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HEALTH

The Paradox of Eort


A medical case against too much self-control

Ron and Joe / Shutterstock / Zak Bickel / The Atlantic

JAMES HAMBLIN

JUL 16, 2015

Denying instant gratication in deference to long-term goals is virtuous, people


tell me. Those people might be right. Psychologists call it self-regulation or selfcontrol. And together with conscientiousness, its at least a trait (or a coping
mechanism) thats reasonably good at predicting a young persons future. People
with less self-control are more likely to end up where the world tells them to go.
Even in the worst circumstances, people with the most self-control and resilience
have the highest likelihood of defying oddspoverty, bad schools, unsafe

communitiesand going on to achieve much academically and professionally.


Except that even when that is possible, those children seem to age rapidly during
the process. That is, their cells visibly age before their time (based on DNA
methylation) among other undesirable eects on the body, according to research
published this week from Northwestern University and the University of
Georgia.
Meanwhile the opposite eect is seen in high-achieving people from highly
advantaged backgrounds, where achievement goes hand-in-hand with health.
The psychological phenomenon known as John Henryism posits that when
goal-oriented, success-minded people strive ceaselessly in the absence of
adequate support and resources, they canlike the mighty 19th-century folk
legend who fell dead of an aneurysm after besting a steam-powered drill in a
railroad-spike-driving competitionwork themselves to death. Or, at least,
toward it. Its an idea that resonated with health researchers including Gregory
Miller, a professor of psychology and medical-social sciences at Northwestern,
who led this weeks investigation.

There seems to be a health cost to


self-control and/or to the successes
that it enables.
For the past several years, Miller and colleagues have studied the relationship
between stress and physical health, and how self-control translates one into the
other. For people who manage unlikely feats of upward mobility, how does that
aect their bodies? On Monday the research team released ndings that build
out the picture of just how detrimental that rise can be. In Proceedings of the

National Academy of Sciences, Miller and Tianyi Yu, Edith Chen, and Gene Brody
build on their body of existing research showing that self-control among
disadvantaged youth is associated with poorer physical healthhigher blood
pressures, more body fat, and higher levels of the stress hormone cortisol
compared to peers who are more impetuous (and, then, less upwardly mobile).
We're talking about kids where the family is likely to be on multiple forms of
government assistance, often single-parent caregivers with a high-school
diploma or less, Miller explained to me. Those kidswho come from really,
really challenging backgrounds but nonetheless do well in terms of psychosocial
outcomesby their early 20s have cells that look quite aged relative to their
chronological age.
The eect is related to the idea that chronic stress breaks down every bodily
process and induces or at least catalyzes unknowably many diseases. The current
case, a familiar one, opens with 496 black teenagers in rural Georgia, most from
working-poor families. They are kids who begin with the panoply of
disadvantages, related to race, geography, classkids who, demographically,
dont do as well by traditional academic standards as others across the country,
have more problems with mental and physical health, and have more contact
with the juvenile justice system.
But there were outliers in that population, a subset of kids who despite the odds
being stacked against them, as the researchers put it, excelled in school,
exemplied mental health, didn't engage in criminal behavior or substance
abuse, et cetera. There's this group of kids that everybody is really excited
about, Miller said. They beat the odds, and that's absolutely fantastic.
As a psychologist, Miller brings an interest in the mindset that may have
facilitated that success, and at what cost it was enacted. Though none of that
excitement is meant to detract from the basic point that these odds ought ideally
not to exist. Instead playing elds are so far from level that they make for

eective experimental grounds, a study in psychosocial mediators of health


requiring no laboratory-induced circumstances.
Meanwhile, the disadvantaged people who are not in the outlier superconscientious group don't end up in those higher-pressure successful
situations, and their bodies don't suer for it. They are apparently spared the
physical consequences of upward mobility. What we're nding, said Miller, is
that there seems to be a cost to self-control and/or to the successes that it
enables.
***
When things dont go the way I want them to, that just makes me work even harder.
Ive always thought that I could make my life pretty much what I want to make of it.
Agreeing with those statements, among others, is diagnostic of John Henrysim.
At least, in the right disadvantaged cultural context, according to the JHAC-12
scale. In the 1980s a now-renowned socio-epidemiologist studying public policy
in Chapel Hill, North Carolina set about guring out why black Americans in his
state suered so disproportionately from heart disease and strokes. His name
was Sherman James, and what he landed on was the term John Henryism as a
description for the determined, hopeful manner in which black Americans
engage in day-to-day stressors, not merely to make ends meet ... but to leave
something behind.
Sherman inspired decades of research that would weigh the health costs of
upward mobility against its social and economic returns. After 42 years of
teaching (now a professor emeritus at Duke and part-time professor of public
health at Emory), hes delighted that the next generation of scientists is taking
up the concept and beginning to elucidate the physiologic mechanisms that
appear to underlie the health disparities he rst observed as a student.

Public policies shape the landscape on which goal-striving is practiced, and the
physiologic costs can be high, James told me. That's what the dierent
socioeconomic trajectories in this case are telling us. Some young people are
climbing mountains that are not so steep. Wealthy white folks aren't climbing a
mountain at all.

Age Acceleration as a Function of Self-Control

Miller et al., PNAS / The Atlantic

To James, the inuence of race and class on the slopes shown here is profound, a
reection of culture and dierential value placed on dierent people as a
function of physical appearance and some perceived state of being, known as
race. Researchers at Harvard School of Public Health recently found that the
greatest disparities between blacks and whites in sleep quantity were among
people with high-level professional jobs; that high socioeconomic status is
benecial in terms of sleep among whites but detrimental among blacks. The

high prevalence of poor sleep among African-American executives, the


researchers wrote last year in The New York Times, can be attributed partly to
limited professional and social networks that can provide nancial and
emotional support; discrimination or microaggressions experienced in the
workplace; hypervigilance because of a perceived high work ethic needed to
succeed; or greater levels of neighborhood and home stress.
Of course with a correlation like Millers, between aging cells and self-control,
the inverse of Millers suggested mechanism could be trueaging cells and poor
health indicators could be driving psychosocial success rather than resulting
from it. He believes that unlikely, though. Because if you just go a little bit up the
income/education ladder, these same traits are associated with slower aging and
better health. The exact opposite correlation exists in advantaged kids: Selfcontrol is associated with all sorts of positive health outcomes. Only in the
disadvantaged communities does this paradox exist: good outcomes on the
behavioral/educational/psychosocial side, but apparently at a cost to physical
health.
Where's this pressure coming from? There are a couple of proposed
explanations, and largely they come down to the physiology of stress.
One is that it's the climb up the ladder that takes the toll. It's a long slog to
success. When you come from disadvantaged class/race/place, you have greater
obstacles to overcome. You're likely in schools that are underfunded and
understaed. You come from a small town that had fewer resources and
opportunities, and your parents were struggling in challenging economic
conditions. You don't have the tutors and after-school resources that auent
suburban kids do. So to get to the same placesay, to graduate from college
takes a lot more energy and bandwidth. Miller considers that a very plausible
explanation.

It's the extreme unfairness of the


circumstances in which people nd
themselves that's problematic, not
the self-control.
When you talk to these kids, you see tremendous drive and focus, Miller said.
Part of what may be going on is when you get to a competitive environment like
college, and thereafter competition only becomes more erce, these kids double
down on their tendency to overcometo be focused and persistent. And they do
that to the exclusion of social lives, physical activity, eating well. They become
so focused on this denition of success that they just neglect some of the lifestyles
that happen naturally for the kids who are having an easier time. There's other
work showing that unrelenting eort toward goals has a cost, said Miller.
People who pour their hearts and souls into achieving certain things often do so
at some risk to their health. Weve known that for quite a while.
The other is the simple a stark state of being an outlier as the primary cause of
stress. In addition to discrimination and alienation, having to manage competing
demands of a professional life and a family-of-origin life where expectations
and norms are dramatically dierent. Add systemic discrimination on top of
alienation from both ones root-community and from other high-achievers, and
the stress is compounded immeasurably.
These are somewhat novel ndings, but a trend is emerging, said Miller, and
this helps understand observations by other researchers, and then you pull them
all together, you start to get a story. That story seems at its core to be one of
belonging. The ironic and sobering thing that we nd is that if you just focus in
on the most disadvantaged kids in our studies, the ones who look physically

healthiest in terms of blood pressure, obesity, and cellular aging, those are the
ones who aren't doing well in school, said Miller, the ones who are having
occasional run-ins with the law related to aggressive behaviors or substance
use.
In the most disadvantaged group, that means an almost full trade-o between
physical health and behavioral/educational barometers of success. So the kids
who followed the demographically normative path tend to be the healthiest,
even considering that relative poverty and lack of education are health risk
factors. The message could be to never be an outlier, but thats no message.
I do think the construct of self-control is an ambiguous one, and somewhat
problematic, James said. Because most people would say self-control is a good
thing. To say that in some circumstances it's not, that requires a little bit of verbal
jujitsu. It's the extreme unfairness of the circumstances in which people nd
themselves that's problematic, not the self-control.
With this work, researchers like Miller are drawing closer and closer to the
mechanisms that that lead to cardiometabolic disorders James sought to
understand as a student. It happens in young people who are doing their
damnedest to be successful, James says with consternation as visceral as it
reads in the words he wrote on the subject decades ago. This is what I came to
appreciate and be profoundly disturbed by. Were talking about people hardly
being given a chance to pursue their goals without having to pay with their
health. This is really, really important work.

HEALTH

Living With Invisible Illness


For patients with chronic diseases masked by a healthy-looking exterior, diagnoses can be elusive, or
unhelpful.

ABOUT THE AUTHOR


JAMES HAMBLIN, MD, is a senior editor at The Atlantic. He writes the health column for
the monthly magazine and hosts the video series If Our Bodies Could Talk. | More
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