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An APS Award Address by Howard S. Friedman
For centuries, medicine has approached illness in the same way, essentially trying to discover the magic bullet that kills the bacteria or halts the growth of the tumor. This approach is rooted in the fundamental question “Why do people become ill?” Howard S. Friedman, the 2008 James McKeen Cattell Fellow Award recipient and Distinguished Professor of Psychology at the University of California, Riverside, has been asking a different question throughout his career. According to Friedman, it isn’t so much determining “why” people become ill but instead “who” becomes ill. In his award address “Psychosocial Models of Longevity: Understanding Health the Terman-ator Way,” delivered at the APS annual meeting, Friedman drove home the notion that “understanding the likelihood of disease for an individual is often as important as knowing the general cause of the disease.” Unfortunately, it’s just not given much attention.
Friedman offers an interesting example of his approach to health: Viagra. When a patient reports symptoms of erectile dysfunction (ED), his doctor will in all likelihood prescribe the little blue pill. But ED also has a strong psychological and social component. These complex interactions go largely unnoticed by those who dictate health policy, a circumstance that Friedman decries. “That’s what happens when sexual function becomes a disease,” says Friedman. “It’s controlled by physicians and health economists and is treated in a cause-effect approach with a pill.”
The fact that effective medical treatments hinge upon psychosocial factors is not breaking news. Research over the past 20 years has established that diseases don’t strike at random. The media has been especially keen on advertising this point. On any given day, you can open the paper to read “tomatoes shown to lower risk of cancer” or “exercisers and church-goers live longer.” But of course, links between health and environmental variables are not so simple. This is where Friedman’s research picks up: He has dedicated much of his career to discovering how, when, where, why, how much, and in what combination health factors harmonize to create or stave off disease.
The only way to do this, says Friedman, is through longitudinal studies to test models of health. Fortunately for him, there was Lewis Terman. Terman’s Life Cycle Study began in 1922 with California elementary school children. He examined these children on a host of physical and psychological factors, following them through adulthood. Eighteen years ago, Friedman picked up where Terman left off, collecting death certificates, validating new measures, and modeling lifelong predictors of health and longevity in what has become the longest study of a single cohort ever conducted (and, in an interesting side note, includes I Love Lucy creator Jess Oppenheimer and former Cattell Fellow Award recipient Lee Cronbach).
Friedman’s exhaustive research has shown there are rarely simple pathways to developing disease. “Investigators might like to find simple, elegant associations to make headlines. The determinants of health and longevity can be understood, but the effects are complicated.”
Among these variables is the personality factor “conscientiousness.” From the Terman data, Friedman has found that the subjects who were high in conscientiousness during childhood had lower mortality rates. It turns out that childhood conscientiousness predicts all causes of mortality and unhealthy mechanisms; things like the ability (or lack thereof) to avoid stressful situations, adult smoking and alcohol consumption, work stability, and life accomplishment. Taken together, these variables have dramatic effects on longevity. Moreover, more conscientious subjects are likely better able to adhere to medical regimens when disease does strike, maximizing the effectiveness of their treatment.
“Marriage,” Friedman notes, is another good example of “the various processes in action.” Marriage has been shown to foster healthy habits for men. But if the relationship becomes sour or ends in divorce, the results can be exceptionally stressful or harmful. Moreover, some individuals (“the conscientious folks,” as Friedman puts it) are simply prone to both good stable marriage and good health. “This is why simple health recommendations (‘get married’) are often misleading or ineffective, and why the same general health advice is not appropriate for everyone,” he says.
But the old cause-and-effect models may be going the way of the dodo bird, says Friedman. “Modern psychological conceptions of personality and individual differences are already addressing many of the limitations of old conceptions of health, including changes as a function of maturation, environmental press, situation selection, and culture. We ultimately want to be able to intervene. To do so we need to utilize more complete, lifelong models of health.”
And psychology will undoubtedly be a part of this puzzle, complementing biology and epidemiology in order to truly understand and promote health and longevity.
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