“People think that as we get older we become more depressed, pessimistic, and negative,” Dr. Jeste said. “That’s not true. In our study we found no decrease in optimism bias with aging.”
Other published research supports this notion. A meta-analysis of 83 studies found a significantly positive association between optimism and better cardiovascular and cancer outcomes, better physiological markers such as immune function, better pregnancy-related outcomes, less pain, and improved mortality (Ann Behav Med. 2009 Jun;37[3]:239-56. doi: 10.1007/s12160-009-9111-x). Another meta-analysis of 148 studies involving more than 300,000 subjects found a 50% increased likelihood of survival for individuals with stronger social relationships (PLoS Med. 2010;7[7]:31000361).
Dr. Jeste went on to discuss a growing interest in the association of wisdom with aging. He defined wisdom as “a complex, multidimensional trait involving integration of several components that is useful to society and self.” Common components include social decision-making, emotional regulation, prosocial behaviors such as compassion, insight, tolerance of divergent views, and decisiveness amid uncertainty. To date, he said, studies in the medical literature have found no automatic increase in wisdom with age, but some older people show higher levels of specific components of wisdom, including better social reasoning and experience-based decision-making, and “positivity,” which Dr. Jeste defined as “having fewer negative emotions, better emotional regulation, positive biases in memory, and less regret.”
In the opinion of Dr. Jeste, such findings in medical research warrant a greater emphasis on positive aspects of health such as well-being, successful aging, and behavioral strategies for prevention – a concept known as “positive psychiatry.” “Enhancing positive psychological traits such as optimism, resilience, social engagement, and wisdom should become a key component of any medical treatment,” he said. For example, current strategies for successful aging in people with schizophrenia include optimal pharmacotherapy and psychosocial interventions, “but they are not enough,” he said. “Calorie restriction and physical exercise are critical, because we know that many of our patients are obese, partly because of sedentary habits and partly because of the medication.”
In an interview, Dr. Carl C. Bell, a psychiatrist at Jackson Park Hospital in Chicago, said the concepts behind positive psychiatry are long overdue. “Psychiatry needs to come out of the dark ages and realize that we psychiatrists should not only focus on patients’ psychopathology but also their psychoresilience, psychocreativity, and psychohealth,” Dr. Bell said. “The glass is neither half-empty nor half-full; it is both. Until we realize that wisdom, we are doing our patients a disservice.”
The practice of psychiatry “should go beyond prescribing medication” concluded Dr. Jeste, who is the principal coeditor of “Positive Psychiatry: A Clinical Handbook” (Arlington, Va.: American Psychiatric Publishing, 2015). “We need to get interested in patients’ lifestyle. We need to ask them about their level of physical activity, diet and nutrition, cognitive activity, sleep habits, socialization, and what they do for recreation and leisure.”
Dr. Jeste reported having no financial disclosures.