Human beings are not meant to be solitary animals.
—J. W. Rowe and R. L. Kahn
THE MOVEMENT OF OUR BODIES AND THE ACTIVATION of our senses keep our brains active and growing. In fact, if we are deprived of physical activity and external input, we soon become disoriented and disorganized to the point of psychosis. For the brain to function normally, it depends upon constant interaction with and stimulation from the environment.
Given that our mental abilities depend on intact senses, cognitive declines can result from a loss of hearing, vision, or motor abilities. Studies of older adults have found that declines in the speed and accuracy of sensorimotor functioning accounted for the majority of changes in intellectual abilities.1 And when speed is controlled for during intelligence testing, many of the differences between younger and older individuals disappear.2
Older adults often report having a harder time hearing what is said and tracking the topic being discussed. All of these experiences could be accounted for by diminished vision and hearing that taxes our mental processes and makes communication less automatic. Support for this idea comes from the fact that older adults benefit more from multisensory input, which compensates for a loss in any particular sensory input. Watching others speak and being able to see them clearly adds information from facial expressions and body gestures that reinforce spoken messages.3 For many, language functioning may remain intact and even improve with age, but failing senses can make them more difficult to use.
Gradually deteriorating vision and hearing often go unnoticed by both individuals and those around them. On the other hand, disorientation and memory loss often result in trips to the neurologist, with everyone assuming that their sensory systems are functioning normally.4 Patterns of falling in older adults, often a focus of medical concern, may also be the result of unrecognized declines in sensory, motor, or vestibular functioning.5 Because decreased sensory stimulation results in decreased brain activity, it is extremely important that failing senses in older adults be diagnosed and remedied as quickly as possible. By attending to and maximizing the functioning of our bodies and sense organs, we can protect and enhance our brains’ health and longevity. And of all the experiences we need to survive and thrive, it is the experience of relating to others that is the most meaningful and important.
SEE ME, FEEL ME, TOUCH ME, HEAL ME
Nothing we use or hear or touch can be expressed in words that equal what is given by the senses.
Hannah Arendt
For infants, the eyes of their parents are points of reflexive orientation and play a significant role in initial bonding. During early infancy, exciting interactions that include direct eye gaze stimulate the brain to grow. Escalating positive interactions activate dopaminergic and opioid systems, the reflection of which can be witnessed in the delight children and adults take in games of peekaboo. Thanks to the neurochemistry of bonding, the smiles and laughter elicited from a child during peekaboo and other games are addicting for both parent and child. Each time the wide eyes and smiling face reappear, there is a surge of brain activity and good feelings all around.
While somewhat speculative, it is very likely that these same reciprocal and stimulating interactions optimize brain activity and health throughout life. Face-to-face engagements with others send important messages across the social synapse that stimulate our brains to grow and learn. Visual connection usually includes storytelling which serves to organize our memories. Instead of the passive witnessing of television or watching people from a distance, face-to-face contact calls upon the structures of our social brains to engage in the dance of communication and connects to the group mind. Social engagement tells our brains that we are still part of the tribe and still needed and cared about by others. This is likely why the neural networks involved in face recognition, emotional expression, and empathy are sustained throughout life.
There is no doubt that we are social animals that need contact for both physical and emotional stimulation. In both captivity and the wild, primates spend considerable time grooming one another. While on the surface it looks as if they are protecting one another from the potentially harmful effects of insects, this is only half the story. Grooming also provides physical proximity and touch, which may be more to the point of why it is such a popular pastime. While we no longer rely on grooming for contact, all of us still require touch. Ask a widow what it is like to sleep alone after a lifetime of sharing a bed.
For most of us, being touched feels wonderful. Scratching, tickling, caressing, cuddling, and sexual touch are all central to human communication. Children hang onto their parents, lovers become entangled, and after decades of marriage it still feels good to hold hands. When others are in pain, we instinctively move toward them with physical expressions of warmth and comfort, offering a hug or simply placing a hand on their shoulder. Soothing touch calms us and decreases stress.
Our skin, the body’s largest sense organ, contains two types of sensory receptors. One type transmits information that helps us locate, identify, and manipulate objects, while the second activates social and emotional brain networks.6 This system stimulate attachment, hormonal activation, and sexual responses to affectionate and comforting caresses. While I love having my back scratched, it just doesn’t feel as good when I do it myself. Besides the fact that some spots are impossible to reach, touch actually feels better when someone else touches us.7
The soft touch and comfortable warmth of being held triggers the secretion of oxytocin and endorphins, which lead to mild sedation and decreases in blood pressure. These biochemical processes enhance social bonding through the association of another’s touch with feelings of well-being.8 Physical contact seems especially important for preterm infants, who cry less, gain more weight, sleep better, and are discharged earlier from the hospital if they are held and massaged.9 These mechanisms support connection and group cohesion by reinforcing us for seeking proximity and contact with other members of our tribe.
Touch is an important source of social sensory stimulation and a vital mechanism of early brain building. Increased touch results in more exploratory behavior in infancy and childhood, increased attachment security, better memory, and better parenting skills when full grown.10 Touch also results in lower levels of stress hormones in the bloodstream and enhanced neuronal survival.11 Patients with cancer and other illnesses who receive therapeutic massage benefit via the increased levels of dopamine, serotonin, oxytocin, endorphins, and natural killer cells.12 Both aggressive adolescents and agitated elderly show less negative symptoms when they receive regular massage.13 Touching can be an increasingly important means of comfort and connection, especially for older adults whose other sensory modalities may be decreasing.14
Depressed mothers tend to touch and interact with their children less, and, in turn, their children become more difficult to soothe.15 Studies have found that teaching depressed mothers to massage their infants increased the amount of touching and bonding time between them and decreased levels of stress hormones in both infants and mothers. These infants showed increased alertness, emotionality, and sociability and were easier to soothe.16 Touching their children not only activated smiles and positive expressions on the part of the infants, but also made the mothers feel happier and more effective.17
Younger people often avoid touching older people out of social distance, prejudice, or even physical repulsion. And as people grow older, they may also tend to touch each other less—an unfortunate consequence of losing those closest to them. The power of touch is also active when we pet our pets. In fact, the same centers in our brains—and our cats’ and dogs’—are stimulated during physical contact.18 Pets have been shown to help us recover from organ transplantation, during cancer treatment, in coping with bereavement, and in the general reduction of stress.19 People with pets tend to move around more, suffer less depression, and have higher survival rates after heart attacks.20 So find a pet who likes to cuddle. How can we enhance our opportunities to benefit from touching and being touched? Be strategic—volunteer in hospitals to hold preterm infants or help new mothers struggling with postpartum depression. Get massages and trade back rubs with others. Go out dancing, take martial arts classes, and engage in activities that involve movement and touch. There are all kinds of ways to increase your physical contact. Do it—it’s good for you and those you touch.
WHEN YOU’RE SMILING
Wrinkles should merely indicate where smiles have been.
Mark Twain
Like touch, laughter is good medicine. Laughter stimulates our brains by increasing heart rate, blood pressure, and muscle activity.21 This is why prolonged and hearty laughter can actually tire us out. Laughter helps us cope with stress by both decreasing cortisol levels and stimulating the production of important components of our immunological systems such as T cells, natural killer cells, and B cells.22 Laughter and the biological processes it stimulates have even been shown to alter the expression of 23 separate genes, reflecting its power to influence the brain and body.23
One reason why humor and laughter feel so good is that they stimulate dopamine production, which serves to reduce anxiety, depression, and loneliness while increasing energy, hope, self-esteem, and a sense of empowerment.24 Laughter and humor are good when we are alone but best when shared with others. Laughter is a social phenomenon and is even contagious, demonstrated by the fact that we tend to laugh more when watching a comedy with a group than when we are alone.
Freud considered humor to be one of the most mature of all of the defense mechanisms. Like other defenses, it helps us to cope with psychic pain by allowing for emotional distance and perspective on uncontrollable circumstances.25 In addition to its defensive functions, it also has many other psychological benefits such as increased hope and optimism. Humor can play an active role in the healing process for patients with life-threatening diseases by enhancing mood, improving pain thresholds, and lessening anxiety and discomfort.26 Older adults who use humor on a regular basis demonstrate less emotional and psychological stress.
Humor has been identified as useful in creating a feeling of connection in nursing homes and hospices for residents and staff.27 Not only is humor present in the majority of nurse-patient interactions, but it is more likely to be initiated by the patient than the nurse.28 Another study found a positive correlation between humor appreciation and longevity.29 Humor may correlate with a sense of autonomy and self-efficacy by increasing our perception of control over our environment. If we can’t control certain events in our lives, finding humor in our situation enhances a sense of perspective and control of life’s chaos.
THE TIES THAT BIND US
From caring comes courage.
Lao Tzu
The need to belong to a group and attach to others is a fundamental human motivation.30 Animals that evolved in groups, such as ourselves, can only be fully understood in the context of their relationships. Pack animals are linked to one another via social brain networks and use each other to regulate their internal biochemistry as well as their emotions, thoughts, and behaviors. The importance of these connections is often clearest when they are ruptured. For example, if the matriarch of a herd of elephants is killed by human hunters (which is often the case), the testosterone levels of the herd’s adolescent males skyrocket, making them more aggressive and dangerous to humans.31 Perhaps in a similar manner, fractured families and environmental stress seem to correspond to a greater level of adolescent aggression and the formation of gangs.
Because we are interconnected social organs, our relationships serve to regulate our physical health and emotional well-being. Secure attachment to supportive, kind, and caring others makes us happier, healthier, and longer lived.32 This is why the positive correlations between health and social connectedness are the most consistent and robust findings in psychoneuroimmunology, the study of relationships between the mind, brain, and bodily health.33 Positive social support is associated with better mental health, cardiovascular health, immunological functioning, and cognitive performance.
Social support not only has healthy effects in itself but also buffers us against future stress.34 Supportive attachments, whether between parents and children, husbands and wives, or just between friends, provides security and reduces anxiety.35 Being around supportive family members and friends has been shown to reduce blood pressure, autonomic and cardiovascular reactivity, and decreases the risk of illness.36 Social support also decreases the production of stress hormones, while facilitating the production of protein-based structures such as T cells and natural killer cells that promote immune functioning.
For social support to promote health, it has to provide a sense of belonging and allow older adults to continue to feel competent, important, and efficacious.37 Social support enhances well-being if it makes us feel cared for, esteemed by others, and a member of a network of mutual obligations.38 Positive relationships may serve as a buffer against both chronic and acute stress, thereby enhancing both health and longevity.39 Social support appears to slow many processes related to brain and body aging.40 See Table 12.1 for an overview of the benefits of social support.
Table 12.1. Benefits Associated With Positive Social Support
| Cardiovascular Health | |
| General heart health a | Lower cardiovascular reactivity to stress d |
| Lower blood pressure b | Decreased risk of fatal coronary heart disease e |
| Lower levels of serum cholesterolc | Higher post–heart attack survival rates f |
| Immunological Functioning | |
| Higher level of natural killer cells g
Improved immunological functioning h |
Lower urinary cortisol i |
| General Health Status | |
| Increased health status and well-being j | Decreased vulnerability to clinical illness l |
| Decrease in symptom display k | Decreased risk of cancer recurrence m |
| Mental Health | |
| Better all-around mental health n | Decreased depression and anxiety q |
| Decreased depression in the elderly o | Less bereavement depression in men r |
| Better emotional regulation p | |
| Cognitive Functioning and Related Functions | |
| Less severe cognitive decline with age s | Better sleep t |
Married people tend to live longer than single people, as do people who are members of social organizations and those who have intimate friends and broader social support networks. In a study of over 7,000 subjects, it was found that people with more social ties live longer regardless of their socioeconomic status, smoking, drinking, exercise, or obesity.41 These findings support the fact that relationships serve our physical health by regulating our emotions, metabolism, and immunological functioning.
In decades past, it was found that married men were more financially successful in their careers than those who were unmarried. This phenomenon, known as the marriage premium, is reflected in an estimated 15–27% gain in income for married men over those who stay single, and a 12% gain in income for divorced men who remarry over those who remain divorced.42 For divorced men who stay divorced, the marriage premium is lost.43 The marriage premium has even been found in cases of shotgun weddings (forced marriage due to conception) and has also been found to exist with unmarried but cohabitating couples.44
Recently widowed men experience greater anxiety, and people over 65 with no social ties are more likely to experience cognitive decline.45 Considerable evidence suggests that the risk of death is greater for people with less social contact and support and those grieving the loss of a loved one.46 This is certainly consistent with all that we have seen about the power of sensory and interpersonal stimulation.
Sometimes people can be lonelier in bad relationships than they are in isolation. Troubled marriages result in higher levels of stress hormones and suppressed immunological functioning than social isolation, especially in women.47 Although broad social support and close relationships are just about always good for us, critical and hostile others are bad for our health.48 The presence of negative relationships has been found to correlate with exacerbations and relapses of psychiatric illnesses, while marital conflict and hostility have been found to have an adverse impact on different aspects of brain chemistry.49
Unhealthy environments, such as those that are chronically stressful, conflictual, and abusive, create unhealthy brains and bodies.50 And when individuals are stressed by the combination of caring for others and not receiving significant support themselves, their immunological health can be significantly compromised.51 The maintenance of abrasive, critical, and hostile close relationships takes its toll on immunological functioning, health, and longevity.52 Hostile interactions between married people have been found to impair immunological functioning, increase stress hormone levels, and actually slow the healing of wounds.53 In fact, some believe that the destructive effects of negative relationships may be stronger than the benefits of positive relationships.54
A leading theory of the 20th century described a gradual disengagement from others as a natural part of aging. Nothing in my experience as a therapist supports this theory. It is true that older adults have a greater likelihood of experiencing loneliness than their younger counterparts. Factors such as an empty nest, retirement, bereavement, and physical limitations can all result in isolation and may be more difficult to overcome with increasing age. But in every instance where I have encountered social withdrawal in older clients, it has been an expression of physical limitations, psychological distress, or both, not a loss of desire to connect with others.
While a regular dose of solitude can make an important contribution to emotional balance and self-awareness, imposed isolation can be painful, debilitating, and worse. Isolation, loneliness, and depression have been shown to have a synergistic effect in diminishing well-being that results in reduced autonomic regulation, cardiac health, and immunological functioning.55
MAY HE REST IN PEACE
The secret of a happy marriage remains a secret.
Henny Youngman
Men currently have shorter life spans than women and are often older than the women they marry. These two facts lead many women to be condemned to long periods of widowhood. Or are they? About 10 years ago, I had an eye-opening experience at a cozy Parisian restaurant, famous for its great soufflés. A friend and I were enjoying drinks while anticipating the arrival of our meals when, with a flurry of commotion, a group of six expressive Italian women were installed at the next table. In the French style, we ignored their arrival as best we could and continued our conversation. Although we tried to keep our conversation going, my dinner partner kept smiling and breaking into laughter in response to what she was overhearing from the next table. Eventually she leaned forward to quietly fill me in on their conversation.
Apparently, the women were lifelong friends from Milan, visiting Paris as part of a celebration—the death of the last remaining husband. My friend and I tried to continue our private conversation but, too intrigued to stop eavesdropping, she finally began an ongoing translation. Soon both of us were laughing along with the group and began to smile and nod in their direction. The group quickly included us in their conversation, and we eventually joined their dinner party.
Over the course of the evening, I learned that these six gals had grown up and gone to school together, been in each others’ wedding parties, and helped to raise each others’ children. Over the years, one by one, their husbands had died off—accidents, illnesses, and old age—one had even been killed by his mistress. Two months before our dinner, the sixth husband had eaten his last cannoli. As part of his last words to his soon-to-be widow, he gave her permission to remarry. “Are you kidding?” she shouted to the group. “There will never be another man for me!” The double meaning of this phrase brought a roar of laughter from our table and dirty looks from those sitting around us. What made me laugh the hardest was that whenever one of them would mention the name of one of their husbands, they would all lift their glasses and together say, “May he rest in peace.” It seemed clear that the last thing any of these women wanted was another husband. They had paid their dues, done their duty, and earned their freedom.
The general flavor of the conversation portrayed men as immature; needing their egos stroked and help picking out their clothes. They were worthless around the house, had little patience with the children, and needed help to find things right in front of them. Alas, men were no prize, rather burdens to be tolerated for the sake of the family. These women had come to the city of romance to celebrate their liberation from marriage.
For years, the band of six had been planning African safaris, shopping on Rodeo Drive, and walking the Great Wall of China. A few had homes in different countries, which would now become additional destination points for the group. Listening to them made me remember how I felt when I first went to college—the friends, the adventure, so many things to look forward to. Who ever thinks of a group of older women going out to explore the world?
Despite the gaiety and a considerable quantity of wine, there was a bittersweet flavor to the evening. I’m sure that these women cared for and missed their husbands and that some part of their bravado was a way to cope with loss. At the same time, there was a great deal of genuine love and enthusiasm about their relationships and future together. To say I felt like the odd man out was both figuratively and literally true—a bit like having a preview of my own funeral. It didn’t help that they expressed mock pity for my unfortunate choice of gender and lack of linguistic abilities. At the same time, my evening with the Milanese six reinforced my belief that there are many ways to grow old.
Listening to their conversation made me think about how much of what they said about men is actually true. They didn’t talk about their husbands as if they were wise men, but rather self-centered children in adult bodies. However, I also wondered how much these women’s limited expectations of their husbands shaped the men their husbands had become. Did they allow their husbands to be involved in child care, deal with emotions, and struggle with intimacy, or did both partners simply fall into stereotypical roles?
Is it possible that the women colluded with their husbands’ immaturity to make themselves feel superior and more in control of the family? How many families have I worked with in which no one confronted the father with their feelings or told him about anything unsettling because everyone assumed the truth would kill him? Women are generally better at dealing with emotions and tolerating pain, but is this difference made worse by cultural norms and gender roles? Part of building and maintaining a successful support system for physical and mental health is pushing those around you to rise to the challenge of supporting you. Asking for help and experimenting with new, expanded, and more flexible roles can be empowering. Give it a try—the results may surprise you.