Original articles
What's in a name: Mortality and the power of symbols

https://doi.org/10.1016/S0022-3999(99)00035-5Get rights and content

Abstract

One's attitude about oneself, and the treatment one receives from others, might be affected, in some small but measurable way, by stigmatic or salutary labeling due to one's name. If names affect attitudes and attitudes affect longevity, then individuals with “positive” initials (e.g., A.C.E., V.I.P.) might live longer than those with “negative” initials (e.g., P.I.G., D.I.E.). Using California death certificates, 1969–1995, we isolated 2287 male decedents with “negative” initials and 1200 with “positive” initials. Males with positive initials live 4.48 years longer (p<0.0001), whereas males with negative initials die 2.80 years younger (p<0.0001) than matched controls. The longevity effects are smaller for females, with an increase of 3.36 years for the positive group (p<0.0001) and no decrease for the negative. Positive initials are associated with shifts away from causes of death with obvious psychological components (such as suicides and accidents), whereas negative initials are associated with shifts toward these causes. However, nearly all disease categories display an increase in longevity for the positive group and a decrease for the negative group. These findings cannot be explained by the effects of death cohort artifacts, gender, race, year of death, socioeconomic status, or parental neglect.

Introduction

Symbolic aspects of the environment appear to affect health. For example, fewer people die just before their birthdays 1, 2, 3 and major holidays 1, 4, 5, and more die just after these symbolic occasions. In addition, suicides peak at ages 21, 30, and 40 years, presumably because of the symbolic significance of these ages [6]. There is also evidence suggesting that people's attitudes about their prospects can influence their health. In the extreme, some strongly superstitious people may sicken if they believe they are fated to do so, either by a voodoo curse 7, 8 or by a Chinese astrological prediction [9]. More generally, optimistic and pessimistic attitudes have been linked to longevity 10, 11, 12, 13.

One personal and enduring aspect of the symbolic environment is one's name and all its meanings and connotations [14]. The name a person bears has been found to affect self-esteem 15, 16, 17, 18, 19, 20 and people's names can also affect the treatment they receive in educational [21], legal [22], political [23], psychiatric [24], and other [25] settings. Of course, the importance of names is documented not only in the scientific press, but in the lay press as well. There are many popular books on what to name a baby 26, 27, 28 They typically note that “every name is wreathed with a cluster of associations” [26], rendering the naming of a child both difficult and important. Baby books routinely advise particular care in selecting a child's initials, because parents might fail to notice that the initials they are about to give a child could have negative connotations 26, 27. This oversight by parents suggests that there may be many offspring who have been inadvertently assigned initials with negative connotations.

Stigmatic or salutary labeling due to one's initials might affect, in some small but measurable way, how one is viewed by others or oneself. Initials like “A.P.E.” or “B.U.M.” may cause individuals not to think well of themselves, and the bearers of these initials may have to endure teasing and other negative reactions from those around them. Conversely, people whose initials have positive connotations (e.g., “A.C.E.” or “J.O.Y.”) may form a more positive self-image that is supported by the reactions of those around them. These considerations are consistent with labeling theory, which indicates that “labels” can shape self-images directly, or indirectly from the reactions of others 29, 30, 31.

Because attitudes can affect morbidity and mortality 10, 11, 12, 13, 32, 33, 34 it is conceivable that “positive” and “negative” initials may do so as well, if these initials influence self-regard. Of course, some will not attribute significance to their initials, but others will probably do so. If so, and if attitudes influence longevity, then individuals with “positive” initials should live detectably longer than those with “neutral” initials, whereas individuals with “negative” initials should die sooner.

We use death certificates to examine the mortality of positive, negative, and control groups to determine whether those in the positive group live longer, and those in the negative group die sooner, than expected. Our research design also enables us to look for particular diseases with mortality patterns showing unusually strong effects of the symbolic environment. In addition, our approach allows us to determine whether those diseases most affected by membership in the positive group are also most affected, in the opposite direction, by membership in the negative group. In contrast to our approach, previous research designs have typically examined only a few diseases 12, 13, 32, 33 and small or specialized samples 9, 34.

Section snippets

Method

To create a list of positive and negative initials, we generated (by means of the Unix electronic dictionary) an exhaustive list of three-letter English words, ranging from “ace” to “zoo.” We then searched this list for all the words that suggest positive self-regard or positive prospects. Words with alternate nonpositive meanings (e.g., “top”) were not included. This list was supplemented with three-letter “near words” (e.g., “luv”) with the same type of positive connotation. Disagreements

Male positive group compared with controls

As shown in Figure 1, the longevity benefit of belonging to the male positive group is evident for 26 of the 27 years under study (p<0.0001, binomial test). Members of the positive group lived an average of 4.48 years longer than matched controls (p<0.0001, two-tailed t-test, se of estimate=0.58, t=7.71). This finding remains significant when the analysis is restricted to autopsied decedents (p<0.0001; two-tailed t-test, se of estimate=1.35; t=4.17). The distribution of age at death for the

Discussion

Males with positive initials live 4.48 years longer, whereas males with negative initials die 2.80 years younger than their matched controls. As predicted, the longevity effects are smaller for females, with an increase of 3.36 years for the positive group and no decrease for the negative group. Positive initials are associated with shifts away from suicides and accidents, whereas negative initials are associated with shifts toward those causes. Nearly all disease categories display an increase

Acknowledgements

We thank R. Christenfeld, Ph.D., E. Strasser, Ph.D., H. Phillips, M.D., J. Dimsdale, M.D., N. Spitzer, Ph.D., M. Sanders, Ph.D., A. Steinberg, B.A., C. Rondeau, B.A., and N. Ebbesen for helpful comments and suggestions. This article was supported by grants from the Sutherland Foundation and the Alfred A. and Marion E. Smith Foundation.

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