Thursday, May 16, 2013

Health Is Other People

However much we pride ourselves on our scientific approach to health, too often we get caught up in a story.

Fascinated by the story of the battle between physicians and disease, we see ourselves as potential patients wheeled into the ER in agony, only to be rescued by an intrepid band of young medical residents. If, perchance, they do not know what is ailing us, well, Dr. Gregory House is on call.

Now, if only someone will pay for it, all will be well.

Doctors and scientists fighting a war against disease: it’s a compelling narrative, one that unfortunately gives us a false impression about health and health care.

Beyond the obvious fact that there’s more to good health than being disease-free, we note that in psychiatry, where the world is agog over the discovery of the newest classes of anti-depressants, people have tended to overlook the fact that aerobic exercise is an excellent anti-depressant.

And exercise is good for you in many more ways than that.

Physicians understand the value of exercise well. They talk about it all the time. Yet, large numbers of Americans have chosen to ignore the message. Perhaps, they have more faith in the cavalry of medical residents.

In a nation that has devalued the work ethic, it must seem easier to take a pill than to run in the park for a half hour. Why exert yourself actively when you can be a passive receptacle of the latest biochemical miracle.

Now, science has been accumulating evidence to suggest another, less than obvious, narrative-bending way that you can improve your health. The answer: other people.

Yes, other people.

You recall that famed philosopher Jean-Paul Sartre famously declared: “Hell is other people.” I am not going to parse the existential meaning of the phrase. For all I know, it means that Sartre should have chosen his friends better.

We cannot speak for him, but the fact is, if you follow the logical consequences of his remark and try to avoid other people, you will be making yourself sick.

Who knew that philosophy could make you sick?

It turns out that human beings are social beings and that the human body functions best when it is involved in social interactions with other human organisms.

Jane Brody reports some recent research in The New York Times:

Loneliness, says John T. Cacioppo, an award-winning psychologist at the University of Chicago, undermines people’s ability to self-regulate. In one experiment he cites, participants made to feel socially disconnected ate many more cookies than those made to feel socially accepted. In a real-life study of middle-aged and older adults in the Chicago area, Dr. Cacioppo and colleagues found that those who scored high on the U.C.L.A. Loneliness Scale, a widely used psychological assessment, ate substantially more fatty foods than those who scored low. “Is it any wonder that we turn to ice cream or other fatty foods when we’re sitting at home feeling all alone in the world?” Dr. Cacioppo said in his well-documented book, “Loneliness,” written with William Patrick. “We want to soothe the pain we feel by mainlining sugar and fat content to the pleasure centers of the brain, and absent of self-control, we go right at it.”

He explained that lonely individuals tend to do whatever they can to make themselves feel better, if only for the moment. They may overeat, drink too much, smoke, speed or engage in indiscriminate sex.

Being socially isolated is bad for your health in many ways. Yet, it’s really old news.

Brody writes:

review of research published in 1988 found that “social isolation is on a par with high blood pressureobesity, lack of exercise or smoking as a risk factor for illness and early death,” Dr. Cacioppo wrote.

Even without indulging in unwholesome behaviors, Dr. Cacioppo and others have shown that loneliness can impair health by raising levels of stress hormones and increasing inflammation. The damage can be widespread, affecting every bodily system and brain function.

Loneliness affects the way genes are expressed. Loneliness can lead to “cognitive decline.”

In The New Republic Judith Shulevitz explains the science of loneliness:

Psychobiologists can now show that loneliness sends misleading hormonal signals, rejiggers the molecules on genes that govern behavior, and wrenches a slew of other systems out of whack. They have proved that long-lasting loneliness not only makes you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality as smoking. A partial list of the physical diseases thought to be caused or exacerbated by loneliness would include Alzheimer’s, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people.

When human organisms are isolated from their group, Shulevitz explains, they feel especially vulnerable and threatened. This produces certain biochemical reactions in the human body.

In her words:

Cacioppo thinks we’re hardwired to find life unpleasant outside the safety of trusted friends and family, just as we’re pre-programmed to find certain foods disgusting. “Why do you think you are ten thousand times more sensitive to foods that are bitter than to foods that are sweet?” Cacioppo asked me. “Because bitter’s dangerous!”

Researchers believe that loneliness can only be cured by meaningful relationships. Surely, this is true. Unfortunately, there is less agreement on what they mean by meaningful relationships.

Shulevitz writes:

To the degree that loneliness has been treated as a matter of public concern in the past, it has generally been seen as a social problem—the product of an excessively conformist culture or of a breakdown in social norms.

She might have added that a culture that tells everyone to be independent and autonomous, and not to need other people for anything will be producing considerable loneliness.

In my view, America has never really been excessively conformist. Some people have denounced and even caricatured American conformism, but that does not make it true.

Those who have trafficked in the caricature have wanted to break down social norms. They have wanted to undermine social cohesion because they have believed that it would be a liberating experience.

Apparently, they were wrong. Social isolation makes you sick.

Recent research has approached the problem of sociability more seriously.

In Brody’s words:

But according to Dr. Cacioppo, having many friends and family members around does not guarantee immunity from loneliness if the relationships are missing a strong emotional connection. The quality of these relationships — how meaningful they are to the individual — counts more than numbers in predicting loneliness, his studies and others have shown.

People are fundamentally social beings who require meaningful connections with others to maximize health and well-being. Dr. Cacioppo suggests reaching out to others with “random acts of kindness”: doing something that helps them physically or emotionally, maybe something as simple as complimenting a stranger’s outfit, leaving behind the change in a coffee machine, or helping an old person carry groceries or cross the street.

Obviously, doing a good deed for someone is a meaningful action, but one finds it difficult to believe that you can be surrounded by friends and family and not have any emotional connection. What are friends, after all, but people with whom you forge voluntary connections?

I have on occasion quoted a line by Harvard psychiatrist Richard Mollica, to the effect: “the best antidepressant is a job.”

Before convincing ourselves that a descent into the fever swamps of empathy and do-goodism will cure loneliness, let’s note that a job requires meaningful human connections because it defines rules and roles, imposes good order and discipline, and makes everyone’s activities meaningful because they are part of an enterprise.


kfb5926 said...

Great post. So true.

Slarti said...

As a natural introvert I agree with the quality of friendships being more important than quantity. I have taken the Myers-Briggs on two occasions for companies I have worked for, both times I scored as an INTJ with an 85% rate of introversion. I find it physically draining to go out and socialize for any length of time. I'm not fearful of socializing, I just find it to be difficult and tedious to make small talk. I get along well with people at the office but I look forward to spending time alone. That said I have very few friends but enjoy the limited time I spend with them. I am conflicted though, I have always believed life would probably be more enjoyable and even easier were I an extrovert but since I am not I will never know.

Slarti said...

I should add that I enjoy excellent health (have never had to fill a prescription for anything in my entire adult life) and i don't see how having more friends or being an extrovert could enhance my health or mental well-being.

Anonymous said...

In the Psychology of Self Esteem, author Nathaniel Brandon tells of his discovery of the principle of admiration while playing with his dog Mitnik. He discovered that the source or origin of self-esteem is the desire for, and experience of, admiration, which caused his mind to form "good" or "proper" ideas about the causes of life and life-pleasure. We seek interaction with other forms of life, particularly other human beings, because we need this interaction to satisfy the need for cognitive development and social expression. However if this process is wounded by pain that results in ideas of shame and blame, then what is the remedy? One might feel pain triggered by the norms and roles of society which did not provide the original desire for pleasure, due to subtle conditions in self-other dynamics.

Sam L. said...

Well, there are toxic people. Some intentional, some perhaps by accident, and most of us know to stay away from them as best we can.

Friends are anti-toxins.

Anonymous said...

I've been a Huge introvert all my life. Innate nature intensified by sad family (Ma was Borderline, Pa somehow blamed me - told me when I was adult). They both beat me naked when drunk.

Bitter experience taught me I'm incapable of intimacy. Yet I have 2 best friends of 50 years, tho 1000 miles distant.

Upside was I escaped into books. Became speechwriter. Retired now at 66, No self pity living alone. History taught me most others had it far worse.

I'm Irked that our cognitive Elites pathologize every darn thing. Latest Danger is sitting down!

I smoke, am overweight, don't exercise, drink a bit, read books, enjoy media, talk to myself & 2 friends, write. It's a pretty good life. I don't envy the New Puritans.