11

Love as a Drug

Although living alone can offer conveniences . . . physical health is not among them.

—Julianne Holt-Lundstad, professor of psychology and neuroscience at Brigham Young University

Dying of a Broken Heart?

North Dakota residents Clifford and Eva Vevea were happily married for sixty-five years, and in 2013 they died within a few hours of each other. That same year, Illinois residents Robert and Nora Viands, who had been married for seventy-one years, died on the same day. A year earlier in the United Kingdom, Marcus Ringrose died twenty-four hours after his wife’s funeral. Stories like this are reported in newspapers with sensational headlines like, “You Really Can Die of a Broken Heart.” This is an exaggeration, because broken hearts rarely actually kill us. Yet research is beginning to prove there is some truth beneath the overblown headlines. Of course, poets have known for millennia that bad relationships are bad for our health. Shakespeare’s Lady Montague dies of a broken heart after her son is banished in Romeo and Juliet. The Bible (Psalm 69) affirms that broken hearts can make people weak. Perhaps the great Persian poet Rudaki put it most romantically:

Look at the cloud, how it cries like a grieving man

Thunder moans like a lover with a broken heart.

Recently, scientists have found a growing body of evidence of real changes in the body following heartbreak. Broken heart syndrome, or Takotsubo cardiomyopathy to geeks like me, is an officially recognized medical condition. A Harvard study involving more than 12,000 people found that married couples often die within a few months of each other. Another study at the Mayo Clinic found that people who were stressed out after the loss of a loved one were more likely to die sooner than those who were not. These results have been generalized in numerous studies.

You Can Die Young of Loneliness

A recent review of previous studies involving almost 50,000 people provides more evidence that loneliness is bad for our health. The study found out how isolated people were by asking questions such as:

The results were clear. Seven years after first questioning the participants, lonely people were 25 percent more likely to have died than those who were not lonely. In one of the studies that was included in the review, a group of researchers led by Dr. Carla Perissinotto in San Francisco followed 1,604 adults for six years between 2002 and 2008. They asked these patients if they (1) felt left out, (2) felt isolated, or (3) lacked companionship. They were then categorized as not lonely if they responded “hardly ever” to all three questions and lonely if they responded “some of the time” or “often” to any of the three questions.

Lonely subjects were more than 10 percent likelier to experience decline in the number of daily activities they could do, had more problems with their movements, and had more difficulty climbing stairs. Most strikingly, lonely people were more likely to die during the study. Some 22.8 percent of the lonely people died over the six years, compared with 14.2 percent of those who were not lonely.

Another study involving more than 300,000 people showed that good social relationships can increase life span. At the beginning of the study, participants were asked about how many close family members and friends they had and what support they felt these provided. They then followed these people for many years. The results were clear: those with good social support lived an average of five years longer. Five years is a long time. It is as good as smoking is bad.

Why Is Loneliness Bad for Health?

One reason loneliness can be bad for health is that when people are isolated they are more likely to do things that are bad for health such as smoke, avoid exercise, and sleep poorly. You may know of friends who tend to isolate themselves and start doing things that are bad for their health when they are having a tough time. One of my friends is a former professional athlete. He was a very healthy and strong guy. When he split up with his long-term girlfriend, our group of friends didn’t see him for a few weeks and he would not answer his phone. Together with two of his friends, we went to see him and there were pizza boxes all over the floor, the television was on, and he looked like he had not slept properly for days, because he hadn’t. He had also started smoking.

We didn’t do any blood tests, but if we had, we would have noticed that his biology had changed. Poor sleep and lack of exercise can raise blood pressure and reduce immune function. We told him to get up and come to the gym with us. He told us to go away. Fortunately, the two other friends who went to visit him are bouncers at a nightclub, with a lot of practice at making people get out of places when they decide it is the right time for them to go. So we dragged him to the gym and made him do a workout, then took him out for dinner. We put the pizza boxes in the trash and did a quick clean of his place. One of us visited him every day to drag him to the gym and make sure he didn’t smoke. Within about three weeks, he was more or less back on his feet.

This was a success story that was made possible by a good network of friends. Unfortunately, evidence suggests that we have fewer and fewer close friends.

Is Loneliness an Epidemic?

In the 1950s, more than 80 percent of doctors and most of the population smoked, because they didn’t know it was bad for their health. Of course, loneliness is not considered to be a good thing, but it is not the subject of public health information campaigns. Yet loneliness seems to reduce our life span by almost as much as smoking, and it is on the rise in developed nations. Our grandparents’ and even our parents’ generations had to share rooms, cars (if they had one), and phones with other family members. Now most of us grow up with our own room, nearly everyone over the age of eighteen in North America has their own car, and nearly everyone over twelve has their own phone. My nephew is eight years old and complains that “everyone in his class” has their own cell phone. He may be exaggerating, but it is certainly true that some eight-year-olds have their own phones.

While there are certainly benefits to mobile phones and other technology, they are associated with wider changes that have led to less intergenerational living, greater social mobility, bigger houses, delayed marriage, and increased divorce. As a result, we have become more socially fragmented and therefore more isolated. Compared with twenty years ago, three times more Americans report having nobody to confide in. One in ten people in the United Kingdom report feeling lonely often; a third have a close friend or relative whom they think is very lonely; and half think that people are getting lonelier.

Technology and wealth are neither bad nor good in themselves. The problem is that together they make it easy for us to be lazy and lonely. We need to use wisdom and intelligence so that our technology and wealth benefit us. I called Professor Sheldon Cohen, who did much of the research quoted in this chapter, to ask him why he never took up any job offers away from his native Pittsburgh. He said he refused, partly so that he and his family could maintain their strong social ties in the city where they grew up.

My former rowing coach, Dusan Kovacevic, did something more dramatic. He went to Canada to get away from the Balkan War in the mid-1990s. Within a few years, he achieved what many Serbs dreamed of—Canadian citizenship. Yet soon after he received his Canadian passport, he returned to Belgrade. There he lived in his small apartment in the suburbs and took a prestigious but modest-paying (and politically difficult) job as a rowing coach at his former club. He also had to deal on a daily basis with his extended family. This is great in some ways because they help with babysitting, but it has a big downside, too.

As any of you with large families will know, some drama is inevitable. In Dusan’s case, his mother is lovely and supportive, but completely domineering. She also lives next door. Apparently, she comes from an area that is so cold in the winter that cars could not reach it between December and April. The people in that area have a strong work ethic, partly because in winter those who are inactive risk being frozen to death. Under these circumstances, some people from this region don’t have time for jokes or trivial arguments. For Dusan’s mother, trivial things include arguing about who is right and wrong. She knows she is right.

Why did Dusan move from Canada back to what is clearly a materially poorer and more complicated family life? His friends didn’t understand and thought he was crazy. When I asked him to explain, he said, “In ancient Greece, the most serious punishment was exile, even more serious than death. In Canada, I felt as if I were exiled from my family and friends. In Canada, everyone is rich, but you have to make an appointment to see them. In Belgrade, people just walk in without any appointment.”

I’ve been to visit him, and what he says is true. His in-laws, sister, and mother drop in frequently without invitation or warning. His children share one room. His mother tells him what to do (he doesn’t listen). In the midst of all that chaos, he is happier than when he was in Canada, despite the prospects of a bigger house, a bigger car, more money, and much more security. As Julianne Holt-Lunstad, the psychologist who led the large review of loneliness and health, put it: “Although living alone can offer conveniences . . . physical health is not among them.”

How Do Social Networks Improve Health?

The main reason social isolation is bad for health is that it removes the benefits of social integration. To prove more definitively that smoking causes lung cancer, researchers also had to show that stopping smoking reduced the risk of lung cancer (which it does). Julianne Holt-Lunstad did the same thing to check how isolation was bad for health. She did a systematic review of studies that looked at the benefits of having friends, family, and belonging to social groups. She did a systematic review of 148 studies with 308,849 people and found that they lived an average of five years longer when they were well integrated into their social networks.

Benefits of the links to other people come in three categories. First, friends and family provide actual help. You might take a disabled friend for a walk, lend an ear to someone who is feeling sad about a bereavement, or inform a relative with an illness about a new treatment. Researchers call this the main-effects hypothesis. Second, helpful friends and family can make you feel protected and less anxious, thus reducing the harmful effects of stress—the stress-buffering hypothesis, if you want to get technical. Finally, human contact boosts the amount of a hormone called oxytocin in our bodies, which is good for us. I will say a bit about each of the explanations for how social networks improve health.

Friends Point You in the Right Direction

In one of Sheldon Cohen’s most interesting studies, he gave a group of people a virus that causes the common cold. He also asked them whether they

  1. 1. were married,
  2. 2. had a parent with whom they had contact,
  3. 3. had a family member with whom they had contact,
  4. 4. had a neighbor with whom they had contact,
  5. 5. had a friend with whom they had contact,
  6. 6. had a workmate with whom they had contact,
  7. 7. had a schoolmate with whom they had contact,
  8. 8. volunteered,
  9. 9. or were part of a wider group with or without religious affiliation.

Cohen reported that participants who checked at least six of the roles listed above were only half as likely to develop a cold in the days after being exposed to the cold virus, compared with those who were less socially integrated. This study and others like it have been replicated numerous times. Good social support can stop people getting certain diseases or reduce their symptoms. The reason the main-effects hypothesis works is clear. Besides making us feel better, family and friends can help us through illnesses.

For example, someone might begin to develop a cold and feel tired because they have become infected with the cold virus, but they don’t have a full-blown cold yet. A friend or family member might encourage them to take a rest, make them a cup of tea, or do something else that will boost their immune system and help them fight the cold more quickly. Someone who is knowledgeable about exercise and diet might help a friend lose weight or provide them with an individually tailored exercise program. A family member might let you know about a website that contains advice on healthy eating. Having an extensive and caring social network increases the chances of your becoming aware of these opportunities.

I will give you an example from my own experience. A close friend had to go to the hospital recently for a minor operation on his ankle. He was meant to be out by noon. I drove him there, made sure he settled in properly, and told him about the benefits of listening to calming music for recovery after an operation. He followed this advice, but he was not ready to leave at noon. I had to get to London to give a speech, so I called another friend, who went to the hospital to pick him up. The doctors told him not to walk for three days, so other friends brought him food. None of this caused any miracles, but three days after his operation he was up and walking around. It is easy to see that someone without the support of friends might have taken a few more days to recover.

I can remember a time that my friends helped me to stay healthy. In September 2014, my mother passed away in Montreal. Within twenty-four hours, my three best friends made their way from three different countries to support me. People are more likely to drink, smoke, and eat junk food when a family member dies. I don’t remember being tempted by any of these, but I was certainly not in my normal state of mind and if I had been around alcohol, cigarettes, or junk food I don’t know what I would have done. As it turns out, having supportive friends around kept me feeling better than I would have felt otherwise. One of them actually dragged me on a two-and-a-half-hour run that helped me release stress and made me feel so tired that I had a great sleep, when normally the grief might have kept me awake.

You may have an example from your own experience. If you are a parent, you could rightly worry that if your kids mix with people who smoke, drink, or take drugs, they might also take up these habits. This is because being around people who make unhealthy choices makes it more likely that you will do so. Studies show that if you are a smoker and your friends quit smoking, you are more likely to quit, too. You may also remember a time when the people around you helped you to make a healthy choice. So the studies I am describing here probably confirm what you already know from experience. However, social support does more than provide help: It also makes you feel generally calmer. That’s the other reason why social support improves health—it protects us from the damaging effects of stress.

Social Support Protects Against Stress

In 1983 more than 700 Swedish men age fifty and over were given physical health assessments. Researchers also handed the men questionnaires about:

After seven years, forty-one of the men had died. When the investigators looked at the causes of death, they found the usual suspects such as cholesterol levels, obesity, and heart disease had not been the major killers. Obese people with high cholesterol were as likely to die as slim people with healthy cholesterol. However, those men who reported having lots of stress in their lives were three times more likely to die sooner than those who didn’t. This is not surprising given the mechanism of stress and the fight-or-flight response described in earlier chapters: stress changes your biology in measurable ways, and a lot of it does so in harmful ways.

When the researchers looked more closely at the men’s questionnaire responses, they found the stressed-out men who had strong social support were just as healthy as the relaxed men. So stress only increased the chances of an early death in those without strong bonds with friends and family. Think back to stressful events in your own life and you might find this resonates with your experience. Having good people around does not simply provide assistance and advice; it makes you feel more relaxed and less anxious, because you feel supported. I certainly felt that way when my friends flew in after my mother passed away. This brings us to the third reason why better social networks improve health. Contact with social networks also helps the body produce its own drug: oxytocin.

Oxytocin: The Love Drug

Oxytocin is rare among hormones in that it gets as much press as Hollywood celebrities. It even has a nickname: the cuddle hormone. It makes you want to connect with people, especially when there are problems, and it also reduces your stress. It can even make you empathetic when you see someone who looks like they are having a tough time. Some people say we should snort the stuff to become better people. In one study, people actually did snort the stuff.

A researcher invited thirty-seven healthy men to an experiment without telling them what was being studied. He gave them either oxytocin or a placebo to snort. Then the researcher did his best to make these poor men very nervous by making them do three things that typically make people anxious. He told the men they would have to:

The men were given ten minutes to prepare. Half had to prepare alone, while the other half were allowed to bring their best friend along to offer support. The participants were divided into four groups: with a friend and given oxytocin; with no friend and given oxytocin; with a friend and given a placebo; and with no friend and given a placebo. Throughout the study, researchers measured the men’s levels of the stress hormone cortisol. As the researchers expected, cortisol levels were highest in the group that didn’t bring their best friends and didn’t have oxytocin, and lowest in the group that had oxytocin and their best friends along. The study provides further proof that a lack of social interaction increases our stress levels.

Reversal: Just as Social Integration Helps, Negative Social Interaction Can Harm

If you choose a criminal gang as your social group, you will probably not live longer. It is not just any family, friends, and social group that improve health, but positive ones. Less dramatic than joining a gang, Sheldon Cohen did another study proving the negative impact of toxic relationships on health. His team interviewed 276 adults to find out whether they were experiencing social conflicts, such as marital conflict lasting more than one month. They then exposed them to a common cold virus. They found that people who were experiencing chronic social stress were more than twice as likely to get an infection as those who were not stressed out.

When I talk to groups about the negative impact on health of damaging relationships, there is always one person in the room who tells me a story about someone in their close circle of friends or a family member whom they feel is toxic. Since no family or group of people is perfect, we probably all have some of these people in our lives. Those attending such discussions often ask me what to do. The truth is I don’t know. And even if I did, the answer for one person in a particular set of circumstances would be different from that for someone else. I can only tell you what I do when this situation affects me: I reach out to a wise, trusted person in my social network to ask for their help. This works very well.

A Note About Proving Causes

This section is a bit geeky, so if you are not interested in proving causes, skip to the next section. Here is the question: Does social support cause better health, or does better health cause social support (remember the chicken-and-egg problem from Chapter 5)? Sick people don’t have the capacity to keep up with friends or family as much as healthy people. So when we look at the studies that prove a connection between good social networks and healthier lives, how do we know which comes first?

Some of those who carried out this research were well aware of this problem, so they looked more carefully at how healthy participants were at the beginning of the studies. They wanted to see whether those with and without social networks had the same level of health before they took part in the research. They concluded that the social networks seemed to cause better health rather than vice versa.

In one Canadian study, researchers investigated fifty-five initial health issues ranging from heart disease to respiratory conditions and mental-health conditions such as dementia and depression. They also measured and controlled for forty-one additional miscellaneous conditions, including electrolyte abnormalities and celiac disease. They still found that those with stronger social support networks were more likely to have stayed healthy by the end of the study.

You might ask why the researchers didn’t simply do a randomized trial of people with the same initial health status to avoid having to rely on measuring fifty-five health conditions and doing fancy statistical analyses. For example, they might have chosen a thousand people, then flipped a coin to decide which ones would be allowed to have a strong social support network for the period of the study. This of course would be impossible, except perhaps in an extraordinarily authoritarian state. You cannot randomly control whether people have good friends and family or not. There are some other types of experiments, however, that lend more support to the view that social support improves health.

Some studies in the 1950s of foster homes came close to what we would consider a rigorous trial today. The homes were full of signs with instructions such as “Wash your hands twice before entering this ward.” These places were often clean, but the atmosphere was cold and the foster children experienced little human warmth. Then psychologist Harold Skeels removed some children from a sterile orphanage with this kind of environment and handed them into the care of young women. The children’s IQs rose dramatically. Similar studies followed and eventually the World Health Organization published a report that emphasized the importance of human contact and warmth for both the mental and physical health of those in foster care. Reading the report, one doctor in a foster home took down the “Wash your hands twice” sign and replaced it with a sign saying, “Do not enter this nursery without picking up a baby.” More dramatic experiments proved that social networks improve health in monkeys as well.

In the 1960s, scientists took baby monkeys from their mothers and kept them separated for periods of several weeks. The baby monkeys screamed, scratched, and sucked on the wires of their cages in search of their mothers’ breasts. They clung to the cage walls and eventually curled up into little balls and stopped moving. Many became ill and at least one died. In some of the experiments the baby monkeys were reunited with their mothers and became happy again. We don’t have all the details of what happened in other experiments, ones in which the babies were not returned to their mother’s care following separation.

This book is not about the thorny debate over animal rights. But in this case, it is hard not to side with activists who pointed out that the experimenters were cruel to the monkeys and didn’t teach us anything new. We already knew from the foster children experiments that parental warmth was necessary for normal development. If you take baby humans and primates away from their mothers, they get mentally and physically ill.

If you add all this evidence up, we can safely conclude that the chicken or egg problem (at least for social networks) has been solved. It is fair to say that good social networks improve health rather than vice versa. You can, of course, study a lot more about proving causes than what I’ve written here. Philosophers have been studying causes for thousands of years and still can’t agree on whether they exist. However, hopefully you now have enough information to form an educated opinion about whether you agree with me that social networks improve health. You are also better equipped to make informed decisions about whether the causes of new discoveries and breakthroughs you might see featured in newspapers are exactly as they are reported or not.

Takeaway: Three Ways to Improve Your Health by Improving Your Social Networks

These are three things that are based on the systematic review evidence discussed in this chapter. You can use them to reduce mild to moderate depression, as well as boost your health and well-being. Your life will also be more fun.

  1. 1. Join a group that interests you. There are so many options, from hiking and singing to playing chess and eating cheese. Most are free and easy to join so there is no need to be lonely. If you can find a group involving a cause you believe in, all the better. Participating in a meaningful social group helps you reduce stress by giving you something bigger to focus on.
  2. 2. Connect with a family member. Invite them over for lunch, tea, or dinner, or just give them a call. If you don’t have any family members that you can connect with, opt for a friend, or even someone from the group you are about to join after reading number 1 above! If you think about it, of course, we are all related if you go back far enough. We are all busy these days, so scheduling these meetings can be important.

    My colleague Iain Chalmers told me that he has lunch every three months with three of his best friends. It is a regular event that is permanently in their schedules. I have regular weekly meetings with some friends, and my friend Colin even uses a spreadsheet. The spreadsheet contains a list of all his friends, and he circulates through the list. The sheet seems a bit robotic to me, but I always like it when I get a call from him, so I can’t complain. The reality is that unless we schedule things, we tend to put them off.

  3. 3. Reach out to someone. Do something this week for someone else, even if it is small. Smile and say hello to a homeless person. Reach out to a friend, family member, or acquaintance who could use some social interaction. It will make the world a healthier and better place. And as we will see in the discussion of oxytocin in Chapter 11, you will be helping yourself as much as you help the other person.