CHAPTER THREE
We once saw a beautiful scene in a documentary about the life of Mother Teresa. She and several of her Sisters of Charity had appeared in Lebanon during the war, asking, “How can we help?” They were sent to a home for spastic children that was short-staffed. The children there seemed small for their ages, shrunken and stunted. They were suffering from an illness known as hospitalism, or failure to thrive, that often occurs in group homes for infants. Although the children are fed and changed, their needs are met on schedule with little chance for the give and take that is natural between infant and caretaker. The pituitary glands of these unloved children fail to put out enough growth hormone. In effect, the baby gives itself a die message since there is no one to receive it into life.
Mother Teresa was holding one such child in the palm of her hand. The baby's face was squeezed into what looked like a death mask, and its shriveled limbs were contorted in spasm. All she did was hold the baby and croon to it, looking at the child with great love. After a few moments, the baby began to smile, and its tortured limbs relaxed. When MotherTeresa was asked why she bothered to care for the sick and the dying since they had no hope of recovery, she replied that her job was simply to love them. That was enough.
Research indicates that love—what researchers often call “social support”—is critically important to staying well. In fact, social support is the best predictor of good health, more powerful than any health habit, including diet and exercise. There is a well-known study based on data collected about the health and lifestyles of 7,000 residents of Alameda County, California. Women who actually had many social contacts but reported feeling lonely (those who couldn't let the love in) had a 2.4 times greater risk of developing hormone-related cancers including uterine, breast, and ovarian cancer than those who felt connected. Women who actually did have fewer social contacts and also felt isolated had five times the risk of dying from these cancers!
As we'll discuss in the next chapter, our immune system is very sensitive to loneliness, providing a mechanism through which feeling unloved and isolated might actually affect our body's ability to reject tumor cells. Isolation also affects the metabolism of fat and cholesterol, predisposing one to heart disease. In a fascinating study that involved rabbits—whose cardiovascular systems are very close to those of human beings—cuddling and care actually protected the rabbits from most of the artery-clogging effects of a high-cholesterol diet. Delightfully, the findings were serendipitous. The laboratory technician who ran the study loved rabbits and patted them whenever possible. But since she was short, she could comfortably reach only about half of the cages. Incredibly, the rabbits she cuddled were protected from most of the harmful effects of the cholesterol.
Obviously, our diets are important, but they are not the entire determinant of our health. There is a small town in Pennsylvania called Roseto. About 30 years ago, epidemiologists decided to study Roseto because the level of heart disease there was very low. They expected to find a lean, bean sprout-munching group of marathon runners, but were they ever surprised to find that many of the residents were overweight, sedentary, cigarette-smoking carnivores. The health risk was high, so what was the explanation?
Well, it seems that the issue of social support accounted for the town's unusually good health. Rosetans were a particularly close-knit community, and their values had more to do with neighborliness and kindness than with materialism. Unfortunately, over the next 25 years, Rosetans became more like many of their fellow Americans. Acquiring things and keeping up with the Joneses became more important than spending time with family and friends. As this value shift occurred, the level of heart disease in Roseto rose to the national norm.
In 1945, about 85 percent of all Americans lived in extended-family situations. By 1989, only 3 percent of Americans lived in that fashion. During Miron's sabbatical year at the Beth Israel Hospital, he sometimes volunteered as a translator for new emigrants from the former Soviet Union who spoke Russian or Ukrainian. We became friends with a family that consisted of grandma and grandpa, their two daughters and their husbands, and their three grandchildren. Within a year of immigration, they had found a three-family house to share. We loved to have dinner with these folks because the long “table” was a patchwork of bridge tables, end tables, and old doors. At least 20 people were eating there at any one time. Other immigrants and newly made friends all showed up with something to add to the feast. Storytelling about the old country, as well as sharing the perils and challenges of their new life, created an atmosphere of intimacy and closeness. From a financial standpoint, these people were poor, but I realized that they were a lot wealthier than we were when it came to the commodity that counted most—love.
The 1967 Surgeon General's report on smoking and health tells a similar story. When age-adjusted death rates were compared for men who who were cigarette smokers versus those who were not, it turned out—as you might expect—that those who smoked had twice the death rate of those who did not. But when married smokers were compared to divorced nonsmokers, the death rate was about the same. Dr. James Lynch, who reported these statistics in his excellent book, The Medical Consequences of Loneliness, wrote that the person who compiled these statistics had quipped that if a man's wife was driving him to smoke, he had a delicate statistical decision to make!
The men who were most at risk for cigarette-related death were those who were single, widowed, or divorced. Why might this be the case? We might reasonably assume, for example, that married men eat more carrots or cantaloupe and thus are protected by higher levels of beta-carotene. But that was not true. The protective factor turned out to be marriage itself. Think back to Sam, the man we met at the beginning of the previous chapter who had a heart attack five months after his wife's death. There is a significant increase in illness and death for men who lose their spouses. Interestingly enough, this is not true for women. When Miron and I teach together, he often jokes that the reason for this discrepancy is that men are more invested in their relationships! But there's a more obvious explanation. Stop and reflect for a moment. What could it be?
Well, it seems that women, in general, tend to form social networks and have a variety of friends with whom they can share feelings and on whom they can depend. American men, in contrast, often have fewer friends—a more limited network for social support. Oftentimes, a man's wife is his best friend, and sometimes she is the only one with whom he can really share his feelings. So when a woman's husband dies, she has other people to support her emotionally. But when a man's wife dies, he's often lost his best or only friend and is much more likely to either become or feel lonely and isolated.
Dr. David Spiegel is a Stanford psychiatrist who has been running support groups for women with metastic breast cancer for many years. He observed that the support that women gave one another in these groups, coupled with instruction in how to cope with the illness, helped to reduce anxiety and depression. He admits, however, that he was very skeptical that these positive changes in the quality of life might have anything to do with how long the women survived. But when he analyzed data from a group of 36 women who had come weekly to the group for one year, in contrast to 50 women with the same illness and treatment who had not come to the group, he was surprised. Those who were in the support group, on average, lived twice as long as those who were not. Eight years after they had entered the group with cancer that was already metastatic, four of the women in the support group were still alive. Two subsequently died of causes other than cancer, but at the ten-year mark, two were still alive without recurrence!
Dr. Spiegel's research was featured on Bill Moyers' acclaimed Public Television series, Healing and the Mind. The dynamics of the group were actually hard to watch. Many of the women seemed depressed at the prospect of the losses they were facing, including the loss of their lives. Spiegel helped the women air their feelings, face the worst, and then learn to cope.
Too often, however, support groups are well-meaning but don't allow the real sharing of feelings that is so important to healing. I counsel people to avoid the kind of support group where feelings of fear or depression are seen as signs of failure. “Positive thinking” can sometimes amount to pushing away the very pain and fear that can motivate us to heal our lives. Pasting on a smile and repressing our fears so that they can work on us in an underground fashion is a tactic that is likely to create chronic stress and a far worse medical outcome. On the other side of the spectrum, however, some support groups help their members air their concerns, but then leave the partipants to marinate in their distress.
Once we've faced our fears, the most important thing is to learn how to live our lives—not only in spite of them—but in a fuller, more present way because of them. Fear can be a wonderful teacher of love.
