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Dr. Tomaino's Blog

The Power of Positive Thinking

March 25th, 2012
I have always noted that if I feel “down”, it tends to be accompanied by an increase in my somatic (bodily) complaints. The opposite is true too----if I feel really “up”, the aches and pains of being middle-aged seem to be less obtrusive and distracting. Lots is written nowadays about the relationship between mood and well-being. In medical literature there is increasing evidence of the physical impact of “pain catastrophizing” and depression---which may potentially impact on not only response to pain but also recovery from various illnesses. So too has research associated a positive outlook—Optimism—with recovery.

I had the occasion a couple of months ago to read portions of Sir William Osler’s biography. He is perhaps the most famous physician ever; among other accomplishments, he was revered as a brilliant diagnostician. Unfortunately, when he practiced medicine in the early 20th century, treatments were very limited----Osler has been mythologized in part for his reputed compassion and optimism as he guided his dying patients to the next life, with dignity. Dial forward 100 years, and it seems that our advocacy of “positive outlook” may at times be dismissed as unrealistic, or worse yet, as evidence of not caring or not confronting reality. But once again—there are compelling examples in life of the power of hope----arguably a stronger sentiment than fear.

“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.”

One of Winston Churchill’s most famous quotes suggests that optimists and pessimists have fundamentally different ways of interpreting the world--and research indicates that their ability to cope successfully with adversity differs as a result. Martin Seligman defines optimism as reacting to problems with a sense of confidence and high personal ability. Specifically, optimistic people believe that negative events are temporary, limited in scope (instead of pervading every aspect of a person’s life), and manageable. Of course, optimism, like other psychological states and characteristics, exists on a continuum.

One of the things I’ve been blessed to appreciate over the past several months is that “hopefulness” is a better “medicine” than the alternative. I often say to my patients with persistent pain or loss of function—despite our best efforts to improve things—“Never is a long time---too long to speculate about.” I often reference the movie “Cast Away” with Tom Hanks. He survived only because he lived another day to see what the surf might deliver to him!

Optimism is a learnable skill. Psychologists talk about “explanatory Styles” which reflect three attributions that a person forms about a recent event.
Did it happen because of me (internal) or something or someone else (external)?
Will this always happen to me (stable) or can I change what caused it (unstable)?
Is this something that affects all aspects of my life (pervasive) or was it a solitary occurrence (limited)?

Pessimistic people tend to view problems as internal, unchangeable, and pervasive, whereas optimistic people are the opposite. Pessimism has been linked with depression, stress, and anxiety, whereas optimism has been shown to serve as a protective factor against depression, as well as a number of serious medical problems, including coronary heart disease.

Schou and colleagues (2005) found that a superior “fighting spirit” found in optimists
predicted substantially better quality of life one year after breast cancer surgery. Optimism also predicted less disruption of normal life, distress, and fatigue in one study of women who were undergoing painful treatment for breast cancer (Carver, Lehman, & Antoni, 2003). In this case, optimism appeared to protect against an urge to withdraw from social activities, which may be important for healing. There is also evidence that optimism can protect against the development of chronic diseases. Optimism can have an effect on a person’s immune system, as well. In a study conducted by Segerstrom and Sephton (2010), they examined a sample of law students over five time points in their first year of law school. Dispositional optimism (the tendency to be generally optimistic about your life) and optimism about law school, in particular, were assessed, along with measures of positive and negative affect (to determine whether any relationships between optimism and immune system functioning could be better explained through positive or negative affect). This study found that optimism predicted superior cell-mediated immunity, an important part of the immune system’s response to infectious agents. Furthermore, an individual’s changes in optimism levels from time point to time point were associated with changes in immune functioning: as optimism increased from one time point to another, immune function increased, as well.

The studies described above share a common theme: optimism can have profound effects on a person’s physical health. The mere act of expecting positive outcomes and being hopeful can boost a person’s immune system, protect against harmful behaviors, prevent chronic disease, and help people cope following troubling news.
Furthermore, optimism has been found to correlate positively with life satisfaction and self-esteem (Lucas, Diener, & Suh, 1996). So, in short, it appears as though optimism is a powerful tool in our repertoire; it may help to keep us healthy, happy, and alive. sm makes sense on a number of levels.

This news is great for people who are “natural” optimists, but what about others who don’t generally “look on the bright side”?

This is where my interest in Osler’s talents and style, my personal experiences, and my privilege of being a physician (not just an Orthopaedic Specialist) intersect. The result is not merely my intrigue regarding the power of positive thinking, but also my embrace of its import in treating my patients---not just their painful shoulder, hand or elbow.

An optimist sees the opportunity in every difficulty.



I met a cardiologist today who seemed to embrace this way of thinking. After the exam he noted that my symptoms were typically benign, but in some cases just the emotional reaction of ‘oh no, I’ve got heart problems’ would cause the brain to release adrenaline which could in turn make the problem worse. He explained that by telling me precisely what was going on and emphasizing that it was completely normal, he was circumventing the whole adrenaline release through a negative thought process.
I’m thinking God is really looking out for me by giving me an awesome team of docs to work with!

Keep doing your work as an instrument of His healing.


March 27th, 2012 @ 10:26 pm

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