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The Ethics of Positive Thinking in Healthcare … ________________________________________________________________________________________________________________________________ ____________ ________________________________________________________________________________________________________________________________Review Article ____________ ____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ ________________________________The ethics of ________________________________positive thinking in ________________________________healthcare ____________________________________________ ____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________________________________ Gabriel Andrade 1* 1.Assistant Professor, College of Medicine, Ajman University, United Arab Emirates. Abstract In continuation with the New Thought movement that arose in *Corresponding Author th the United States in the 19 Century, there is now a massive Gabriel Andrade self-help industry that markets books and seminars. This Al Jurf Complex, Flat No. 504, Building industry has also extended to healthcare in the form of positive No. 21, Ajman, United Arab Emirates. thinking, i.e., the idea that happy thoughts are essential for Tel: (+971) 54 45 62552 Email: [email protected] health. While some of these claims may seem reasonable and commonsensical, they are not free of problems. This article Received: 2 Sep 2019 posits that positive thinking has some ethical underpinnings. Accepted: 2 Dec 2019 Extreme positive thinking may promote alternative forms of Published: 21 Dec 2019 medicine that ultimately substitute effective treatment, and this Citation to this article: is unethical. The emphasis on positive thinking for cancer Andrade G. The ethics of positive patients may be too burdensome for them. Likewise, thinking in healthcare. J Med Ethics Hist unrestricted positive thinking is not necessarily good for mental Med. 2019; 12: 18. health. After considering the ethics of positive thinking, this article proposes a more realistic approach. Keywords: Positive thinking; Self-help; Cancer; Healthcare; Positive psychology MEDICAL ETHICS AND HISTORY OF MEDICINE OF MEDICAL HISTORY ETHICS AND Journal of © 2019 Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences. All rights reserved. Volume 12 Number 18 December 2019 1 The ethics of positive thinking in healthcare … Introduction: world as a hopeless place. Perhaps the most Pessimism and Optimism as notorious of all pessimist philosophers, Philosophies Arthur Schopenhauer, presented this view in no ambiguous terms: “Human life must be “Positive thinking” suggests that in order to some kind of mistake. The truth of this will accomplish good things and pursue be sufficiently obvious if we only remember happiness, human beings must constantly that man is a compound of needs and have positive thoughts and prevent negative necessities hard to satisfy; and that even thoughts from entering their mind. This can when they are satisfied, all he obtains is a be done by envisioning success, repeating state of painlessness, where nothing remains constant affirmations, continuously saying to him but abandonment to boredom. This is good things to oneself in order to build self- direct proof that existence has no real value esteem, and arousing happy thoughts that in itself; for what is boredom but the feeling may block stressing ideas from one’s mind. of the emptiness of life?” (1). Although he In the last three decades, this trend has been founded no school of philosophy, massively popular in psychology, and it has Schopenhauer had considerable influence also been extended to healthcare and the over thinkers such as Nietzsche and Freud, business world. Positive thinking is also the both of whom also leaned towards grim foundation of the self-help industry, which is understandings of human nature and the estimated to make around 10 billion US$ world. More recently, philosopher David every year in products such as books and Benatar is so disappointed with life, that he seminars. The healthcare industry has also makes the ethical case for not having borrowed ideas from this movement by children: “Each one of us was harmed by assuring patients that their prognosis will be being brought into existence. That harm is dramatically improved if they think positive not negligible, because the quality of even thoughts. the best lives is very bad – and considerably Although it may seem like a recent worse than most people recognize it to be. phenomenon (with all the marketing Although it is obviously too late to prevent MEDICAL ETHICS AND HISTORY OF MEDICINE OF MEDICAL HISTORY ETHICS AND Journal of techniques of advanced capitalism), in fact, our own existence, it is not too late to positive thinking is a very ancient prevent the existence of future possible movement, long defended by many people” (2). philosophers. Some philosophers are By contrast, religious thinkers tend to affirm optimists; others are pessimists. The the other end of the spectrum, i.e., optimism. dialectic between optimism and pessimism In their view, inasmuch as the world is is an ancient one, and to a certain extent, God’s creation, by necessity it is a good discussions about the merits of positive place. Obviously, there appear to be many thinking in healthcare and elsewhere reflect imperfections in the world, but these this ancient dialectic. philosophers typically go to great lengths in Pessimist philosophers are prone to see the order to prove that those imperfections are 2 Volume 12 Number 18 December 2019 Andrade G. actually part of a cosmic plan for a greater shall see, The Secret, a major promoter of good. This approach, known as “theodicy”, positive thinking, relies on a variant of attempts to justify God’s ways to man, and Hindu idealism adapted to Western cultural by doing so, attempts to present the world in markets. an optimistic light. Perhaps the most This is in fact a major shortcoming of notorious philosopher in this regard was positive thinking in the West. In non- Leibniz, who affirmed that this is by Western cultures, there are numerous necessity “the best of all possible worlds” traditions that posit specific ideas about (3). wellness. In the last century, these ideas Leibniz’ brand of optimism was more have been introduced in Western cultures, cosmic, and it did not provide much solace and they have been applied in very different to people. In his philosophy, the world may contexts from where they originally arose. seem like a terrible place, but in fact, it is the The result has often been a misapplication of best one there can ever be. By contrast, some these ideas to entirely different cultural American philosophers and religious authors settings (such as Ayurvedic medicine in the were presenting a more radical form of West), with negligible results. th optimism by the 19 century. This school of Schopenhauer’s gloomy approach is thought came to be known as New Thought certainly not supportive of health. Although (4), and its main principle was that “our Schopenhauer was not apologetic about mental states are carried forward into suicide, his pessimistic views about the manifestation and become our experience in human condition and the purpose of life may daily living” (5). This basically means that easily lead to neglect of health, for one may our minds are sufficiently powerful to bring wonder what the point of healthy living is, if about whatever we desire, also presented in life is horrible anyways. Yet, the kind of the phrase “mind over matter”. In religious optimism embraced by Leibniz and the New terms, this was upheld by the Christian Thought movement is not without its Science, a movement founded by Mary problems. In fact, although Voltaire’s Baker Eddy, whose main thesis is that Candide is not an entirely accurate MEDICINE OF MEDICAL HISTORY ETHICS AND Journal of disease is fundamentally a state of mind that representation of Leibniz’s philosophy, he can be mentally reversed. did raise a legitimate criticism: sometimes In the late 20th century, this approach was optimism can be as cruel as pessimism. To additionally upheld by New Age spirituality. tell someone that they must cheer up in the New Age actually encompasses a wide face of tragedy because this is the best of variety of beliefs, but one of its recurring possible worlds, or because in every crisis themes is the appeal to Hindu idealist there is an opportunity, is despotic on its traditions. According to these doctrines, the own. material world is an illusion, and it can be Voltaire was not a pessimist. In fact, he changed with the power of the mind. As we seemed to lead a happy life, and he was Volume 12 Number 18 December 2019 3 The ethics of positive thinking in healthcare … confident that Enlightenment was guiding positive thinking has increasingly become humanity through a good path
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