality. There now appears to be little question that one is much better off with a positive, outgoing optimistic personality—the half-full bottle appears to have won hands down. Hopefully, Maruta et al will soon publish additional papers that will delve into the exact causes of mortality among both the optimistic and pessimistic individuals in somewhat more detail.

References

1. Seligman MEP. Helplessness: On Depression, Development and Death. 2nd ed. New York, NY: WH Freeman; 1992.

2. Peterson C, Maier SF, Seligman MEP. Learned Helplessness: A Theory for the Age of Personal Control. New York, NY: Oxford University Press; 1993.

3. Richter C. Psychosom Med 1957;19:191-198.

4. Engel GL. Ann Intern Med 1971;771-782.

5. Peterson C, et al. J Pers Soc Psychol 1988;55:23-27.

6. Weary G, Stanley MA, Harvey JH. Attribution. New York, NY: Springer-Verlag; 1989:106-147.

7. Seligman ME, et al. J Abnorm Psychol 1979;88:242-247.

8. Peterson C. Congit Ther Res 1988;12:119-132.

9. Levenson JL, Bemis C. Psychosomatics 1991;32:124-132.

10. Buchanan GM, Seligman MEP. Explanatory Style. Hilldale, NJ: L Erlbaum; 1995.

11. Seligman MEP. Learned Optimism. New York, NY: AA Knopf; 1991.

A pessimistic explanatory style, as measured by the Optimism-Pessimism (PSM) scale of the Minnesota Multiphasic Personality Inventory (MMPI) was significantly associated with:

a. decreased mortality.

b. increased mortality.

c. no change in mortality.

d. decreased risk of cancer.