摩顶平
APPLIED PSYCHOLOGY: AN INTERNATIONAL REVIEW, 2008, 57, 3–18
doi: 10.1111/j.1464-0597.2008.00351.x
Positive Health
Martin E.P. Seligman*
University of Pennsylvania, USA
I propo a new field: positive health. Positive health describes a state beyond
the mere abnce of dia and is definable and measurable. Positive health can be operationalid by a combination of excellent status on biological, subjective, and functional measures. By mining existing longitudinal studies, we can test the hypothesis that positive health predicts incread longevity (correcting for quality of life), decread health costs, better mental health in aging, and bette
r prognosis when illness strikes. Tho aspects of positive health which specifically predict the outcomes then become targets for new interventions and refinements of protocol. I propo that the field of positive health has direct parallels to the field of positive psychology, parallels that suggest that a focus on health rather than illness will be cost saving and life saving. Finally, I suggest a different mode of science, the Copenhagen-Medici model, ud to found positive psychology, as an appropriate way of beginning the flagship explorations for positive health.
Je propo de créer un nouveau domaine d’investigations: la santé positive.
La santé positive désigne une condition définissable et mesurable qui situe au-delà de la simple abnce de maladie. Elle peut être opérationnalisée par une combinaison de scores excellents sur les dimensions biologiques, subjectives et fonctionnelles. On peut, sur la ba des études longitudinales existantes, mettre à l’épreuve l’hypothè que la santé positive annonce une longévité accrue (ce qui renvoie à la qualité de vie), une réduction des coûts liés à la santé, une meilleure santé mentale lors du vieillisment et un pronostic plus favorable en cas de maladie. Ces facettes de la santé positive qui prédint spécifiquement de telles conséquences deviennent des objectifs pour de nouvelles interventions et une amélioration du protocole. Je pen que le domaine de la santé positive est en liaison directe avec celui de la psychologie positive, liens qui suggèrent que le f
ait de focalir sur la santéplutôt que sur la maladie réduira les coûts tout en allongeant la vie. J’introduis en dernière analy un nouveau type de connaissance, le modèle Copenhague-Médicis, utilisé pour fonder la psychologie positive, comme outil pertinent pour initier des travaux majeurs pour la promotion de la santé positive.
* Address for correspondence: Martin E.P. Seligman, Positive Psychology Center, 3701 Market Street, Suite 200, Philadelphia, PA 19103, USA. Email: ligman@psych.upenn.edu This rearch was supported by grant no. 11286 from the John Templeton Foundation. I would like to thank Helene Finizio, Arthur Barksy, Christopher Peterson, Paul Tarini, George Vaillant, and James Fries for their help on this manuscript.
4SELIGMAN
INTRODUCTION
Health is a state of complete positive physical, mental, and social well-being and not merely the abnce of dia or infirmity. (Preamble to the Constitu-tion of the World Health Organization, 1946)
The mere abnce of dia is often taken to be equivalent to health. Disclaimers such as WHO’s above, tho in the charter of the National Institute of Health, and on the wall at the entrance of Robert Wood Johnson health-care oriented Foundation’s headquarters in Princeton notwithstanding, a scientific discipline of health—beyond the mere abnce of dia—barely exists. This paper is the call to such a discipline.
In this paper, I first discuss the rationale for positive health, grounded as it is in the field of positive psychology. I then outline the parallel conceptual framework within which positive health can be defined and operationalid. Thereupon I discuss the predictions—incread longevity, decread health costs, better mental health, and better prognosis—that follow from this framework and the flagship activities for testing the predictions empiri-cally. I then suggest a different scientific structure, the Copenhagen-Medici model for carrying out the studies expediently. I conclude with the potential novel and inexpensive interventions that successful prediction would entail.
RATIONALE
I was elected President-elect of the American Psychological Association in 1996. As I surveyed a century of accomplishments (and their lacunae), I argued that psychology and psychiatry had done r
easonably well with mental illness: suffering, victims, depression, anger, substance abu, and anxiety. But they had done very poorly with mental health: positive emotion, engage-ment, purpo, positive relationships, and positive accomplishment.
And it was clear that mental health was not the mere abnce of mental illness. Clinically, the positive states of mental health did not reliably ensue when the disorders ended, and statistically, the correlation between “happi-ness” and depression is not clo to what Freud and Schopenhauer (the best human beings can ever hope for is the abnce of miry) would expect—minus 1.0. Rather it is clor to minus 0.35. The mental disorders, in short, somewhat impede, but do not remotely preclude, positive emotion, engage-ment, purpo, positive relationships, and positive accomplishment (Haidt, 2006; Lyubomirsky, 2007; Seligman, 2002).
菊花的作文怎么写
Why, however, in a world of suffering should one bother to work on mental health, well-being, and happiness in the first place? Perhaps, in a few hundred years when AIDS and Alzheimer’s dia and suicide are all con-quered, we should then turn science to the enabling of well-being. Surely
POSITIVE HEALTH5 suffering trumps happiness, both in the priority for brains and for funding. There are two good reasons why this is wrong. The first is obvious: People desire well-being in its o
wn right, and they desire it above and beyond the relief of their suffering. The cond is less obvious: Bringing about well-being —positive emotion, engagement, purpo, positive relationships, positive accomplishment—may be one of our best weapons against mental disorder. This is testable, and a substantial body of rearch, the best of it using prospective, random assignment, and placebo controlled designs, now suggests that interventions that build the positive states alleviate depression (Seligman, Rashid, & Parks, 2006; Seligman, Steen, Park, & Peterson, 2005). The non-tautological inference from such studies is that building mental health prevents and relieves mental illness.
The findings that have emerged from the positive psychology initiative have not been confined to positive interventions (e Peterson, 2006, for a review). Many of the findings are not of the “my grandmother already knew it” variety; among the more surprising ones:
•Women who flashed a Duchenne (genuine) smile in their yearbook positive photos as freshmen have more marital satisfaction twenty-five years later (Harker & Keltner, 2001).
•Brief raising of positive mood enhances creative thinking and makes positive physicians more accurate and faster to come up with the proper liver diagnosis (Fredrickson, 2001; In, 2005).
•The relation of national wealth to life satisfaction is dramatically cur-vilinear; after the safety net is m
et, increas in wealth produce less and less life satisfaction (Diener, Sandvik, Seidlitz, & Diener, 1993).
•In business meetings a ratio of greater than 2.9:1 for positive to negative statements predicts economic flourishing (Fredrickson & Losada, 2005).
•Peripheral attention is superior under positive emotion (Fredrickson & Branigan, 2005).
Some newer findings concern optimism predicting cardiovascular dia (CVD) and mortality and the studies bear directly on the likelihood that a state of positive health will increa longevity and improve prognosis:炒牛蒡子的功效与作用
•Giltay, Geleijn, Zitman, Hoekstra, and Schouten (2004) followed 999 Dutch niors for a decade: high optimism produced a remarkably low hazard ratio of 0.23 for CVD death (upper versus lower quartile of optimism, 95% confidence interval, 0.10–0.55) when controlling for age, x, chronic dia, education, smoking, alcohol, history of CVD, body mass, and cholesterol level. Similarly, Buchanan (1995) found that among 96 men who had had their first heart attack, 15 of the 16 most pessimistic men died of CVD over the next decade, while only 5 of the 16 most optimistic died, controlling for major risk factors.
6SELIGMAN
带然的成语•Kubzansky, Sparrow, Vokonas, and Kawachi (2001) followed 1,306 men who were evaluated by the MMPI Optimism–Pessimism scale.
In a 10-year follow-up, incidence of coronary heart dia (CHD), non-fatal myocardial infarction, fatal CHD and angina pectoris were recorded. A robust positive correlation was found between increasingly high levels of optimism and incread protection against each of the cardiovascular events and depression significantly increa the risk for cardiac events. Similarly Kubzansky and Thurston (2007) found a strong positive relationship between emotional vitality and lack of CVD.
文明礼仪内容•Optimism and positive emotions have also been linked to recovery after a major cardiac event. Leedham, Meyerowitz, Muirhead, and Frist (1995) interviewed 31 heart-transplant patients both before and after surgery. Tho who reported a high level of positive expectation and good mood before the surgery were found to have greater adherence to medical regimen after surgery, as well as a better status report obtained by nursing 6 months post-operation.
•Scheier, Matthews, Owens, Magovern, Lefebvre, Abbott, and Carver (1989) investigated the effect of dispositional optimism in 51 middle-aged men who had coronary artery bypass surgery. Dispositio
nal optimism was associated with faster recovery rates during hospitalisation, as well as a speedier return to normal living upon discharge. At the 6-month follow-up, there was a strong positive association between high optimism and good quality of life.
•Optimism and positive affect may also be protective against other physical deteriorations. Ostir, Ottenbacher, and Markides (2004) followed 1,558 initially non-frail older Mexican-Americans for 7 years. Frailty incread by 7.9% over the cour of follow-up, but tho men with high positive affect were found to have a significantly lower risk of frailty ont.
•Positive emotional style (PES) may also act as preventive against the ont of the common cold. Cohen, Alper, Doyle, Treanor, and Turner (2006) administered nasal drops carrying either rhinovirus or influenza to 193 healthy normal volunteers, ranging in age from 21 to 55. They found that a high level of PES was associated with a lower risk of developing either of the two conditions, manifest as upper respiratory conditions.
•In looking at more vere physiological events, positive affect and positive explanatory styles have been found to be protective against stroke (Ostir, Markides, Peek, & Goodwin, 2001), rapid progression of HIV (Taylor, Kemeny, Reed, Bower, & Gruenewald, 2000), and general mortality rates in the elderly (Cohen & Pressman, 2006; Maruta, Colligan, Malinchoc, & Offord, 2000).
The overriding theme to emerge from a decade of positive psychology rearch is that mental health (consisting of positive emotion, engagement, purpo,
POSITIVE HEALTH7 positive relationships, and positive accomplishments) is something over and above the abnce of mental illness, and it is quantifiable and predictive. It predicts lack of depression, higher achievement, and—intriguingly—better positive physical health. The most important theme that runs through the tantalising positive physical health outcomes is a link between positive psychology and positive health: Subjective well-being, as measured by optimism and other positive emotions, protects one from physical illness.
竣工验收申请报告I take up this rationale again when I discuss the operationalisation of positive health into high status on combinations of subjective, biological, and functional measures.
CONCEPTUAL FRAMEWORK病毒的战争
In formulating the conceptual framework for positive psychology, we took the scientifically unwieldy notion of “happiness” and broke it down into veral more quantifiable aspects: positive emotion (the pleasant life), engagement (the engaged life), and purpo (the meaningful life). Similarly, I believe that the global notion of positive health—beyond the abnce of illness—can be broken down into th
ree kinds of independent variables: subjective, biological, and functional. Each of the realms is quantifiable, and the combination of the can be ud to predict health targets of interest: longevity, health costs, mental health, and prognosis. The biological measures for the most part will vary with the medical disorder under study. The subjective measures will be similar for all disorders under study. The functional measures may be a combination of measures developed specifically for a disorder and measures that will be ud across all of the disorders.
•Subjective—when a person feels great, defined by high ends of measures of veral psychological states. The states are (a) a n of positive physical well-being. The individual enjoys a n of energy, vigor, vitality, robustness (as oppod to a n of vulnerability to dia, tenuousness of health status, health-related anxiety); (b) the abnce of bothersome symptoms, measured, for example by the Somatic Symptom Inventory; (c) a n of durability, hardiness, and confidence about one’s body (as oppod to a n of fragility, susceptibility to dia);
(d) an internal health-related locus of control so that the individual
feels a measure of control over health; (e) optimism, measured for example by the Attributional Style Questionnaire and by content ana-lysis of verbatim materials, and confidence about one’s future hea
感统游戏lth (as oppod to anxiety, bodily preoccupation, dia fear); (f) high life satisfaction, as measured for example by Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q); and (g) positive emotion, minimal and appropriate negative emotion, high n of engagement and meaning
