Altruism, Happiness, and Health

12 Pages·2005·0.11 MB·English

International Journal of Behavioral Medicine Copyright ©2005by
2005, Vol.12, No.2,66–77 Lawrence Erlbaum Associates, Inc.
Altruism, Happiness, and Health: It’s Good to Be Good
Stephen G. Post
Altruistic (other-regarding) emotions and behaviors are associated with greater
well-being,health,andlongevity.Thisarticlepresentsasummaryandassessmentof
existingresearchdataonaltruismanditsrelationtomentalandphysicalhealth.It
suggestsseveralcomplimentaryinterpretiveframeworks,includingevolutionarybi-
ology,physiologicalmodels,andpositivepsychology.Potentialpublichealthimpli-
cationsofthisresearcharediscussed,aswellasdirectionsforfuturestudies.Thearti-
cle concludes, with some caveats, that a strong correlation exists between the
well-being, happiness, health, and longevity of people who are emotionally and
behaviorally compassionate, so long as they are not overwhelmed by helping tasks.
Key words: kindness, altruism, well-being, happiness, health, public health
ThevastmajorityofpeopleintheEuropeanUnion the case of the stressed caregiver of a loved one with
andtheUnitedStateshavemorematerialwealththan dementia(Kiecolt-Glaser,Preacher,MacCallum,Ma-
did their parents; the percentage of these populations larkey,&Glaser,2003),therearehealthbenefitslinked
thatishappy,however,hasnotincreased,anddepres- tohelpingbehaviorwhenitisnotexperiencedasover-
sion and anxiety rates have risen dramatically whelming.Arelevantstudy(Schwartz,Meisenhelder,
(Easterbrook,2003).Theriseindepressionratesisin Ma,&Reed,2003)pointstohealthbenefitsingenerous
part due to greater public and medical awareness. behavior but with the important caveat that there are
However,suchelevatedratesrequireseriousreflection clearadversehealthconsequencesassociatedwithbe-
on our social environment, which has been described ingoverlytaxed.Althoughthehealthbenefitsofreceiv-
byonesociologistwiththeterms“bowlingalone”and inglovearewidelydeemedsignificant,wewanttogo
loss of “social capital” (Putnam, 2001). These terms beyondtherecipienttoexaminebenefitsfortheagent.
suggest that a partial solution to the problem may lie Whathappenstothehealthandlongevityofpeoplewho
with the restoration of prosocial altruistic emotions are(a)emotionallykind,(b)charitableintheiractions
and behaviors. Current research does indeed show a towardotherswithoutbeingoverwhelmed,orboth?
strong association between kindly emotions, helping Emotional states and related behaviors have been
behavior, or both, on the one hand, and well-being, studied by mainstream scientists in relation to health
health,andlongevity,ontheother.Thisarticlesumma- promotionanddiseaseprevention(Oman,Thoresen,&
rizes and interprets existing research, points to future
McMahon,1999;Young&Glasgow,1998).However,
researchdirections,andsuggestsimplicationsofsuch
theimpactofpositiveemotionalstatesandrelatedbe-
research for public health.
haviorsonhealthconstitutesanovelareaforresearchers
Ifkindemotions,helpingbehavior,orbothareas-
(Edwards&Cooper,1988).Inthe1990s,forexample,
sociated with well-being, health, and longevity, the
Danner et al. (2001) reviewed short, personal essays
implications for how we think about human nature
writtenbynunsinthe1930s;thiswasasecondarypro-
and prosperity are significant (Hendrick & Hendrick,
jectintheirfamousnunstudyonAlzheimerdisease.The
1986;Levin,2000).Althoughthosewhoarephysically
nuns who expressed the most positive emotions were
overwhelmed, mentally overwhelmed, or both by the
livingabout10yearslongerthanthosewhoexpressed
needsofothersdoexperienceastressful“burden”that
the fewest such emotions, and they were somewhat
canhavesignificantnegativehealthconsequences,asin
protected from the onset of dementia (Danner et al.,
2001).Inanotherexample,Fredrickson(2003)summa-
StephenG.Post,DepartmentofBioethics,SchoolofMedicine, rized2decadesofinvestigationandconcludedthatposi-
Case Western Reserve University, Cleveland, Ohio 44106–4976,
tive emotions were linked with a “broader thought-
USA.
The author wishes to acknowledge the support of the John action repertoire,” which is to say that “big picture”
Templeton Foundation; the Institute for Research on Unlimited creativethinkingwasenhanced(asmeasuredbystan-
Love—Altruism, Compassion, Service; and the Ford Foundation. dardtests).DrawingonherownstudiesandthoseofAl-
Correspondenceconcerningthisarticleshouldbeaddressedto
iceIsen(1987),Fredericksonfoundthat“whenpeople
StephenG.Post,DepartmentofBioethics,SchoolofMedicine,Case
feelgood,theirthinkingbecomesmorecreative,inte-
Western Reserve University, Cleveland, Ohio 44106–4976, USA.
E-mail: [email protected] grative,flexibleandopentoinformation”(p.333).She
66
ALTRUISM, HAPPINESS, AND HEALTH
alsofoundthatpositiveemotionsenhancedpsychologi- in a major longitudinal prospective study of Harvard
calandphysicalresilienceandinterpretedthiseffectasa graduates over a 50-year period (Vaillant, 2002).
result of the “undoing” of negative emotions that are It is already well established that compassion,
clearlyphysicallyharmful.However,“helpfulcompas- love, and social support have health benefits for re-
sionateacts,”shealsoargued,justallowpeopletofeel cipients (Ainsworth et al., 1978; Harlow, 1958). Re-
elevatedandgoodaboutthemselvesandothers(Post, searchers in the late 1970s, for example, were study-
Underwood,Schloss,&Hurlbut,2002). ing the effects of a diet high in fat and cholesterol in
Therearefewnewideasintheworld.Thelinkbe- rabbits.Onesubgroupofrabbitshad60%lessathero-
tween “reasonable” altruism—that is, helping behav- sclerosisthanthegroupasawhole,eventhoughthey
iorthatisnotoverwhelming—andhealthisatthecore ate the same diet. The only notable difference in
ofDickens’storyofEbenezerScrooge;forwitheach treatmentwasthatthehealthiersubgroupwasfedand
newexpressionofbenevolence,Scroogebecamemore caredforbyalabassistantwhotookthemoutoftheir
buoyant,untilfinallyhewasamongthemostgenerous cages, petted them, and talked to them before feed-
ofmeninallofEnglandandappearedallthemoreef- ing. The study was repeated twice with the same re-
fervescent and fit. He surely felt a great deal happier sults and was reported in Science (Nerem, Levesque,
withlifethemoregeneroushebecame,followingthe &Cornhill,1980).Alsointhisearlyperiod,research-
patternofthe“helper’shigh”(Luks,1988).Thereisno ers followed 10,000 Israeli men aged 40 years and
either–or dualism between quickening that innate ca- older to clarify the risk factors for angina pectoris.
pacityforbenevolenceandthefulleractualizationofa Anxiety and severe psychosocial problems were con-
happierandhealthierself(Frankl,1956).Settingaside firmed risks; in addition, “those who perceived their
preoccupationwith“purity”andperfectlyselflessmo- wivestobelovingandsupportivehadhalftherateof
tives, it may be that people who live generous lives angina of those who felt unloved and unsupported”
soonbecomeawarethatinthegivingofselfliestheun- (Medalie & Goldbourt, 1976, p. 917). A wife’s love
sought discovery of self as the old selfish pursuit of waslaterassociatedwithloweredriskofduodenalul-
happiness is subjectively revealed as futile and short- cers(Medalie,Stange,Zyzanski,&Goldbourt,1992).
sighted. Dostoyevsky’s images of the Elder Zossima Studies show depressed lymphocyte function after
havethesamebuoyancy.Jewish,Hindu,Buddhist,Is- bereavement (Bartrop, Lazarus, Luckhurst, Kiloh, &
lamic, and Native American spiritual traditions high- Penny,1977).Whenloveislostduetothedeathofa
lighttheflourishingthatfollowsfromalifeofunself- beloved spouse, T and B cells in the immune system
ish love—a life in tune with one’s true self (Post, behave abnormally and, for many months, must be
2002).Thus,thereisanalternativeimagetothatofthe stimulated to perform their usual functions (Rees &
selfless ascetic who seems intent on withering away, Lutkins, 1967, Zisook, 1987). In a remarkable study
(Goode, 1959). that needs to be replicated, 126 healthy young men
Scientificallyspeaking,however,isagenerousand were randomly selected in the early 1950s from the
loving life typically happier, healthier, and longer Harvard classes of 1952 and 1954 and given ques-
than a life of negative affect and solipsism? Is it un- tionnairesabouttheirperceptionsofthelovetheyfelt
healthytofeelandbehaveasthoughoneisthecenter from their parents. Thirty-five years later, 91% of
of the universe, relating to others only in so far as participants who did not perceive themselves to have
they contribute to “my” agendas? The link between had warm relationships with their mothers had diag-
altruism and health is important to how we think of nosed midlife diseases (coronary artery disease, high
human nature and human fulfillment, and it was al- blood pressure, duodenal ulcer, and alcoholism), as
luded to a half century ago. Sorokin (1954/2002), in comparedtoonly45%ofthosewhoreportedawarm
hisclassic1954treatiseentitledTheWaysandPower relationship with their mothers; 82% of those indi-
of Love, began his “Preface” with the assertion that cated low warmth and closeness to their fathers had
unselfish love and altruism are “necessary for physi- such diagnoses, compared with 50% who reported
cal,mental,andmoralhealth”andthat“altruisticper- high warmth and closeness. One hundred percent of
sons live longer than egoistic individuals” (p. xi). those who reported low warmth and closeness from
Although he did not make a clear scientific case to both parents had diseases diagnosed in midlife,
demonstrate a link between altruism and prolongevi- whereas only 47% who reported both parents as be-
ty, he did use available historical collections of the ingwarmandclosehadmidlifediagnoses(Russek&
lives of the saints to argue that such generous people Schwartz, 1997). Although this Harvard study needs
generally live longer—unless their lives are cut short corroboration, it points to the now widely accepted
by misfortune. Erik Erikson, another maverick Har- biopsychosocial model that being loved, cared for,
vardprofessoratthetime,lightlysurmisedaconnec- and supported by others is critically important to
tion between health and generativity—that is, altru- health and treatment efficacy (Goodkin & Visser,
isminolderadultsfocusedonayoungergenerational 2000). No one questions the importance to health of
cohort. This connection is currently being examined receiving compassionate love (Ornish, 1999). How-
67
POST
ever, this end of the spectrum needs to be balanced toothers.Anearlystudycomparedretireesolderthan
withafocusontheimportancetohealthofgivingun- the age 65 who volunteered with those who did not
selfish love. (Hunter&Lin,1980–1981).Volunteersscoredsignifi-
Biogerontologists are studying the molecular and cantlyhigherinlifesatisfactionandwilltoliveandhad
cellular science of aging with the goal of its eventual fewer symptoms of depression, anxiety, and
deceleration (Post & Binstock, 2004). One plausible somatization.Becausetherewerenodifferencesinde-
hypothesisthatshouldbesimultaneouslyinvestigated mographic and other background variables between
is longevity enhancement through the cultivation of the groups, the researchers concluded that volunteer
generousemotionsandhelpingbehaviors.Ontheone activity helped explain these mental health benefits.
hand,itisintriguingtoseethatgeneticmodifications Thenonvolunteersdidspendmoredaysinthehospital
offruitfliesandnematodeworms,caloricrestrictionin and were taking more medications, which may have
miceandprimates,andrelatedantioxidantstudiesall preventedthemfromvolunteering.However,themen-
pointtowardthepossibilityinfuturedecadesoflonger tal health benefits persisted after controlling for dis-
humanlivesthroughbiotechnology(Post&Binstock, ability.Inanotherolderstudy,familiesofrecentlyde-
2004).However,thistechnologicalapproachdoesnot ceased loved ones reported a psychological benefit
ensure that longer lives will be morally good lives, fromtheirdecisiontodonateorgans(Batten&Prottas,
whereas the inner cultivation of altruistic and loving 1987).Morerecentstudiesconfirmanassociationbe-
emotions coupled with generous actions does (Post, tweenaltruisticactivitiesandbothwell-beingandlife
2004).Anewdirectionintheemotionalandbehavioral satisfactioninolderadults(Dulin&Hill,2003;Liang,
aspects of antiaging research (Epel et al., 2004) indi- Krause, & Bennett, 2001; Morrow-Howell, Hinter-
catesthatchronicstressimpactshealthbymodulating lonh, Rozario, & Tang, 2003).
the rate of cellular aging. Evidence is mounting that Midlarsky(1991)posedfivereasonsforbenefitsto
psychological stress is associated with higher oxida- older adults who engage in altruistic behavior: en-
tive stress, lower telomerase activity, and shorter hancedsocialintegration,distractionfromtheagent’s
telomerelength,allofwhichareknowndeterminants own problems, enhanced meaningfulness, increased
ofcellsenescenceandlongevity.Inthisstudy,women perception of self-efficacy and competence, and im-
with the highest levels of perceived stress had proved mood or more physically active lifestyle.
telomeresthatwere,onaverage,shortenedby1decade Midlarsky and Kahana (1994) associated adult altru-
when compared with low-stress women. Thus, stress ism—thatis,voluntarybehaviorthatis“motivatedby
accelerates aging and increases susceptibility to the concernforthewelfareoftheother,ratherthanbyan-
many illnesses for which age is the major risk factor ticipationofrewards”(p.11)—withimprovedmorale,
(Epel et al., 2004). self-esteem, positive affect, and well-being.
Cultivating loving emotions, engaging in helping Thementalhealthbenefitsofvolunteerisminclude
and self-forgetful activities, and a serene spirituality reductionindepressivesymptoms(Musick&Wilson,
may thus contribute to good health and longevity by 2003), happiness, and enhanced well-being (Krueger,
preventing the acceleration of aging at the cellular Hicks, & McGue, 2001). Schwartz et al. (2003) fo-
level. In commenting on this study, Sapolsky (2004) cusedonastratifiedrandomsampleof2,016members
indicates that, although more research is needed, the of the Presbyterian Church located throughout the
Epeletal.(2004)studypointstoapathwaybywhich UnitedStates.Thestudy’spurposewastoinvestigate
stress influences a fundamental aspect of the aging whetheraltruisticsocialbehaviorssuchashelpingoth-
process. ers were associated with better physical and mental
Whatdowereallyknow,scientifically,aboutaltru- health.Mailedquestionnairesevaluatedgivingandre-
ism,happiness,andhealth?(Rotzeinetal.,1994).Evi- ceivinghelp,prayeractivities,positiveandnegativere-
dencehasbeenaccumulatingforseveraldecades,and ligious coping, and self-reported physical and mental
research has clearly escalated since the late 1990s. health.Multivariateregressionanalysisrevealednoas-
sociationbetweengivingorreceivinghelpandphysi-
cal functioning, although the sample was skewed to-
Background of Existing Research ward high physical functioning. After adjusting for
age, gender, stressful life events, income, general
This section presents a brief overview of existing health, religious coping, and asking God for healing,
studies on altruism that are relevant to mental and bothhelpingothersandreceivinghelpwereassociated
physical health. with mental health (i.e., anxiety and depression).
Giving help was more significantly associated with
bettermentalhealththanwasreceivinghelp.Theau-
Mental Health
thorsconcludedthat“helpingothersisassociatedwith
Well-being consists of feeling hopeful, happy, and higher levels of mental health, above and beyond the
goodaboutoneself,aswellasenergeticandconnected benefits of receiving help and other known
68
ALTRUISM, HAPPINESS, AND HEALTH
psychospiritual, stress, and demographic factors” (p. havebenefits,andtoomuchvolunteeringtothepoint
782). The authors also add an important caveat that of strain “incurs just enough detriments to offset the
“feelingoverwhelmedbyothers’demandshadastron- potentialbeneficialeffectsoftheactivity”(Musicket
gernegativerelationshipwithmentalhealththanhelp- al.,1999,S178).Theresearchersaddedthat69%who
ingothershadapositiveone”(p.783).(Whethersome reportedvolunteeringdidsothroughareligiousorga-
formsofhelpingaremorerewardingthanothersisnot nization, but they found no relation between reduced
examined.) riskofmortalityandreligiousserviceattendance.Vol-
unteering, rather than its religious context, explained
the effect.
Physical Health
OmanoftheUniversityofCaliforniaatBerkeleyis
Areviewofexistingstudiesindicatesthatresearch oneoftheleadingresearchersinthisfield.Omanetal.
on the effect of kindness and volunteerism on health (1999) focused on 2,025 community-dwelling resi-
mayhavebeguninadvertentlyin1956,whenateamof dentsofMarinCounty,California,whowerefirstex-
researchers from Cornell University School of Medi- amined in 1990–1991. All respondents were 55 or
cine began following 427 married women with chil- olderatthisbaselineexamination;95%werenon-His-
dren under the hypothesis that housewives with more panicWhite,58%werewomen,andamajorityhadan-
childrenwouldbeundergreaterstressanddieearlier nualincomesabove$15,000.Residentswereclassified
than women with few children (Moen, Dempster- as practicing “high volunteerism” if they were in-
McCain,&Williams,1993).Surprisingly,theyfound volved in two or more helping organizations and as
that numbers of children, education, class, and work practicing “moderate volunteerism” if they were in-
status did not affect longevity. After following these volvedinone.Thenumberofhoursinvestedinhelping
womenfor30years,however,itwasfoundthat52%of behaviorwasalsomeasured,althoughthiswasnotas
those who did not belong to a volunteer organization predictive as the number of organizations. Physical
hadexperiencedamajorillness,comparedto36%who health status was assessed on the basis of reported
didbelong.Althoughapotentialconfoundingfactoris medical diagnoses, as well as such factors as “tiring
thatpeoplewhovolunteermaystartoutinbetterphysi- easily” and self-perceived overall health. Thirty-one
calhealth,thiswouldnotgreatlydiminishthestudy’s percent(n=630)oftheseelderlyparticipantspartici-
implications. patedinsomekindofvolunteeractivity,andabouthalf
AstudybyMusick,Herzog,andHouse(1999)ex- volunteered for more than one organization. Those
aminedthehypothesisthatoldervolunteersbenefitin whovolunteeredfortwoormoreorganizationsexperi-
terms of health as well as well-being. Based on data enceda63%lowerlikelihoodofdyingduringthestudy
fromanationallyrepresentativesample,thestudyused period than did nonvolunteers. Even after controlling
Coxproportionalhazardsregressiontoestimatetheef- forage,gender,numberofchronicconditions,physical
fects of volunteering on the rate of mortality among mobility, exercise, self-rated general health, health
persons65andolder.Thedataareamultistagestrati- habits (smoking), social support (marital status, reli-
fied area sample representative of the noninsti- gious attendance), and psychological status (depres-
tutionalizedU.S.populationaged25andolder;there- sivesymptoms),thiseffectwasonlyreducedtoastill
sponseratewas67%ofsampledindividualsand68% highly significant 44%.
forsampledhouseholds.Thedatawerecollectedover Observational physical performance measures and
threewaves:1986(n=3,617),1989(n=2,867),1994 self-reportedfunctioningmeasureswereincluded.So-
(n=2,348).Face-to-faceinterviewswereconductedin ciodemographicdatawerecollected,aswellasinfor-
the respondents’ homes. From mid-1986 through mation on social functioning and support. Frequency
March1994,deathswereascertainedthroughtracking of attendance at religious services was included in
andinterviewprocessesandviatheNationalDeathIn- the many social functioning questions. Psychological
dex.Respondentswereaskedwhethertheyhadvolun- measureswereimplementedaswell.Mortalitywasde-
teeredinthepastyearthroughareligious,educational, termined by screening local newspapers, attempted
political,seniorcitizen,orotherorganization.Respon- contact for reinterview at the time of a second inter-
dentswhohadvolunteeredwereaskedhowmuchtime view,andsubmissionofnamestotheNationalDeath
theyhaddevotedtovolunteerism.Controlledanalysis Index.Mortalitywasexaminedfrom1990throughNo-
indicated that the protective effects of volunteering vember13,1995,theclosingdateofthesecondexami-
“werestrongestamongthosevolunteeringforoneor- nation. During this follow-up period of 3.2 to 5.6.
ganizationorforlessthanfortyhours”(Musicketal., years,203(23.8%)menand247(21.1%)womendied.
1999,p.S175)andamongthosewholackedotherso- Remarkably, “the mortality rate of 30.1 among non-
cialsupports.Moderateamountsofvolunteerismwere volunteers declined by 26 percent to 24.2 (p = .04)
associatedwithloweredriskofdeath.Indeed,simply among moderate volunteers, and by an additional 50
addingthevolunteeringrolewasprotective(Musicket percentto12.8(p=.008)amonghighvolunteers(two
al.,1999).Oneneednotvolunteertoagreatextentto or more organizations)” (Oman et al., 1999, p. 307).
69
POST
Multivariateadjustedassociationsindicatedthatmod- Despite concerns that the longevity effects might be
eratevolunteerismwasnotstatisticallysignificantaf- duetoahealthierindividual’sgreaterabilitytoprovide
tercontrollingforhealthstatus.Highvolunteerismre- help,theresultsremainedthesameaftertheresearch-
mained significantly associated with lower mortality erscontrolledforfunctionalhealth,healthsatisfaction,
rates.Specifically,“the44percentreductioninmortal- health behaviors, age, income, education level, and
ityassociatedwithhighvolunteerisminthisstudywas otherpossibleconfounders.Theresearchersconcluded
largerthanthereductionsassociatedwithphysicalmo- that“Ifgiving,ratherthanreceiving,promoteslongev-
bility (39 percent), exercising four times weekly (30 ity, then interventions that are currently designed to
percent), and weekly attendance at religious services helppeoplefeelsupportedmayneedtoberedesigned
(29percent),andwasonlyslightlysmallerthanthere- sothattheemphasisisonwhatpeopledotohelpoth-
duction associated with not smoking (49 percent)” ers”(Brown,Nesse,Vonokur,&Smith,2003,p.326).
(Oman et al., 1999, p. 310; Oman & Reed, 1998).
Onacross-culturallevel,Krause,Ingersoll-Dayton,
Liang,andSugisawa(1999)attheUniversityofMichi- The Plausibility of Altruistic Causality
ganstudiedasampleof2,153olderadultsinJapan,ex-
amining the relations among religion, providing help Altruismresultsindeeperandmorepositivesocial
toothers,andhealth.Theyfoundthatthosewhopro- integration,distractionfrompersonalproblemsandthe
vided more assistance to others were significantly anxietyofself-preoccupation,enhancedmeaningand
more likely to indicate that their physical health was purposeasrelatedtowell-being,amoreactivelifestyle
better.Theauthorsconcludedthattherelationbetween thatcountersculturalpressurestowardisolatedpassiv-
religion and better health could be at least partly ex- ity,andthepresenceofpositiveemotionssuchaskind-
plainedbytheincreasedlikelihoodofreligiouspersons nessthatdisplaceharmfulnegativeemotionalstates.It
helping others. is entirely plausible, then, to assert that altruism en-
The benefits of altruism are not limited to older hances mental and physical health.
adults (Omato & Snyder, 1995); the differences in Itmustalwaysbekeptinmindthatsignificantfind-
health outcomes between helpers and nonhelpers is ingsregardinghealthinrelationtoaltruismandother
more difficult to detect in younger age groups, how- phenomenainpopulationstudiesareexpressed(a)on
ever,wherehealthisnotaffectedbysusceptibilitiesas- average, (b) across a given population, and (c) all
sociatedwithaging(Houseetal.,1982).Ironson,Solo- thingsbeingequal.Inotherwords,whatwecancon-
mon, and Balbin (2002) at the University of Miami clude,atbest,isthataltruismisoneofthefactorsthat
compared the characteristics of long-term survivors increasestheoddsofwell-being,betterhealth,orsur-
with AIDS (n = 79) with a HIV-positive comparison vivalinmanypeople;itisnoguaranteeofgoodhealth.
groupequivalent(basedonCD4count)thathadbeen This could be said of any ostensible protective fac-
diagnosedforarelativelyshortertime(n=200).These tors—forexample,gooddiet,lowbloodpressure,not
investigators found that survivors were significantly smoking, good family history, not living in poverty,
more likely to be spiritual or religious. The effect of nontoxic environment, and educational level.
spirituality and religiousness on survival, however, Studiesusingbiologicalmarkersprovideastronger
was mediated by “helping others with HIV.” Thus, basis for claiming that altruistic emotions and behav-
helping others (altruism) accounted for a significant iorscausebettermentalorphysicalhealth.Ifsomeone
partoftherelationbetweenspiritualityandreligious- isdepressedorphysicallydisabled,itislesslikelythat
ness and long-term survival in this study. he or she will engage in helping behaviors. In this
Brown et al. (2003) reported on a 5-year study in- sense,thereisaselectionofthehealthyintoaltruism,
volving 423 older couples. Each couple was asked andthispartiallyexplainsthebetterhealthofaltruists.
whattypeofpracticalsupporttheyprovidedforfriends However, there is more to this story. Other-regarding
or relatives, if they could count on help from others behavior orders and shapes the lives of individuals in
whenneeded,andwhattypeofemotionalsupportthey profound ways that improves their health and length-
gaveeachother.Atotalof134peoplediedoverthe5 enstheirlives.Peopleengagedinhelpingbehaviordo
years.Afteradjustingforavarietyoffactors—includ- generally report feeling good about themselves, and
ingage,gender,andphysicalandemotionalhealth— this has measurable physiological correlates. Studies
theresearchersfoundanassociationbetweenreduced usingbiologicalmarkerslookatindividualsbeforeand
risk of dying and giving help but no association be- afterengagementinaltruisticmoodsandbehaviorsand
tweenreceivinghelpandreduceddeathrisk.Brown,a indicate immune-enhancing biological changes (see
researcherattheUniversityofMichigan’sInstitutefor the section on physiological advantages).
Social Research, concluded that those who provided The argument for causality is further strengthened
no instrumental or emotional support to others were bytheinarguableassertionthatemotionalstatesofun-
morethantwiceaslikelytodieinthe5yearsaspeople selfishloveandkindnessdisplacenegativeemotional
whohelpedspouses,friends,relatives,andneighbors. states(e.g.,rage,hatred,fear),whichcausestressand
70
ALTRUISM, HAPPINESS, AND HEALTH
stress-related illness through adverse impact on im- specieswillevolvetotheoptimalpointofinvestment
munefunction(Fredrickson,2003;Lawleretal.,2003; of older adults in the well-being of grandchildren. In
Sternberg,2001).Thus,thecultivationofother-regard- otherwords,theselectiveadvantagetoyouthofgrand-
ingaffectionseliminatesnegativeemotionalstatesthat parenting may explain human longevity well past the
are often harmful to health. stageofreproductivepotential.Thereissomeevidence
Althoughitisthecasethatpeoplewhoarealtruistic thatnaturalselectionisatworkthroughtheimproved
must have some baseline of health and functionality, survivalratesofgrandchildrenwhoarehelpedbyboth
thisdoesdiminishtheplausibilityoftheassertionthat parentsandgrandparents.Thisholdstruetodayinava-
altruism itself contributes to health. Indeed, a rietyofethnicgroups,includingtheAfricanAmerican
nurse–doctor team based at Duke University Medical community(Gallup&Jones,1992).Arecentstudyin-
Centerstudiedhealthoutcomesofpatientswithcoro- dicates that older veterans with diagnoses of post-
nary artery disease, hypothesizing that volunteerism traumaticstressdisorder(PTSD)showreducedsymp-
may improve the health outcomes of patients previ- toms after caring for their grandchildren (Hierholzer,
ously hospitalized with this condition. The authors 2004).Ifolderadultsareorientedtowardhelpingbe-
drewonevidencefromtheDukeHeartCenterPatient haviorstowardgrandchildren,thishelpinginclination
Support Program, which is staffed by former cardiac can be manifested in a broader social generativity.
patientswhomakeregularvisitstocardiacinpatientsat
themedicalcenter.Thevolunteersreportthatthisrole
Possibilities for Physiologic Advantages
providesthemwithaheightenedsenseofpurposefor
continuedprogressandreducesthedespairordepres- Thefight–flightresponse,withitswell-documented
sion that is linked to increased mortality in these pa- physiological cascade, is adaptive in the face of per-
tients (Sullivan & Sullivan, 1997). ceived danger. If the threat continues for an extended
The idea that human beings are inclined toward period, however, the immune and cardiovascular sys-
helpfulprosocialandaltruisticbehaviorseemsincon- temsareadverselyimpacted,weakeningthebody’sde-
trovertible,anditishighlyplausiblethattheinhibition fenseandmakingitmoresusceptibletoabnormalin-
of such behavior and related emotions would be un- ternal cellular processes involved in malignant
healthy. What conceptual models would help explain degeneration (Sternberg, 2001). Altruistic emotions
the connection between altruism and health? Three cangaindominanceoveranxietyandfear,turningoff
closely interwoven models can be suggested: evolu- the fight–flight response. Immediate and unspecified
tionarybiology,physiologicaladvantages,andpositive physiologicalchangesmayoccurasaresultofvolun-
emotion. teering and helping others, leading to the so-called
helper’s high (Luks, 1988). Two thirds of helpers re-
portadistinctphysicalsensationassociatedwithhelp-
Evolutionary Psychology
ing; about half report that they experienced a “high”
The association between a kind, generous way of feeling,whereas43%feltstrongerandmoreenergetic,
life and health prolongevity can be interpreted in the 28% felt warm, 22% felt calmer and less depressed,
lightofevolutionarypsychology.Groupselectionthe- 21%experiencedgreaterself-worth,and13%experi-
ory,forexample,suggestsapowerfullyadaptivecon- encedfewerachesandpains.Despitethesereports,the
nectionbetweenwidelydiffusealtruismwithingroups physiologicalchangesthatoccurinthebodyduringthe
and group survival. Altruistic behavior within groups process of helping others have not yet been scientifi-
confers a competitive advantage against other groups callystudied.However,Fieldetal.(1998)showedthat
that would be selected for (Sober & Wilson, 1998). olderadultswhovolunteertogivemassagestoinfants
Members of a successful group would likely be in- atanurseryschoolhaveloweredstresshormones,in-
natelyorientedtoother-regardingbehaviors,theinhi- cluding salivary cortisol and plasma norepinephrine
bitionofwhichwouldnotbesalutary.Anthropologists and epinephrine. Lowering of cortisol is associated
discoveredthatearlyegalitariansocieties(suchasthe with less stress (Lewis et al., 2000).
bushmen) practice institutionalized or “ecological al- These are interesting results that resonate with
truism” where helping others is not an act of volun- Reisman’s(1965)“helper-therapyprinciple”—thatis,
teerism but a social norm. Perhaps those of us in that the agents of helping behavior benefit in many
contemporary technological cultures are isolated in ways.Itwouldbeusefultohaveadditionalstudiesof
variousrespectsandhavestrayedtoofarfromoutal- thephysiologicaleffectsofhelpingothers(Edwards&
truistic proclivities (Putnam, 2001). Cooper, 1988). Students who were simply asked to
Lee(2003)positsaconsiderableevolutionaryselec- watchafilmaboutMotherTeresa’sworkwiththepoor
tivepressureforaltruisticgenerativityinolderadults. and sick in Calcutta showed significant increases in
In contrast to other species, human beings live and the protective antibody salivary immunoglobulin A
work well past their reproductive years. Lee suggests (S-IgA) when compared with those watching a more
intergenerational transfer as an explanatory factor. A neutral film. Moreover, S-IgA remained high for an
71
POST
hour after the film in those participants who were and/or the recipient and about the physiological me-
asked to focus their minds on times when they had diators of the altruism–health relation (e.g., changes
loved or been loved in the past. Thus, “dwelling on inimmunefunction,endorphinproduction,norepine-
love” strengthened the immune system (McClelland, phrine levels, cortisol levels, and blood pressure)?
McClelland, & Kirchnit, 1988; McClelland, 1986). Doessustainedaltruismpromotehealth,psychological
well-being,andhigh-levelwellnessintheagentand/or
therecipientoveralongtime?Underwhatconditions
Positive Emotions May Protect
can altruistic actions become “burdens” rather than
or Distract from Negative Ones
sourcesofmeaningandfulfillment,andhowdospiri-
Anderson (2003) of the American Psychological tual-religious or other world views come into play?
Association highlights six dimensions of health: Can new assessment instruments for altruism and al-
truisticlovebedevelopedandvalidated?Howcancau-
(cid:127) Biology (biological well-being) sality be further clarified?
(cid:127) Thoughtsandactions(psychologicalandbehav-
ioral well-being)
(cid:127) Environment and relationships (environmental Public Health Significance
and social well-being) and Implications
(cid:127) Personal achievement and equality (economic
well-being) Analtruism–healthcorrelationappearsestablished.
(cid:127) Faith and meaning (existential, religious, spiri- Might generous emotions and behaviors be taught as
tual well-being) anaspectofmentalandphysicalhealthinschoolsand
(cid:127) Emotions (emotional well-being) the workplace? Could they even be prescribed by
healthcare professionals, as has been discussed ethi-
AccordingtotheAnderson(2003)model,positive callywithrespecttophysiciansandpatientspirituality
emotions(kindness,other-regardinglove,compassion, (Post, Pulchalski, & Larson, 2000)? Can we bring
etc.)enhancehealthbyvirtueofpushingasidenegative these empirical studies to the training of health care
ones.Thegenerousaffectthatgivesrisetoloveofhu- professionals and thereby encourage greater compas-
manity is usually associated with a certain delight in sionateloveinthemfortheirownsake,aswellasfor
theaffirmationofothers;itseemstocastoutthefear therapeutic efficacy?
andanxietythatemergefrompreoccupationwithself. Researchonthebenefitsofdoinggoodcouldspark
Andersondrawsonawealthofstudiestoconcludethat amovementinpublichealththatfocusesoncivicen-
“thebigthree”negativeemotionsare“sadness/depres- gagement and helping behavior within communities.
sion, fear/anxiety, and anger/hostility” (p. 243). It is Somuchofpublichealthisrightlyfocusedonenviron-
difficult to be angry, resentful, or fearful when one is mental toxins and the control of epidemics (McCul-
showing unselfish love toward another person. lough&Snyder,2000).However,apositivevisionof
Manyemotionscanevokethefight–fightresponse: publichealthmustnurturebenevolentaffectandhelp-
stress(fear,anxiety,worry,orsenseoftimepressure), ingbehavior.RoweandKahn(1998)pointtothepub-
aggressiveemotions(e.g.,anger,resentment,orbitter- lic health benefits of volunteerism for older adults.
ness from unforgiveness), and depressive emotions They include a brief discussion of some examples of
(e.g.,sadness;boredom;lossofpurpose,meaning,or volunteerism, pointing out that older adults for the
hope). The consequences of these negative emotional mostpartagreewiththesetwostatements:“Lifeisnot
responses are increased susceptibility to disease and worthlivingifonecannotcontributetothewell-being
worse health outcomes. Little research has examined of others” and “Older people who no longer work
theeffectsofaltruisticlove(compassion,kindness,de- should contribute through community service” (p.
siretohelpothers)onimmuneorcardiovascularfunc- 178).Theyalsopointoutthat“fewerthanone-thirdof
tion.Insofarasforgivenessisonemanifestationofal- alloldermenandwomenworkasvolunteersandthose
truistic love, it has been shown that unforgiving who do spend, on average, fewer than two hours a
thoughts prompt more aversive emotion and signifi- weekonthejob”(p.180).Ifthesefiguresarecorrect—
cantly higher heart rate and blood pressure changes andtheycanbedisputed—afirmlyestablishedassoci-
frombaseline.Thesefindingsuggestpossiblemecha- ation between helping behavior and longevity might
nisms through which chronic unforgiving responses encouragegreatervolunteerisminolderadults.Rowe
(grudges) may erode health, whereas forgiving re- andKahnurgevoluntaryassociationstolearnhowto
sponsesmayenhanceit(Lawleretal.,2003;Witvliet, “reach out to active and able elderly” (p. 180).
Ludwig, & Kelly, 2001). Theideaofprescribingaltruismasamatterofpub-
Of course, further research is always welcome: lichealthisnotunprecedented.Thenotionthatthereis
What more can we learn about altruism as a protec- aconnectionbetweenakindlygenerouslife,well-be-
tivefactoragainstmorbidityandmortalityintheagent ing,happiness,andhealthhasbeenunderstoodbyev-
72
ALTRUISM, HAPPINESS, AND HEALTH
ery mother who has instructed a sullen youngster to (24.0% of respondents), once in a while (22.3% of
“Gooutanddosomethingforsomeone.”Currentcon- respondents), and never or almost never (10.4% of
sensus indicates that helping behavior contributes to respondents). Feelings do not always translate into
diminished depression rates in adolescents (Commis- helping behavior, but these results are cause for hope
sion on Children at Risk, 2003). (Fetzer Institute, 2002).
Indeed, the transition in the 1820s in the United The essential conclusion of this article is that a
StatesandEnglandfromthemaltreatmentofmentally strongcorrelationexistsbetweenthewell-being,hap-
ill individuals—usually bound in shackles and physi- piness, health, and longevity of people who are emo-
callyabused—to“moraltreatment”wasbasednotonly tionally kind and compassionate in their charitable
ontreatingtheinsanewithkindnessandsympathybut helping activities—as long as they are not over-
onoccupyingtheirtimewithchoresandotherhelping whelmed,andhereworldviewmaycomeintoplay.Of
behaviors(Clouette&Deslandes,1997).Anotherex- course,thisisapopulationgeneralizationthatprovides
ampleofthetherapeuticuseofaltruismcanbefoundin noguaranteesfortheindividual.However,thereiswis-
the Twelve Steps of Alcoholics Anonymous (AA). dominthewordsofProverbs11:25“agenerousman
Step12requirestherecoveringalcoholictohelpother will prosper, he who refreshes others will himself be
personswithalcoholism.Theframeworkisoneofpar- refreshed” (Revised Standard Version). It can be said
adox:Therecoveringindividualwhohelpsotherswith thatagenerouslifeisahappierandhealthierone.The
thisdiseaseistodosofreelyandwithnoexpectationof freedomfromasolipsisticlifeinwhichonerelatesto
reward,“Andthenhediscoversthatbythedivinepara- others only in so far as they contribute to one’s own
doxofthiskindofgivinghehasfoundhisownreward, agendas,aswellasageneralfreedomfromthenarrow
whetherhisbrotherhasyetreceivedanythingornot” concerns of the self, bring us closer to our true and
(AA, 1952, p. 109). The AA member finds “no joy healthier nature, as all significant spiritual and moral
greater than in a Twelfth Step job well done” (AA, traditionsprescribe.Here,epidemiologyandthespiri-
1952,p.110).Thoseexperiencedwithrecoveringalco- tuality of love can enter a fruitful dialogue (Levin,
holicswillwidelyattestastohowimportantsuchindi- 2000).Lifecanbedifficult,anddeathshouldnotbede-
vidualsfeelhelpingothersiswithregardtotheirown nied.Love,however,makesthewayeasierandhealth-
continued recovery; however, much such helping be- ier both for those who give and those who receive.
haviorisineffectanAArecruitmentactivity.AAisin
certain respects a sectarian phenomenon, and such
groups do often tap into otherwise inhibited altruistic
capacities. References
Tociteasomewhatmorecontroversialinstanceof
untapped altruism in relation to well-being, Galanter Ainsworth,M.,Blehar,M.,WatersE.,&Wall,S.(1978).Patternsof
(1999), based on 2 decades of psychiatric research, attachment: A psychological study of the strange situation.
Mahwah, NJ: Lawrence Erlbaum Associates, Inc.
concluded that young people who join demanding
AlcoholicsAnonymous.(1952).Twelvestepsandtwelvetraditions.
charismatic groups are generally relieved of neurotic
New York: Author.
distress and depression through enhanced in-group Anderson, N. B. (2003). Emotional longevity: What really deter-
altruism, however much they may be subject to au- mines how long you live.New York: Viking.
thoritativemanipulationandmisplacedutopianideal- Bartrop,R.W.,Lazarus,L.,Luckhurst,E.,Kiloh,L.G.,&Penny,R.
(1977). Depressed lymphocyte function after bereavement.
ism. It is certainly not always the case that altruistic
Lancet, 1,834–836.
emotions and behavior are directed in worthwhile
Batten,H.L.,&Prottas,J.M.(1987).Kindstrangers—thefamilies
ways (Post, 1992). of organ donors.Health Affairs, 6(2), 35–47.
However, a great deal of altruistic idealism exists Brown,S.,Nesse,R.M.,Vonokur,A.D.,&Smith,D.M.(2003).
outsideofsuchcontexts.OneoftheoldestoftheNa- Providingsocialsupportmaybemorebeneficialthanreceiving
it:Resultsfromaprospectivestudyofmortality.Psychological
tionalOpinionResearchCenter’slandmarksurveysis
Science, 14,320–327.
the General Social Survey, which has been adminis-
Clouette,B.,&Deslandes,P.(1997).TheHartfordretreatforthein-
teredacrossanationalsampleofAmericans24times sane: An early example of the Use of “moral treatment” in
since1972.Its2002administration,withsupportfrom America.ConnecticutMedicine:TheJournaloftheConnecti-
theFetzerInstitute,includedanitemdevelopedbyDr. cut State Medical Society, 61,521–527.
CommissiononChildrenatRisk.(2003).Hardwiredtoconnect:The
Lynn G. Underwood, then with Fetzer, regarding un-
newscientificcaseforauthoritativecommunities.NewYork:
selfishlove:“Ifeelaselflesscaringforothers.”Based
Institute for American Values.
on sample methods of the American population that Danner,D.D.,Snowdon,D.A.,&Friesen,W.V.(2001).Positive
enjoythehighestlevelofconfidenceacrossahighlydi- emotions in early life and longevity: Findings from the nun
versifiedsamplepool,thefollowingresultswerefound study. Journal of Personality and Social Psychology, 80,
804–813.
withregardtothepreviousquestion:manytimesaday
Dulin,P.,&Hill,R.(2003).Relationshipsbetweenaltruisticactivity
(9.8% of respondents), every day (13.2% of respon-
andpositiveandnegativeaffectamonglow-incomeolderadult
dents),mostdays(20.3%ofrespondents),somedays service providers.Aging & Mental Health, 7,294–299.
73
POST
Easterbrook,G.(2003).Theprogressparadox:Howlifegetsbetter Levin,J.(2000).Aprolegomenontoanepidemiologyoflove:The-
while people feel worse.New York: Random House. ory,measurement,andhealthoutcomes.JournalofSocialand
Edwards,J.R.,&Cooper,C.L.(1988).“Theimpactsofpositive Clinical Psychology, 19,117–136.
psychologicalstatesonphysicalhealth:Reviewandtheoretical Lewis,T.,Amini,F.,&Lannon,R.(2000).Ageneraltheoryoflove.
framework.”Social Science and Medicine, 27,1447–1459. New York: Random House.
Epel,S.E.,Blackburn,E.S.,Lin,J.,Dhabhar,F.S.,Adler,N.E., Liang,J.,Krause,N.M.,&Bennett,J.M.(2001).Socialexchange
Morrow, J. D., & Cawthorn, R. M. (2004). “Accelerated andwell-being:Isgivingbetterthanreceiving?Psychology&
telomereshorteninginresponsetolifestress.”Proceedingsof Aging, 16,511–523.
the National Academy of Sciences, 101,17312–17315. Lawler,K.A.,Youner,J.W.,Piferi,R.L.,Billington,E.,Jobe,R.,
FetzerInstitute/NationalInstituteonAgingWorkingGroup.(2002). Edmundson,K.,&Jones,W.H.(2003).Achangeofheart:Car-
Multidimensionalmeasurementofreligiousness/spiritualityfor diovascular correlates of forgiveness in response to interper-
use in health research.Kalamazoo, MI: The Fetzer Institute. sonal conflict.Journal of Behavioral Medicine, 26,373–393.
Field,M.F.,Hernandez-Reif,M.,Quintino,O.,Schanberg,S.,& Luks,A.(1988,October).Helper’shigh:Volunteeringmakespeople
KuhnC.(1998).Elderretiredvolunteersbenefitfromgiving feel good, physically and emotionally. And like “runner’s
messagetherapytoinfants.JournalofAppliedGerontology,17, calm,”it’sprobablygoodforyourhealth.PsychologyToday,
229–239. 22(10), 34–42.
Frankl,V.E.(1956).Man’ssearchformeaning.NewYork:Pocket McClelland,D.C.(1986).Somereflectionsonthetwopsychologies
Books. of love.Journal of Personality, 54,334–353.
Fredrickson, B. L. (2003). The value of positive emotions: The McClelland,D.,McClelland,D.C.,&Kirchnit,C.(1988).Theef-
emergingscienceofpositivepsychologyiscomingtounder- fectofmotivationalarousalthroughfilmsonsalivaryimmuno-
stand why it’s good to feel good. American Scientist, 91, globulin A.Psychology and Health, 2,31–52.
330–335. McCullough,M.E.,&Snyder,C.R.(2000).Classicalsourcesofhu-
Galanter,M.(1999).Cults:Faith,healing,andcoercion(2nded.). manstrength:Revisitinganoldhomeandbuildinganewone.
New York: Oxford University Press. Journal of Social and Clinical Psychology, 19,1–10.
Gallop, G. H., & Jones, T. (1992). Saints among us. New York: Medalie, J. H., & Goldbourt, U. (1976). Angina pectoris among
Morehouse Group. 10,000 men. II. Psychosocial and other risk factors as evi-
Goode,W.J.(1959).Thetheoreticalimportanceoflove.American dencedbyamultivariateanalysisofafiveyearincidencestudy.
Sociological Review, 24,38–47. American Journal of Medicine, 60,910–921.
Goodkin, K., & Visser, A. P. (Eds.). (2000). Psychoneuro- Medalie, J. H., Stange, K. C., Zyzanski, S. J., & Goldbourt, U.
immunology:Stress,mentaldisordersandhealth.Washington, (1992).Theimportanceofbiopsychosocialfactorsinthedevel-
DC: American Psychiatric Association. opment of duodenal ulcer in a cohort of middle-aged men.
Harlow,H.(1958).Thenatureoflove.TheAmericanPsychologist, American Journal of Epidemiology, 136,1280–1287.
13,673–685. Midlarsky,E.(1991).Helpingascoping.ProsocialBehavior:Re-
Hendrick,C.,&Hendrick,S.(1986).Atheoryandmethodoflove. view of Personality and Social Psychology, 12,238–264.
Journal of Personality and Social Psychology, 50,392–402. Midlarsky,E.,&Kahana,E.(1994).Altruisminlaterlife.Thousand
Hierholzer,R.W.(2004)ImprovementsinPSTDpatientswhocare Oaks, CA: Sage.
fortheirgrandchildren.AmericanJournalofPsychiatry,161, Moen,P.,Dempster-McCain,D.,&Williams,R.M.(1993).Suc-
176. cessful aging.American Journal of Sociology, 97,1612–1632.
House,J.S.,Robbins,C.,&Metzner,H.L.(1982).Theassociation Morrow-Howell, N., Hinterlonh, J., Rozario, P. A., & Tang, F.
ofsocialrelationshipsandactivitieswithmortality:Prospective (2003). Effects of volunteering on the well-being of older
evidencefromtheTecumsehCommunityHealthStudy.Ameri- adults. Journals of Gerontology Series B-Psychological Sci-
can Journal of Epidemiology, 116,123–140. ences Social Sciences, 58(3), S137–145.
Hunter,K.I.,&Linn,M.W.(1980–1981).Psychosocialdifferences Musick,M.A.,Herzog,A.R.,&House,J.S.(1999).Volunteering
betweenelderlyvolunteersandnon-volunteers.International and mortality among older adults: Findings from a national
Journal of Aging and Human Development, 12,205–213. sample.JournalsofGerontologySeriesB-PsychologicalSci-
Ironson,G.,Solomon,G.F.,&Balbin,E.G.(2002).Spiritualityand ences Social Sciences,54(3), S173–S180.
religiousnessareassociatedwithlongsurvival,healthbehav- Musick,M.A.,&Wilson,J.(2003).Volunteeringanddepression:
iors, less distress, and lower cortisol in people living with Theroleofpsychologicalandsocialresourcesindifferentage
HIV/AIDS.Annals of Behavioral Medicine,24,34–40. groups.Social Science & Medicine, 56,259–269.
Isen,A.M.(1987).Positiveaffect,cognitiveprocessesandsocialbe- Nerem,R.M.,Levesque,M.J.,&Cornhill,J.F.(1980).Socialenvi-
havior. Advances in Experimental Social Psychology, 20, ronment as a factor in diet-induced atherosclerosis. Science,
203–253. 208,1475–1476.
Kiecolt-Glaser,J.K.,Preacher,K.J.,MacCallum,R.C.,Malarkey, Oman,D.,&Reed,D.(1998).Religionandmortalityamongcom-
W. B., & Glaser, R. (2003). Chronic stress and age-related munity-dwellingelderly.AmericanJournalofPublicHealth,
increases in the proinflammatory cytokine interleukin–6. 88,1469–1475.
Proceedings of the National Academy of Sciences, 100, Oman,D.,Thoresen,C.E.,&McMahon,K.(1999).Volunteerism
9090–9095. andmortalityamongthecommunity-dwellingelderly.Journal
Krause,N.,Ingersoll-Dayton,B.,Liang,J.,&Sugisawa,H.(1999). of Health Psychology, 4,301–316
Religion, social support, and health among the Japanese el- Omoto,A.,&Snyder,M.(1995).Sustainedhelpingwithoutobliga-
derly. Journal of Health & Social Behavior, 40,405–421. tion:Motivation,longevityofservice,andperceivedattitude
Krueger,R.F.,Hicks,B.M.,&McGue,M.(2001).Altruismandan- changeamongAIDSvolunteers.JournalofPersonalityandSo-
tisocialbehavior:Independenttendencies,uniquepersonality cial Psychology, 16,152–166.
correlates, distinct etiologies. Psychological Science, 12, Ornish,D.(1999).Loveandsurvival:Thescientificbasisforthe
397–402. healing power of intimacy.New York: Perennial Currents.
Lee, R. D. (2003). Rethinking the evolutionary theory of aging: Post,S.G.(1992).DSM-III-Randreligion.SocialScienceandMed-
Transfers,notbirths,shapesenescenceinsocialspecies.Pro- icine,35,81–90.
ceedings of the National Academy of Sciences, 100, Post,S.G.(2002).Unlimitedlove—altruism,compassion,service.
9637–9642. Philadelphia: Templeton Foundation Press.
74
ALTRUISM, HAPPINESS, AND HEALTH
Post,S.G.(Ed.).(2004).Theencyclopediaofbioethics(3rded.). vardMasteryofStressStudy.JournalofBehavioralMedicine,
New York: Macmillan Reference. 20,1–13.
Post,S.G.,&Binstock,R.H.(Eds.).(2004).Thefountainofyouth: Sapolsky,R.M.(2004).Organismalstressandtelomericaging:An
Cultural, scientific and ethical perspectives on a biomedical unexpectedconnection.ProceedingsoftheNationalAcademy
goal.New York: Oxford University Press. of Sciences, 101,17323–17324.
Post,S.G.,Pulchalski,C.M.,&Larson,D.B.(2000).Physicians Schwartz,C.,Meisenhelder,J.B.,Ma,Y.,&Reed,G.(2003).Altru-
andpatientspirituality:Professionalboundaries,competency, isticsocialinterestbehaviorsareassociatedwithbettermental
and ethics.Annals of Internal Medicine, 132,578–583. health.Psychosomatic Medicine, 65,778–785.
Post, S. G., Underwood, L. G., Schloss, J. R., & Hurlbut, W. B. Sober,E.,&Wilson,D.S.(1998).Untoothers:Theevolutionofun-
(2002).Altruismandaltruisticlove:Science,philosophyand selfish behavior.Cambridge, MA: Harvard University Press.
religion in dialogue.New York: Oxford University Press. Sorokin,P.A.(2002).Thewaysandpoweroflove:Types,factors,
Putnam,R.D.(2001).Bowlingalone:Thecollapseandrevivalof and techniques of moral transformation. Philadelphia:
American culture.New York: Simon & Schuster. Templeton Press. (original work published in 1954)
Rees, W. D., & Lutkins, S. G. (1967). Mortality of bereavement. Sternberg,E.M.(2001).Thebalancewithin:Thescienceconnecting
British Medical Journal,4,13–16. health and emotions.New York: Freeman.
Reisman,F.(1965).The‘helper’therapyprinciple.SocialWork,10, Sternberg,R.J.,&Barnes,M.L.(Eds.).(1988).Thepsychologyof
27–37. love.New Haven, CT: Yale University Press.
Russek,L.G.,&Schwartz,G.E.(1997).Perceptionsofparentalcar- Sullivan,G.B.,&Sullivan,M.J.(1997).Promotingwellnessincar-
ingpredicthealthstatusinmidlife:A35-yearfollow-upofthe diacrehabilitation:Exploringtheroleofaltruism.Journalof
HarvardMasteryofStressStudy.PsychosomaticMedicine,59, Cardiovascular Nursing, 11(3), 43–52.
144–149. Vaillant, G. E. (2002).Aging well.Boston: Little, Brown.
Rotzien,A.,Vacha-Haase,T.,Murthy,K.,Davenport,D.,&Thomp- Witvliet,C.V.,Ludwig,T.E.,&Kelly,L.V.L.(2001).Grantingfor-
son, B. A. (1994). A confirmatory factor analysis of the givenessorharboringgrudges:Implicationsforemotion,physi-
Hendrick-Hendrickloveattitudesscale:Wemaynotyethave ology and health.Psychological Science,12,117–123.
an acceptable model. Structural Equation Modeling, 1, Young,F.W.,&Glasgow,N.(1998).Voluntarysocialparticipation
360–374. & health.Research on Aging, 20,339–362.
Rowe,J.W.,&Kahn,R.L.(1998).Successfulaging.NewYork: Zisook, S., ed. (1987). Biopsychosocial aspects of bereavement.
Pantheon. Cambridge, UK: Cambridge University Press.
Russek,L.G.,&Schwartz,G.E.(1997).Feelingsofparentalcaring
predicthealthstatusinmidlife:A35yearfollow-upoftheHar-
75