Health psychology: concepts, applications, and practice

Dean Ornish in his 2008 TED talk on "natural healing" presents a simple, low-cost and effective plan for disease prevention and management through lifestyle change. Ornish breaks down the areas of discussion into four basic subjects: diet, smoking cessation, obesity, and finally the "psychosocial" implications of health and how to address them in practice. The thread that runs through all these four topics is Ornish's insistence that "the body can heal itself if given half a chance." The lifestyle changes he offers by way of disease prevention are not just a better option than more drastic medical intervention when the disease has progressed, Ornish compares any kind of medical solution without prevention is like "mopping up a floor without turning off the faucet." And as he notes later in the talk, large-scale lifestyle changes may be viewed as disruptive, but the decision to have children is such a large-scale lifestyle change which does not seem terrifying or difficult to the average parent.

Ornish's "optimal lifestyle program" begins with diet: the ideal diet here is low in fat, and uses a lot of whole foods and plant-based foods. Ornish wants to emphasize, though, that not only are dietary changes an effective way of disease prevention, such changes (if adhered to strictly) can also reverse the progress of disease. He offers statistics where, in cases of coronary artery blockage, dietary change can help the patient recover as surely as drastic surgical interventions. (Part of the problem here, Ornish ruefully notes, is that insurance companies will cover the cost of an angioplasty but not of dietary changes. Yet he points out that eighty percent of patients could avoid the angioplasty merely through the dietary changes, which is cost-effective for those same insurance companies.

Ornish presents his "optimal diet" later, during his extended discussion of the obesity epidemic: it is low in fat and "bad carbs" (sugars, alcohols, white flours) and high in "good carbs" (whole grains, vegetables) and omega-3 fatty acids. He takes time to outline his quarrel with the notorious Atkins diet, which promotes weight loss through high fat content combined with low "bad carbs." He is happy to agree with the late Dr. Atkins on the necessity of reducing intake of "bad carbs" and their effect on insulin levels which hinder weight loss. But Ornish says that the Atkins diet mortgages one's health for the sake of temporary weight loss, and is based on a "half-truth" -- he shows how the high fat content of the Atkins diet leads to heart disease. In fact, Ornish sees fats like carbs: there are, in fact, good fats (the omega-3 fatty acids found in fish oil and elsewhere) and the "bad" trans-fats and saturated fats. These "bad" fats are what needs to be reduced, contrary to Atkins' opinion. Ornish also offers sound ecological reasons for "eating lower on the food chain," and demonstrates the health benefits of his optimal diet with reference to a prostate cancer study in which, after a year, none of those patients who made the recommended lifestyle changes required treatment at all (combined with a high number among those who had not made the changes).

Smoking cessation is also a goal for Ornish's "optimal lifestyle program." Here he also makes a crucial psychological point about smoking cessation and lifestyle changes in general: the most successful anti-smoking campaign was not one which preached about death, but instead offered a graphic illustration of the way in which smoking causes impotence through the vascular constrictive action of nicotine. It is easier to get someone to quit smoking by making them contemplate impotence: presenting them with images of mortality only makes them want to ignore the warning on some level. But Ornish also notes that the real epidemic, and root cause of smoking, is loneliness and depression, quoting a female smoker who says "I have 20 friends right here in this box" (indicating her cigarettes).