情商：为什么情商比智商更重要（第2版）

以上所说的步骤只是一个开始。医学要扩大视野范围，重视情绪的作用，必须重视科学发现带来的两大启示。

1.帮助人们更好地调节不安情绪，比如愤怒、焦虑、抑郁、悲观和孤独等，这是预防疾病的一种形式。有研究数据表明，如果人们长期保持负面情绪，受到的危害相当于吸烟，因此，帮助人们有效应对负面情绪，潜在的医疗作用很可能和瘾君子戒烟一样显著。能够产生广泛的公共健康效果的其中一个方法是向儿童传授最基本的情绪智力技能，使其成为一生的习惯。另一种有效的预防措施是向年届退休的人传授情绪管理的技巧，情绪健康与否是老年人迅速滑向衰老或保持旺盛生机的一个决定因素。第三个目标群体则是所谓的高危人群——穷人、单亲职业妈妈、高犯罪率地区的居民等。这些人群时时刻刻生活在巨大的压力之下，因此协助他们处理困扰情绪会产生更好的医疗效果。

2.如果病人的心理需求与其医疗需求协调一致，他们将会受益匪浅。医生或护士安慰烦恼的病人是一种人道关怀的举动，但仅仅这样是不够的。当今医学界的实践常常会错失情感关怀的良机，情感关怀是医学的盲点。尽管有越来越多的研究表明，关注病人的情绪需要有助于治疗，同时有很多证据表明大脑的情绪中枢与人体免疫系统相互关联，但很多医生仍然对病人情绪会影响医疗效果感到怀疑，认为这些证据无足轻重，或者只是“花边”逸事，甚至更加糟糕，认为这是少数自我吹嘘之徒的夸大之词。

尽管越来越多的病人在寻求更注重人道关怀的医疗服务，但情况越来越严峻了。当然，依然有很多乐于奉献的护士和医生为病人提供悉心体贴的照顾，但是医学的风气改变了，医学变得越来越商业化，人道关怀越来越少。

另一方面，人道医学还包含某种商业价值。前面提到的研究表明，缓解病人的情绪困扰可以节省医疗费用，尤其是在预防或延迟疾病发生、帮助病人迅速康复方面。在纽约西奈山医学院以及西北大学关于髋骨骨折老年病人的研究中，在普通的矫形治疗之外还接受抗抑郁治疗的病人，他们的出院时间平均提早了两天，大约有100位病人总共节省了97361美元的医疗费用。^[55]

人道关怀还有助于提高病人对医生和治疗的满意度。在新兴的医疗市场，病人通常有权选择不同的健康计划，病人的满意度无疑是他们个人选择的重要决定因素——不愉快的经历会让病人选择到其他医院就医，而愉快的经历则可以留住病人。

最后，关怀还是医学伦理的要求。《美国医学协会期刊》的一篇社论针对抑郁导致心脏病人死亡率提高4倍的报道发表评论：“抑郁和社会孤立等心理因素使冠状动脉心脏病患者面临最大的死亡风险，这很清晰地揭示了不对这些情绪因素进行治疗是不符合医学伦理的。”^[56]

从关于情绪和健康的研究中，我们可以了解到，如果忽略病人抵抗慢性或严重疾病时的心理感受，这种治疗是不够的。医学应当更好地利用情绪和健康的关系。现在的例外情况也许会（而且应该会）成为主流，我们所有人都可以得到更注重人道关怀的治疗，至少医学会更有人道精神。对某些人来说，这还可以加速康复过程。正如一位病人在给主治医生的公开信里说的那样：“同情心不仅仅是握着病人的手。它是一剂良药。”^[57]

1. Immune system as the body’s brain: Francisco Varela at the Third Mind and Life meeting,Dharamsala, India (Dec. 1990).
2. Chemical messengers between brain and immune system: see Robert Ader et al.,Psychoneuroimmunology , 2nd edition (San Diego: Academic Press, 1990).
3. Contact between nerves and immune cells: David Felten et al., “NoradrenergicSympatheticInnervation of Lymphoid Tissue,” Journal of Immunology 135 (1985).
4. Hormones and immune function: B. S. Rabin et al., “Bidirectional Interaction Between the CentralNervous System and the Immune System,” Critical Reviews in Immunology 9(4), (1989), pp. 279-312.
5. Connections between brain and immune system: see, for example, Steven B.Maier et al.,“Psychoneuroimmunology,” American Psychologist (Dec. 1994).
6. Toxic emotions: Howard Friedman and S. Boothby-Kewley, “The Disease-Prone Personality: AMeta-Analytic View, ”American Psychologist 42 (1987).This broad analysis of studies used “meta-analysis,” in which results from manysmaller studies can be combined statistically into one immensestudy. This allowseffects that might not show up in any given study to be detected more easilybecauseof the much larger total number of people being studied.
7. Skeptics argue that the emotional picture linked to higher rates of disease is the profile of thequintessential neurotic—an anxious, depressed, and angry emotional wreck—and that the higher ratesof disease they report are due not so much to a medical fact as to a propensity to whine and complainabout health problems, exaggerating their seriousness. But Friedman and others argue that the weight ofevidence for the emotion-disease link is borne by research in which it is physicians’ evaluations ofobservable signs of illness and medical tests, not patients’ complaints, that determine the level ofsickness—a more objective basis.Of course, there is the possibility that increased distress is the resultof a medical condition, as well as precipitating it; for that reason the most convincing data come fromprospective studies in which emotional states are evaluated prior to the onset of disease.
8. Gail Ironson et al., “Effects of Anger on Left Ventricular Ejection Fractionin Coronary ArteryDisease,” The American Journal of Cardiology 10 (1992).Pumping efficiency, sometimes referred to asthe “ejection fraction,” quantifies the heart’s ability to pump blood out of the left ventricle into thearteries; it measures the percentage of blood pumped out of the ventricles with each beat of the heart.Inheart disease the drop in pumping efficiency means a weakening of the heartmuscle.
9. Of the dozen or so studies of hostility and death from heart disease, some have failed to find a link.But that failure may be due to differences in method,such as using a poor measure of hostility, and tothe relative subdety of the effect.For instance, the greatest number of deaths from the hostility effectseem to occurin midlife. If a study fails to track down the causes of death for people during thisperiod,it misses the effect.
10. Hostility and heart disease: Redford Williams, The Trusting Heart (NewYork: TimesBooks/Random House, 1989).
11. Peter Kaufman: I interviewed Dr. Kaufman in The New York Times (Sept. 1,1992).
12. Stanford study of anger and second heart attacks: Carl Thoreson, presented at the InternationalCongress of Behavioral Medicine, Uppsala, Sweden (July1990).
13. Lynda H. Powell, Emotional Arousal as a Predictor of Long-Term Mortality and Morbidity in PostM.I. Men,” Circulation, vol. 82, no. 4, Supplement III, Oct.1990.
14. Murray A. Mittleman, “Triggering of Myocardial Infarction Onset by Episodes of Anger,”Circulation , vol. 89, no. 2 (1994).
15. Suppressing anger raises blood pressure: Robert Levenson, “Can WeControl Our Emotions, andHow Does Such Control Change an EmotionalEpisode?” in Richard Davidson and Paul Ekman, eds.,Fundamental Questions About Emotions (New York: Oxford University Press, 1995).
16. The angry personal style: I wrote about Redford Williams’s research on anger and the heart inThe New York Times Good Health Magazine (Kpx. 16,1989).
17. A 44 percent reduction in second heart attacks: Thoreson, op. cit.
18. Dr. Williams’s program for anger control: Williams, The Trusting Heart .
19. The worried woman: Timothy Brown et al., “Generalized Anxiety Disorder,”in David H. Barlow,ed., Clinical Handbook of Psychological Disorders (NewYork: Guilford Press, 1993).
20. Stress and metastasis: Bruce McEwen and Eliot Stellar, “Stress and theIndividual: MechanismsLeading to Disease,” Archives of Internal Medicine 153 (Sept. 27,1993). The study they are describingis M. Robertson and J. Ritz,“Biology and Clinical Relevance of Human Natural Killer Cells,” Blood 76(1990).
21. There may be multiple reasons why people under stress are more vulnerable to sickness, apartfrom biological pathways. One might be that the ways people try to soothe their anxiety—for example,smoking, drinking, or bingeing on fatty foods—are in themselves unhealthy. Still another is thatconstant worry and anxiety can make people lose sleep or forget to comply with medical regimens—such as taking medications—and so prolong illnesses they already have. Most likely, all of these workin tandem to link stress and disease.
22. Stress weakens the immune system: For instance, in the study of medical students facing examstress, the students had not only a lowered immune control of the herpes virus, but also a decline in theability of their white blood cells to kill infected cells, as well as an increase in levels of a chemicalassociated with suppression of immune abilities in lymphocytes, the white blood cells central to theimmune response. See Ronald Glaser and Janice Kiecolt-Glaser, “Stress-Associated Depression inCellular Immunity,” Brain, Behavior, and Immunity 1(1987). But in most such studies showing aweakening of immune defenses with stress, it has not been clear that these levels were low enough tolead to medicalrisk.
23. Stress and colds: Sheldon Cohen et al, “Psychological Stress and Susceptibility to the CommonCold,” New England Journal of Medicine 325(1991).
24. Daily upsets and infection: Arthur Stone et al., “Secretory IgA as a MeasureofImmunocompetence,” Journal of Human Stress 13 (1987). In another study,246 husbands, wives, andchildren kept daily logs of stresses in their family’slife over the course of the flu season. Those who hadthe most family crises alsohad the highest rate of flu, as measured both by days with fever and fluantibodlevels. See R. D. Clover et al., “Family Functioning and Stress as Predictors ofInfluenza BInfection,” Journal of Family Practice 28 (May 1989).
25. Herpes virus flare-up and stress: a series of studies by Ronald Glaser and Janice Kiecolt-Glaser —e.g., “Psychological Influences on Immunity,” American Psychologist A3(1988). The relationshipbetween stress and herpes activity is so strong that it has been demonstrated in a study of only tenpatients, using the actual breaking-out of herpes sores as a measure; the more anxiety, hassles, andstress reported by the patients, the more likely they were to have herpes outbreaks in the followingweeks; placid periods in their lives led to dormancy of the herpes. See H. E. Schmidt et al., “Stress as aPrecipitating Factor in Subjects WithRecurrent Herpes Labialis,” Journal “of Family Practice , 20(1985).
26. Anxiety in women and heart disease: Carl Thoreson, presented at the International Congress ofBehavioral Medicine, Uppsala, Sweden (July 1990).Anxiety may also play a role in making some menmore vulnerable to heart disease. In a study at the University of Alabama medical school, 1,123 menand women between the ages of forty-five and seventy-seven were assessed on their emotional profiles.Those men most prone to anxiety and worry in middle age were far more likely than others to havehypertension when tracked down twenty years later. See Abraham Markowitz et al., Journal of theAmerican Medical Association (Nov. 14, 1993).
27. Stress and colorectal cancer: Joseph C. Courtney et al., “Stressful LifeEvents and the Risk ofColorectal Cancer,” Epidemiology (Sept. 1993), 4(5).
28. Relaxation to counter stress-based symptoms: See, for example, DanielGoleman and Joel Gurin,Mind Body Medicine (New York: Consumer ReportsBooks/St. Martin’s Press, 1993).
29. Depression and disease: see, e.g., Seymour Reichlin, “Neuroendocrine-Immune Interactions,” NewEngland Journal of Medicine (Oct. 21, 1993).
30. Bone marrow transplant: cited in James Strain, “Cost Offset From a Psychiatric Consultation-Liaison Intervention With Elderly Hip Fracture Patients,” American Journal of Psychiatry 148 (1991).
31. Howard Burton et al., “The Relationship of Depression to Survival in Chronic Renal Failure,”Psychosomatic Medicine (March 1986).
32. Hopelessness and death from heart disease: Robert Anda et al., “Depressed Affect, Hopelessness,and the Risk of Ischemic Heart Disease in a Cohort of U.S.Adults,” Epidemiology (July 1993).
33. Depression and heart attack: Nancy Frasure-Smith et al., “Depression Following MyocardialInfarction,”J ournal of the American Medical Association (Oct. 20,1993).
34. Depression in multiple illness: Dr. Michael von Korff, the University of Washington psychiatristwho did the study, pointed out to me that with such patients, who face tremendous challenges just inliving from day to day, “If you treat a patient’s depression, you see improvements over and above anychanges in their medical condition. If you’re depressed, your symptoms seem worse to you. Having achronic physical disease is a major adaptive challenge. If you’re depressed, you’re less able to learn totake care of your illness. Even with physical impairment, if you’re motivated and have energy andfeelings of self-worth—all of which are at risk in depression—then people can adapt remarkably evento severe impairments.”
35. Optimism and bypass surgery: Chris Peterson et al. ,Learned Helplessness:A Theory for the Age ofPersonal Control (New York: Oxford University Press,1993).
36. Spinal injury and hope: Timothy Elliott et al., “Negotiating Reality After Physical Loss: Hope,Depression, and Disability,”J ournal of Personality and Social Psychology 61, 4 (1991).
37. Medical risk of social isolation: James House et al., “Social Relationships and Health,”ScienceQuly 29,1988). But also see a mixed finding: Carol Smith et al., “Meta-Analysis of theAssociations Between Social Support and HealthOutcomes,” Journal of Behavioral Medicine (1994).
38. Isolation and mortality risk: Other studies suggest a biological mechanism at work. These findings,cited in House, “Social Relationships and Health,”have found that the simple presence of anotherperson can reduce anxiety and lessen physiological distress in people in intensivecare units. Thecomforting effect of another person’s presence has been found to lower not just heart rate and bloodpressure, but also the secretion of fatty acids that can block arteries.One theory put forward to explainthe healing effects of social contact suggests a brain mechanism at work. This theory points to animaldata showing a calming effect on the posterior hypothalamic zone, an area of the limbic system withrich connections to the amygdala. The comforting presence of another person, this view holds, inhibitslimbic activity, lowering the rate of secretion of acetyl choline,cortisol, and catecholamines, allneurochemicals that trigger more rapid breathing,a quickened heartbeat, and other physiological signsof stress.
39. Strain, “Cost Offset.”
40. Heart attack survival and emotional support: Lisa Berkman et al., “Emotional Support andSurvival After Myocardial Infarction, A Prospective Population Based Study of the Elderly,” Annals ofInternal Medicine (Dec. 15, 1992).
41. The Swedish study: Annika Rosengren et al., “Stressful Life Events, SocialSupport, and Mortalityin Men Born in 1933,” British Medical Journal (Oct. 19,1993).
42. Marital arguments and immune system: Janice Kiecolt-Glaser et al., “Marital Quality, MaritalDisruption, and Immune Function,” Psychosomatic Medicine 49(1987).
43. I interviewed John Cacioppo for The New York Times (Dec. 15, 1992).
44. Talking about troubling thoughts: James Pennebaker, “Putting Stress IntoWords: Health,Linguistic and Therapeutic Implications,” paper presented at theAmerican Psychological Associationmeeting, Washington, DC (1992).
45. Psychotherapy and medical improvements: Lester Luborsky et al.,“Is Psychotherapy Good forYour Health?” paper presented at the American Psychological Association meeting, Washington, DC(1993).
46. Cancer support groups: David Spiegel et al., “Effect of PsychosocialTreatment on Survival ofPatients with Metastatic Breast Cancer,” Lancet No .8668, ii (1989).
47. Patients’ questions: The finding was cited by Dr. Steven Cohen-Cole, a psychiatrist at EmoryUniversity, when I interviewed him in T he New York Times (Nov. 13, 1991).
48. Full information: For example, the Planetree program at Pacific Presbyterian Hospital in SanFrancisco will do searches of medical and lay research on anymedical topic for anyone who requests it.
49. Making patients effective: One program has been developed by Dr. Mack Lipkin, Jr., at New YorkUniversity Medical School.
50. Emotional preparation for surgery: I wrote about this in The New York Times (Dec. 10, 1987).
51. Family care in the hospital: Again, Planetree is a model, as are the Ronald McDonald houses thatallow parents to stay next door to hospitals where their children are patients.
52. Mindfulness and medicine: See Jon Kabat-Zinn,Full Catastrophe Living(New York: Delacorte,1991).
53. Program for reversing heart disease: See Dean Ornish, Dr. Dean Ornish’s Program for ReversingHeart Disease (New York: Ballantine, 1991).
54. Relationship-centered medicine: Health Professions Education andRelationship-Centered Care.Report of the Pew-Fetzer Task Force on Advancing Psychosocial Health Education, Pew HealthProfessions Commission and FetzerInstitute at The Center of Health Professions, University ofCalifornia at SanFrancisco, San Francisco (Aug. 1994).
55. Left the hospital early: Strain, “Cost Offset.”
56. Unethical not to treat depression in heart disease patients: Redford Williamsand MargaretChesney, “Psychosocial Factors and Prognosis in Established Coronary Heart Disease,” Journal of theAmerican Medical Association (Oct.20,1993).
57. An open letter to a surgeon: A. Stanley Kramer, “A Prescription forHealing,” Newsweek (June7,1993).