Conscientiousness and Catastrophizing
By this point in our studies of Karen, Douglas Kelley, Philip, and all the other Terman participants, we knew that conscientiousness was a major factor in long life. But did conscientiousness relate to catastrophizing and the associated early deaths? It did. The conscientious participants were less likely to be the catastrophizers. In fact, even when symptoms of mental illness in early adulthood were held constant, the children who had been more conscientiousness were less likely to commit suicide.31
One reason conscientious individuals live longer is that they cooperate with their medical treatments. Though not surprising, this is important. People who don’t take their pills in the manner that their doctors prescribe them (such as three times a day with food), or who don’t even bother to take their pills at all, are obviously less likely to have a successful medical treatment. In fact, very large numbers of patients—millions in the United States alone—do not cooperate well with their doctors. Sometimes they can’t afford the treatments, and sometimes they find the treatments too uncomfortable to endure. Sometimes they dislike their doctors.
But many such failures to comply are due to personality. Some people simply do not bother to fully understand their treatments or follow directions. Or they believe that they are doomed in any case: after becoming ill, they catastrophize that everything is over. They are unconscientious, imprudent, and unmotivated.
There is a startling twist, however, to the importance of conscientiousness and noncatastrophizing that is not well understood even by most doctors. The pervasive effects of conscientiousness on health go well beyond these cooperation effects (also called adherence effects).
An excellent randomized study conducted a number of years ago at Yale University on medication use after a heart attack well illustrates this point.32 Patients were given either the medication Propranolol or a placebo sugar pill. The researchers then followed the patients to see who would live long and who would die. What is remarkable about this study is that researchers also evaluated how well each of the participants cooperated with the treatment and took their pills. This was an especially unusual step at the time.
Their first finding was valuable news to cardiologists but not so interesting to us: patients who did not cooperate well with their prescribed treatment—that is, who took less than 75 percent of the prescribed pills—were more than two times more likely to die within a year of follow-up than patients who took all their pills. After all, how could the pills help you if you do not take them?
Most interesting to us, however, was that the conscientious patients (the good adherers) were much more likely to survive whether they were on the Propranolol medication or on the placebo. Being conscientious enough—adherent enough—to fully cooperate with treatment, even if with a placebo, emerged as a more important predictor of mortality risk than the medication itself. Their overall approach to life was what mattered most, not the drug per se.
The conclusion to draw from this and related work is not that one can think positive thoughts and throw away one’s medications. Optimistic, popular Paul (the fun-loving guy who walked on stilts and played pom-pom pull away as a kid) contracted pneumonia in his early forties. He relied on medical expertise and not just his optimistic nature to recover his health. People traveling on healthy pathways have a whole host of healthy thoughts—and associated feelings and behaviors—that combine to produce a dramatic positive influence on their likelihood of long life.
What It Means for You: Guideposts to Health and Long Life
Douglas Kelley swallowed cyanide more than a decade after seeing the horror of the Nazis up close. His suicide decision appeared sudden and unprovoked. After all, in the intervening years, he’d had a family and built a successful career as a professor, doctor, and researcher. But, from intensive study of the Terman participants, we know that those who committed suicide did not suddenly and erratically fall off the path. Negative thoughts became more and more consuming and started to influence feelings and behaviors.
When the actress Marilyn Monroe was found dead of an overdose of barbiturates at age thirty-six, there was much uncertainty about whether this was an accident, a suicide, or even a murder. Dr. Shneidman was called in to work with the coroner and perform what he called a psychological autopsy. He saw that Marilyn Monroe had come from an unstable family, had faced a difficult childhood, had been impulsive and unreliable, had had many romantic relationships and three marriages, and, as the stress of her career built, had turned to alcohol and prescription drugs. She fit the suicidal pattern, and the coroner ruled her death a probable suicide.
Our studies of catastrophizing, coupled with the explorations of Terman subject suicides by Drs. Tomlinson-Keasey, Shneidman, and others, present a multisided picture of those predisposed to a violent death before age sixty. Such individuals not only faced overly dramatic thoughts but they were inclined to dramatic, precipitous actions. They were not only worried about failures but they were often missing something from childhood—usually a parent’s love. They often had headed down a path of alcohol, divorce, or loneliness, but sometimes, as with Douglas Kelley, they had stared into the abyss of a world they could not fathom.
If someone is already far down a self-destructive pathway, the intensive measures needed for detox and sobering up are well-known; they often involve a period of very close monitoring by professionals. But what about someone who has tendencies that could lead in that direction, but who has many strengths as well?
The good news is that catastrophic and related negative thought processes can be changed. The first step is recognizing thoughts for what they are—merely thoughts. This doesn’t mean that they are unimportant or hold no power; we have seen dramatic illustrations of their potency in the lives of some of the Terman subjects, for instance. But the power of thoughts can be harnessed, and this is the basic premise behind cognitive therapy.
Cognitive therapy focuses on changing harmful thoughts using techniques such as “thought stopping.” When you start to think catastrophic thoughts, you literally say to yourself, “Stop!” This is immediately followed by “thought replacement,” which is replacing the negative thoughts with more positive ones. It’s actually very difficult to simply not think about something. Try not thinking about a purple penguin. You likely were not thinking of a purple penguin a minute ago, but now that we’ve brought it to your attention, it’s hard to get it out of your head. The best way to banish penguin thoughts is to focus elsewhere. Thought replacement requires the individual who has just stopped a negative thought to replace it with something else—something positive or distracting.
Rationally examining catastrophizing thought patterns and beliefs also proves useful. Most people probably recognize, at least in part, that things aren’t really as bad as all that, but this nugget of truth gets lost amid all the chaos of perceived calamity. Taking time to thoughtfully evaluate the situation—“What is the worst-case scenario?” or “How likely is it that all of my friends really hate me?”—and to replace inaccurate, catastrophe-oriented thoughts and beliefs with more rational and realistic ones is a worthwhile exercise. Often, writing them down can help. Many recovering catastrophizers benefit from keeping a daily diary, in which they recall the good things that happened today, dismiss the catastrophizing, and write logical plans for tomorrow. But anyone with a troubling, chronic mental health problem should not try to self-diagnose or self-treat. Professional consultations can point one toward the treatments that are most likely to be successful in any particular case.
31
David Lester did a follow-up study on the Terman suicides, matched controls, and childhood personality; see D. Lester, “Completed Suicide in the Gifted,”
32
The study on adherence and health outcomes after heart attack is R. I. Horwitz, C. M. Viscoli, L. Berkman, R. M. Donaldson, S. M. Horwitz, C. J. Murray, D. F. Ransohoff, and J. Sindelar, “Treatment Adherence and Risk of Death after a Myocardial Infarction,”