Comment: The Emotion–Health Link: Perspectives From a Lifespan Theory of Discrete Emotions

Emotions Differ on Multiple Dimensions

Functional approaches emphasize that negative emotions signal an imbalance between the person and the environment, are associated with urges to act and patterns of physiological activity that support behavior aimed at reinstating the balance between the individual and the environment (e.g., Ekman, 1999; Lazarus, 1991; Nesse, 1990). Anger, for example, arises in response to the violation of individual rights (Rozin, Lowery, Imada, & Haidt, 1997) or goal-related problems (Lazarus, 1991), and is associated with urgent impulses and a highly aroused physiological profile that support the removal of goal blockages or reversal of injustice (Frijda, Kuipers, & ter Schure, 1989; Keltner & Gross, 1999). Sadness typically occurs in the context of irreversible losses (e.g., death or social problems), and has evolved to facilitate the rearrangement of goals and creation of constructive plans to manage losses (Lazarus, 1991; Nesse, 2000). Finally, anxiety results from the perceptions of threat and lack of control and consists of a highly aroused physiological pattern that motivates escape in response to threat (Levenson, 1992).

The previous discussion suggests that different negative emotions can serve distinct and highly adaptive functions by helping the individual navigate through a continuously changing social and physical environment. As such, a functionalist perspective could contribute to Suls’s (2018) analysis by addressing the possibility that negative emotions may have distinct health effects because they differ on multiple reaction systems, including behavior and physiology. For example, in the face of a diagnosis, anger may provide the energy to fight against the disease and maintain one’s identity as a healthy person, whereas sadness should be more likely to facilitate acceptance of one’s fate and adjustment of associated goals. Similarly, differential health effects could be observed if emotions exert varying effects on health-relevant physiological systems (e.g., hormonal or immune systems). Thus, a consideration of all emotional reaction systems, particularly behavior and physiology, may help better understand the associations between emotions and health.

A Functionalist-Developmental Perspective on Discrete Emotions

We have extended this functionalist view on emotion by a lifespan developmental perspective. A central tenet of our approach is that the adaptive value of discrete negative emotions depends on the extent to which they facilitate an effective management of age-specific opportunities and constraints, residing in the environment, the person, or both (Kunzmann & Wrosch, 2017). Young adulthood constitutes a phase of growth during which individuals typically have many opportunities and resources to develop their potentials. Perceptions of high personal control, assertiveness, and a tenacious goal pursuit are prevalent in young adulthood and tied to well-being and health. Specific negative emotions that promote such behaviors should be particularly salient and adaptive. For example, in young adulthood anger may trigger a successful “moving against” state and promote persistence in overcoming problems (e.g., Keltner & Goss, 1999; Lazarus, 1991). In contrast, old age is a phase during which personal resources become increasingly limited or irreversibly lost, enhancing the prevalence and adaptive value of understanding the limits of one’s own control potential as well as the necessity of goal adjustment processes. Sadness is likely to support such self-regulatory and social-cognitive functions (Wrosch & Miller, 2009).

The Chronic Experience of Discrete Emotions and Health Across the Lifespan

Research examining emotions in response to specific situations has supported the main assumptions of DEA (e.g., Haase, Seider, Shiota, & Levenson, 2012; Kunzmann & Grühn, 2005; Kunzmann, Richter, & Schmukle, 2013; Kunzmann, Rohr, Wieck, Kappes, & Wrosch, 2017; Seider, Shiota, Whalen, & Levenson, 2011). Nonetheless, individuals may also experience chronic anger, sadness, or anxiety, for example, if emotions and situational affordances are decoupled or the environment consists of persistent stressors taxing individuals beyond their capability. Although designed to be adaptive, in these scenarios negative emotions frequently compromise health, most likely by contributing directly or indirectly to the disturbance of health-relevant behaviors and physiological processes (Carney, Freedland, Miller, & Jaffe, 2002; Cohen, Janicki-Deverts, & Miller, 2009).

Notably, a discrete emotions approach would argue that health-relevant behavioral and physiological disturbances resulting from chronic anger, sadness, or anxiety could differ too. Therefore, these emotions may not exert the same effects on disease-relevant outcomes (Consedine & Moskowitz, 2007; DeSteno, Gross, & Kubzansky, 2013). Moreover, our view would expect that such distinct health effects may depend on the developmental context and opportunities available to the individual, which constitutes a theoretical possibility that is developed thus far particularly for the chronic experience of sadness and anger.

More specifically, we would expect that health effects of chronic sadness could become paramount in young adulthood. Considering that young adults normatively expect to achieve a number of developmental gains, the cessation of behavior and loss of motivation often associated with chronic sadness could undermine these endeavors. Thus, chronic sadness may contribute to young adults’ perception of an “off-time” developmental status (Heckhausen, 1999), create stress, or reduce self-esteem, which could dysregulate health-relevant processes in different bodily systems (Pruessner, Hellhammer, & Kirschbaum, 1999). Among older adults, by contrast, chronic sadness may be less damaging to health since older adults encounter more often circumstances that require the experience of sadness to adjust to irreversible losses.

We would expect a reversed age-related impact of chronic anger on physical health. That is, chronic anger could disturb health-relevant processes particularly among older adults as it may involve the risk of overestimating personal control and trigger repeated failure instead of needed psychological adjustment to age-related losses (Wrosch, Scheier, & Miller, 2013). Such a process could further create social stressors by damaging older adults’ personal relationships. In young adulthood, by contrast, the health effects of chronic anger may be less pronounced because situations in which anger could serve some adaptive function by contributing to overcoming goal blockages or reversing injustice are relatively prevalent.

The literature examining emotion-specific effects on health outcomes is scarce and mixed, as documented in Suls’s review (2018). Moreover, the interpretation of the findings remains difficult, given the absence of a clear theoretical rationale and associated lack of moderators, as well as measures of affect included. For example, of the 17 reviewed studies in Table 1 (Suls, 2018), only one age-heterogeneous study assessed depressive symptoms and anger (Haukkala, Konttinen, Laatikainen, Kawachi, & Uutela, 2010), documenting that anger, but not depression, predicted cardiac outcomes. Here, a discrete emotion approach would suspect that some of the effects of sadness on cardiac outcomes may have been obscured because sadness could become less health-damaging with age. It is further noteworthy that the latter study used a measure of depression (Beck Depression Inventory) that includes a variety of nonaffective symptoms, potentially masking effects of sadness on health outcomes.

Clearly, future work aimed at understanding the unique and common effects of discrete negative emotions is needed. This work would benefit from a greater theoretical foundation, the inclusion of different emotional response systems, the examination of moderators, and an optimization of measurement. While a dimensional approach to the impact of negative emotions on physical disease may provide important insights, we believe that an approach focusing on discrete emotions as they occur in different developmental contexts is likely to result in a more comprehensive understanding of the links between emotion and physical health.