Click here to listen to the exclusive BHC audio interview with Dr. Ellen Langer.

By Robin Jay, BHC Editorial Director

The life and work of Harvard psychologist and author Ellen Langer, Ph.D. is about to get the big-screen treatment. Her book, Counterclockwise: Mindful Health and the Power of Possibility, is being adapted into a major motion picture scheduled for release in 2010. Langer will be played by Jennifer Aniston.

For more than three decades, Langer has studied the mind-body connection, demonstrating that changing one’s mind — becoming mindful of subtle changes and being aware of the power of possibility — could lead one’s body to optimize health and turn back the clock psychologically and physically.

In her book Counterclockwise: Mindful Health and the Power of Possibility, Langer says that focusing on what’s possible, instead of relinquishing hope based on what’s thought not to be possible, can promote better health — no matter how old you are. Langer titled her book after a groundbreaking 1974 “Counterclockwise” study in which she virtually recreated the year 1959 in an area monastery. From the furnishings to the television programs, music, newspapers and daily discussion, everything was retrofitted to a time some 20 years earlier. Langer sought to discover whether returning the mind to an earlier, healthier era could also return the body to a healthier state.

When the study participants — elderly men who at first appeared to be frail and dependent — lived in this environment for a week, the results were nothing short of amazing. Their height, weight, gait, posture, hearing, memory, appetite, dexterity, arthritis, blood pressure and general well being improved in those mere seven days. “We even took photographs of them at the beginning, and at the end of the week,” Langer says. “People who knew nothing about the study evaluated the photos. And according to these unbiased witnesses, they [the elderly men] even looked younger. The ‘magic’ lies in being aware of the ways we mindlessly react to social and cultural cues.”

Many studies of this nature led Langer to the psychology of possibility — putting the mind in a healthy place and then measuring changes in the body. Another interesting example was a study she conducted with chambermaids. These women cleaned rooms, made beds and worked very vigorously in their jobs. But when Langer and her graduate students asked the chambermaids how much exercise they got, they said they didn’t do any exercising.

Even though Langer knew the chambermaids’ work alone was strenuous daily exercise, she found it surprising that they were less healthy than their socioeconomic equivalents. So Langer split the group of chambermaids into two groups. To one group, she explained that their work was indeed a form of exercise — that making a bed was like working on a machine at the gym. The other group was told nothing. Some time later, Langer’s team returned to interview and test the health of the chambermaids. They hadn’t changed how they worked, they hadn’t changed their eating habits and they hadn’t started exercising outside of work, but the chambermaids who were taught to think of their work as exercise showed astounding differences in health compared to the women who continued business-as-usual. “All we did was teach them to view their work differently, to have a different mindset,” Langer says. “We found that they lost weight, there was a positive change in their waist-to-hip ratio and body mass index, and their blood pressure came down — all because of the change in mindset.

“Mindfulness — the simple act of noticing new things — is crucial to our health in several ways. First, when we’re mindless, we ignore all the ways we could exercise control over our health. We turn that control over to the medical world alone and accept limits, which closes us off to the power of possibility.”

In Counterclockwise, Langer also calls for clinicians to change their mindset about how they approach and speak to patients. “Examining the hidden decisions and vocabulary that shape the medical world — like ‘chronic’ versus ‘acute,’ ‘cure’ versus ‘remission,’ the powerful physical effects of placebos, and the intricate but often defeatist ways we define our physical health — the limits that we assume are real need not necessarily exist at all. With only subtle shifts in our thinking, our language, and our expectations, we can begin to change the ingrained behaviors that sap health, optimism and vitality,” she says. “In this context, let’s compare chronic verses acute. The medical world might tell us that we have a chronic illness — an uncontrollable condition. But the reality is that nothing is uncontrollable. You can’t prove uncontrollability — all you can prove is that we haven’t yet figured out how to control it. And that’s very different. So if you believe something absolutely can’t be controlled, you don’t attempt to control it. If you believe maybe it can and we just don’t know yet, then you might take steps to exercise control over your health with that chronic illness.

“Let’s take depression. It’s going to be the same reasoning: that if many people who are depressed think that they are depressed all the time, they think they can’t do anything about it and so they don’t do anything about it. But if they are taught to believe that they can do something about it, they’d start to notice when they’re depressed and when they’re not depressed [and perhaps learn to avoid things that make them depressed.]”

In Counterclockwise, Dr. Langer talks about a study that shows reducing hypertension or high cholesterol will on average add to longevity — and that actually having a positive attitude and mindfulness may even help you live longer. But, Langer also points out that relying too heavily on health-related numbers may cause more harm than good. “Let’s say you go to the doctor and you take your blood test and you find out you have very high cholesterol level. High cholesterol is just correlated with certain diseases. It doesn’t cause it necessarily — it’s just related to it. By worrying about your cholesterol level being so high, that stress actually may be responsible for some of the illness that results. But I think even more interesting is turning it around and taking the end where people are given numbers that are glorious. ‘Wow, my cholesterol level is as if I’m 20 years younger.’ And they feel very proud of that. They take that to mean that they’re healthy.

“Now what happens if you believe that you are completely healthy? You might not pay attention to subtle changes [like diet and exercise.] If you paid attention to them, you could make changes and stay healthy. The larger point with all of this is that everything is in flux. Not only are things different at any point in time, they look different from different perspectives. What we’ve learned to do as a culture is to hold things still. And by doing that, we’re not able to find what’s possible. I think that when we start searching for all of the things that can be improved, we’re going to be surprised at what’s possible. I’m not saying you should ignore your doctor — not at all. Doctors may know what is normatively true — true for most people, and that is useful. But none of us is the norm and only we have information about our unique selves. We need to work together to manage our health, and enlist the medical world as helpers rather than turning ourselves over unquestioningly to the medical world.”

For more information about Counterclockwise: Mindful Health and the Power of Possibility (Ballantine Books), go to www.ellenlanger.com. To listen to the BHC interview with Dr. Langer, click on the media player at the top of this page, or read the transcript that follows.

BHC: Dr. Langer, in Counterclockwise you talk about the psychology of possibility and the power of possibility. Tell us about that and how you came to write Counterclockwise.

Ellen Langer: Well, in studying the elderly for so many years, it seems to me that there are many alternative explanations for the behavior that people expect as you get older.

Let me just take memory for example. It occurred to me that so many changes occur as we get older that this idea of memory loss might not be as wired in as people think, might not be as necessary. Now if you think about it, as you get older, you care less about many things. For the young person, they assume their name and whatever they’re talking about is crucial for the older person, they might listen politely. But if you don’t learn the information in the first place, then later when you don’t know it, it’s not because you’ve forgotten it. You have to learn it before you can forget it. So differences in motivations, intentions are often misunderstood as memory loss.

Let’s take the older person who is retired, for example, but still invited to the company party. Well, all during the time from the moment the invitation is sent out, people at work are talking about it, so they get many reminders. They’re deciding what to wear, who is going to go, how they’re going to get there, and so on. The person who is retired has one reminder, so that when everybody remembers, except that retired person, is it fair to say that their memory is less good? I think that what we tend to do is see old people and presume they have the same attentions and motivations as the rest of us.

So once I started with the idea of looking for alternatives to what may be, what is typically taken as debilitations, I raised the question for myself of a more general question of, “Well, how do we know that any of the decrements have to be?” From there, I thought there are so many mindsets that we have, so much mindlessness about all of these losses in performance that keep us in this negative place. What if we could remove those negative mindsets?

For the Counterclockwise study itself, what I said was, “Okay, we have a mind and a body.” Descartes talked about mind-body dualism a long time ago and that always raised a problem. How do you get from this fuzzy thing, this non-material mind, to this material thing, this body? And I thought that asking that question was what was holding up a lot of progress. So I said, “Well let’s — even just for useful purposes — forget about anything theoretical. Let’s put the mind and the boy back together, and then wherever we’re putting the mind, we’re necessarily putting the body.” So I put the mind in all sorts of good places, and lo and behold, the body seems to cooperate.

In the Counterclockwise study, we took old people and put their minds back 20 years earlier. We had them live as if it was in fact 20 years earlier. They spoke about past events in the present tense. They were living in an environment that was retrofitted to that time period and the results were close to amazing. Their vision improved, their hearing improved [and] their cognitive abilities improved. We’ve even taken photographs of them at the beginning, and at the end of the week, people who knew nothing about the study evaluated the photos. According to these unbiased witnesses, they even looked younger. That study was done awhile ago.

Then I followed up with many new studies. What it was becoming for me — the psychology of possibility — was where we again were going to put the mind in a healthy place and measure the body. So as an example of one of these, we did a study with chambermaids. This is fascinating to me in that chambermaids are these women who are working and exercising all day long. That’s all they do. That’s what their work is, exercise. When we asked them how much exercise they get, remarkably they said they don’t get any exercise. That’s not what we were after to start, but that was rather interesting. That’s because the surgeon general defines exercise as that which you do after work, because he — typically like most white collar people — is sitting behind a desk and not exercising.

So now, the first question was if exercise is so good for your health and these women are exercising all day long, why is it that they’re less healthy then socioeconomic equivalent others? Then we simply took half of them and we said, “You know, your work is exercise. In fact, making a bed is like working on this machine at the gym.” And that’s all we did was teach them to view their work differently, to have a different mindset. Now we took as many measures as we could think to take and then when we came back we asked them, “So are you eating any differently?”

And they said, “No not at all.”

“Are you working any harder?”

“No.”

We said, “Oh, is she working any harder?” We checked on this as many ways as we could. “Are you exercising outside of work?”

“No.”

Everything was the same, except for the change in mindset. And we found that they lost weight, there was a change in their waist-to-hip ratio and body mass index, and their blood pressure came down — all because of the change in mindset.

So I’ve done a series of these sorts of studies that are all reported in the Counterclockwise book, and they all basically start with the idea that most of what we think are our limits are just our mindsets. We really don’t know what we’re capable of. When you look at medical science, for example: medical science can give you what’s normatively true — what’s true for most people most of the time. Although what happens is, after a experiment is conducted, that probability is translated into an absolute statement. And therein lies the problem: If you think that something absolutely can’t be, you’d be foolish to try it. When you recognize that maybe for most people, much of the time, it might not be, then all of the sudden, it’s not so foolish to try to reverse things that are supposedly irreversible.

In the book, I also take a close look at language. In this context, let’s compare chronic versus acute. The medical world might tell us that we have a chronic illness — an uncontrollable condition. But the reality is that nothing is uncontrollable. You can’t prove uncontrollability. All you can prove is that we haven’t yet figured out how to control it. And that’s very different. So as I just said a moment ago, if you believe something absolutely can’t be controlled, you don’t attempt to control it. If you believe, “Well maybe we just don’t know yet,” then you might take steps to exercise control over your health with that chronic illness.

In thinking about it further, it occurred to me when people have chronic illnesses, that’s what happens. Because you don’t think you can control it, you don’t pay any attention to it. But if you do pay attention to it, what you find is that you don’t have the symptoms all the time.

So then I ask, “Well, what’s happening at those times you don’t have the symptoms?” Let’s take an easy one. Let’s take depression. So physical, psychological disorders — whatever, it’s going to be the same reasoning: That if many people who are depressed think that they are depressed all the time, (again no one is depressed all the time, and even when you’re depressed, often it’s not to the same degree), if you think you’re depressed all the time, you can’t do anything about it. You don’t do anything about it. But if you believe maybe you can do something about it, you’d start to notice when you’re depressed and when you’re not depressed.

Let’s say when I’m speaking to you on the phone and I’m not depressed. But when I’m speaking to somebody else, I am depressed. Well, if I notice that, then one of the solutions is right at hand: I should spend my time speaking to you when I want to be on the phone and not to this other person. It’s like asthma. If I find that when I’m at work, I need that inhaler a lot, but when I’m visiting friends, I don’t need the inhaler, well again, that tells me that I have to orient myself towards work differently or perhaps change jobs.

So the larger point is that when we attend to variability, that’s the essence of being mindful. As I have studied it for over 30 years — noticing differences, noticing when it’s more, when it’s less — it gave rise to the question, “Well, why now is it less, and can I harness that in someway?”

And then you begin. The interesting thing to me is that when we begin to try to heal ourselves in this way, even if we’re not successful — which I think we will be most of the time — but even if we’re not, the very journey in searching for these ways and noticing new things is going to be good for our health and well being. For thirty-some-odd years of research, mindfulness — mindfulness as I study it, which is the simple act of noticing new things — is literally and figuratively enlivening.

We also do many of these studies with young people, but when we do these studies with the elderly, and we teach them to be more mindful, just notice new things, they end up living longer. So attempting to positively influence our health is good for our health, even if the ways we’re trying to influence it turn out not to be successful in and of themselves. So it’s a win-win situation.

BHC: It sounds like it’s almost like having will. People who have a strong will to do something are more likely to succeed because they’re going to be looking for ways to achieve.

EL: Yes, but I think that when we talk about having the will, then it sounds like we’re talking about personality. Some people are just sort of built like that, eager to try to overcome obstacles. And that’s true, but it’s also true that even the cynics among us are able to improve, and will do so once they recognize that all the reasons that they think they can’t are faulty. So you start off with, “Well, gee, I thought I couldn’t do this. Maybe I can.” Then many people are going to try. But if you say, “I can’t do it, it can’t be done,” you’re not going to try even if you say have the will to do it. Why do it if it’s useless?

BHC: If it’s hopeless.

EL: Right.

BHC: And in your book, Dr. Langer, you talk about a study that showed that typically reducing your hypertension or having a good cholesterol level will on average add so much to longevity, and that having a positive attitude and mindfulness may actually even help you live longer. Can you talk about that?

EL: It’s interesting. That’s why I might have said having good numbers as the medical world gives us — blood pressure, pulse or cholesterol level — that’s its very nice when those numbers fall in the very healthy range. But I think that there’s a problem in putting too much weight on all of those numbers as well.

Let’s say you go to the doctor and you take your blood test and you find out you have very high cholesterol level. High cholesterol is just correlated with certain diseases. It doesn’t cause it necessarily. It’s just related to it. By worrying about my cholesterol level being so high, that stress actually may be responsible for some of the illness that results. But I think even more interesting is turning it around and taking the end where people are given numbers that are glorious. “Wow, my cholesterol level is as if I’m 20 years younger than I am.” And they feel very proud of that. They take that to mean that they’re healthy.

Now what happens if you believe that you are completely healthy? You might not pay attention to subtle changes. If you paid attention to them, you could make changes and stay healthy. By analogy, let’s say you just put in a smoke alarm. Smoke detectors in the house make you feel safe. Now how much smoke has to be in that house before you’d recognize that in fact there’s a fire because the smoke alarm wasn’t working, for example? What I’m suggesting is that when you have bad numbers, you get stress that’s not good for your health. When you have good numbers, you don’t pay attention to yourself, and that’s not good for your health.

So I think that the numbers, while helpful — we as a culture are putting too much emphasis on them. What we need to do is to tune in and notice subtleties, which as I’ve already said is good for you in and of itself. But also then we get to avert the danger not yet arisen.

Let’s take weight. If you don’t notice until you’ve gained 20 pounds, it’s much harder to fix a situation than if you noticed when you gained a couple of ounces. If we tune into our bodies — not in a hypochondriacal or neurotic way, but just notice how we’re feeling — then we can fix things before things get too out of whack.

Or another example is you’re driving along and if you’re not attuned to the way the car sounds, then all of the sudden the engine falls through wherever the engine can fall through. I know nothing about cars, but where, “Oh, my goodness!” If you had noticed slight changes in the sound early on, then you might just have needed some fluid or a belt tightened or whatever else can be fixed on a car. So we need to tune back in to our bodies and take control back of our health and enlist the medical world as helpers. But we need to stay in charge.

BHC: You mentioned a funny point in your book about when you ask an audience about their cholesterol numbers. Please tell that story.

EL: I lecture on this so it’s such fun. After I talk about mindfulness and mindlessness — meaning being we’re holding things still thinking we know it, when in fact we don’t — instead of noticing differences, that tunes us into the uncertainty, and then we stay in the present and can fix what needs fixing. So I’m going on about some of the research we’ve already spoken of and then I say, “Does anybody here know their cholesterol level?”

There’s usually somebody waving their hand, very excited, which clearly then they were given good numbers, and I ask them, “What is your cholesterol level?” And the person tells me with a big grin on his or her face. Then I ask them, “Well when did you have it measured last?” And they might say, “Four months ago.” And then I ask, “Well, you haven’t eaten or exercised since?” And if they don’t get the point, then I say, “And if you never get it measured again, you’ll die a healthy person.”

We have this overwhelming tendency facilitated by the medical world unintentionally, with some of them giving us these numbers of holding everything still. Nothing stays still, and once we recognize that, we confuse the stability of our mindsets. We’re holding things still with our minds, but things all the while are changing. Then, we would recognize that control comes from noticing these changes. It’s very funny, because we hold things still in order to have some control. But because it is not really staying still, we actually are losing control.

BHC: Dr. Langer, we know what the message is to the person who is aging, that they become more mindful. But I’d also like to talk about: What are the messages for those who are caregivers and may be coddling and taking as set-in-stone what these messages from doctors might be? I’d also like to talk about what doctors can do to get out of this mindset.

EL: If you’re caring for somebody ill — it doesn’t even have to be somebody elderly but in either case — what you want to do is tune in to these subtle changes. But rather than the subtle changes in your own body, you want to notice it in this person that you care for.

And in doing so, that makes the whole caregiving more mindful. You end up feeling better, enlivened literally and figuratively. The person ends up feeling more cared for and then you have the change in recognizing that when you move this way it hurts, when you move that way it doesn’t hurt; at these hours in the morning you seem better than those hours in the morning. And all of that again can lead to questions of why, and then what might we do about it?

I cared for my father for a year before he died. He was 89 years old. And some thought that because he was having some memory problems that he was becoming senile. What I recognized in doing what I’m suggesting everybody does, is that. “Gee, he was remembering a lot more than he was forgetting.” And when you recognize how much one is remembering, how much one is able to do, you treat them differently and you treat them with more respect and more expectation that they’re going to do well. People can feel the way we feel about them, and it ends up in a positive cycle. You expect me to do well, then I come to expect myself to do well, and I tune in differently and I start doing better.

I tell a story in the book about this idea that as we get older, everything falls apart. This is so pervasive even with all the years that I’ve researched it. You can’t get away from it. And I’m playing cards with my father, which we had played for years when I was young, and I’m thinking, “Well, should I let him win?” It’s terribly condescending. This is the man who taught me how to play, never playing gin as if I am a professional card player, but just as a fun activity. And while I’m going through, “Should I let him win? Shouldn’t I let him win?”, all of a sudden he says, “Gin!” and he beat me.

The point is, why should that be a surprise that he won? He always won. Why all of a sudden would he not win? And he might not have won, but the point is that once you show a few signs of loss and you’re at a certain age, then the whole world conspires against you, expecting that all that’s going to happen is loss. Most of the time people are functioning rather well. And when we notice these things, we give them feedback and feel ourselves more positive towards them. All of that tends to work to improve health.

The last part of your question: What should the medical world do? And it’s the same thing. We’re working on changing medical checklists. You know, when you come back into the country after traveling and you have to fill out these little forms and it asks you, “Are you bringing any vegetables?” And after you see the first two questions you just say, “No, no, no, no.” You don’t even read them, right?

That’s the way that most checklists are. You really don’t need to pay any attention to them. But we would like to create these checklists so that before anybody — nurse, doctor — can check it off, they have to actually look at the person and notice. And in the noticing, again, you’re going to see more things are changing. They’re not staying the same. If you tune in to those differences, it becomes much more engaging for you, the medical person, and again, so then you’re more mindful and you’re enjoying your work more and so on. If everybody paid attention to the health, not just to the illness of the person — to all those parts that were working and all the parts that are working that don’t work the times that they actually do work. So, as you said, nobody forgets everything. Even if you’re paralyzed, nothing stays exactly the same. So there are subtle changes, and if you tune in to the subtle changes, big things can happen.

I report a case in the book where I have this suggestion for what I call reverse Zeno strategy. Zeno had this paradox with respect to distance, that if you always go half the distance from where you are to where you want to get to, you’re never going to get there. It’s a foot away, it’s six inches away, three inches, an inch and a half, and you just keep going, a tiny, tiny bit, always.

I use the reverse version of that, that there’s always a distance from where you are to where you want to get to that you can travel that distance. So if you can’t go the foot, maybe you can go six inches. If you can’t go six inches, maybe you can go three inches, and just keep lowering it until you find that space.

I was in this nursing home asking people what is it they’d like to do that they couldn’t do now. This one woman, very sweet, said she was paralyzed and she couldn’t blow her nose. For her, that was humiliating. That’s when I developed the reverse Zeno strategy. I said okay, lift your arm to here. And she couldn’t do that, so I brought it down to half of that. She couldn’t do that. I kept bringing it down to where I found a place where she was able to move her arm, because nothing stays exactly still. And then from that point, we went and we did this again, over and over again over the course of some time. At the end of all of this she was able to blow her nose.

The larger point with all of this is, everything is in flux. Not only are things different at any point in time, they look different from different perspectives. What we’ve learned to do as a culture is to hold things still. And by doing that, we’re not able to find what’s possible. I think that when we start searching for all of the things that can be improved, we’re going to be surprised at what’s possible.
 

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