All things are connected, like the blood which unites one family
All things are connected.
Whatever befalls the earth befalls the sons of the earth.
Man did not weave the web of life, he is merely a strand in it.
Whatever he does to the web, he does to himself.
—CHIEF SEATTLE, 1854
It was a routine day during our research study at the University of Wisconsin Hospital and Clinics. We were investigating the differential effects of caregiver empathy versus caregiver aloofness on people with common colds. With instructions for a “standard” (nonempathic) visit in hand, I stepped into an examination room, only to find a twelve-year-old girl waiting there for me. Careful to follow the study’s protocol and my assigned role as a detached but efficient clinician, I tried to avoid making eye contact with this young person who was known to me only as case number 406. According to the rules, I had to maintain a disconnected, cool demeanor.
“What brings you in?” I asked as I glanced down at my papers, distancing myself as best I could. I turned my back on her and washed my hands. Of course, I knew why she was in the office. She’d been directed to the research group. But I kept that to myself. I faced her again.
“I have a cold,” said the girl, trying to look me in the eye. I sensed her disappointment that I was not returning her inviting gaze. And despite my own need to connect, I kept to the business at hand. “Let’s have a look,” I said.
She climbed onto the table. Sticking to the “standard” protocol that had been randomly assigned to her case, I remained stony-faced and asked only yes-and-no questions: “Do you have a sore throat?” “Is your nose stuffy?” “Are you sneezing?” I continued avoiding eye contact and successfully dodged the bonding that she eagerly tried to establish, again turning my back to her to make some notes in her chart. Then, without another word, I walked over to the table, examined her throat and ears, pressed on the glands in her neck, and listened for congestion in her lungs. The study coordinator had already swabbed her nose, looking for neutrophils, as our research required.
Fighting the urge to look into her eyes, I ended the visit with the customary phrase, “Do you have any questions?”
“Yes,” she said, nodding her head. “Do you have a family?”
This bothered me; I could feel my heart sink. She was reaching out, trying to connect, but I did my duty and stuck to the protocol. Responding in a deadpan monotone, I said, “Yes, a wife and three children.” I then cut off any chance for her to respond by following up with, “Anything else?”
She shook her head dejectedly and cast down her eyes.
I wanted to spend more time getting to know her, but I had just quashed any potential for that. She was trying to make a connection, to see what could be, and I failed her.
I left the room as abruptly as I’d come in and hit the “stop” button on my timer: three minutes, eleven seconds. My stomach churned, and I felt nauseated. I became undone in a mere three minutes because I had blocked the friendly signals that a kindhearted child had offered. The potential consequences of my actions made me physically ill. Did my forced aloofness hurt her as much as it did me? Will it worsen her cold? How will this encounter inform her mind-set about doctors in the future? And will that affect her long-term health? The statisticians may enjoy finding significance for the “standard” or “enhanced” visits, but at that moment, what was most important to me was how terrible I felt interfering with my patient’s attempts to relate to me meaningfully. Even if our research eventually showed that there was no difference in outcome between standard and enhanced interactions, intuitively I knew that creating connections is what helps me facilitate healing and also helps me to feel healthy.
But the bigger question for me was this: I could see that this engaging girl felt unhappy as a result of our sterile encounter, but why was I so perturbed by it? After all, I was following a research protocol that our team at the University of Wisconsin had designed. Was I feeling dejected, the way that she seemed to be feeling? Had I picked up on her emotions? Is there a neurological root to human connectedness?
HOW OUR NERVOUS SYSTEM SHARES FEELINGS WITH OTHERS
The short answer to these questions is a surprising “Yes.”
Bystanders become traumatized when witnessing a car accident or a war atrocity, even if they aren’t involved. Grandparents’ stomachs drop when they watch their grandchildren clamber to the top of a jungle gym. A baby starts to cry in the backseat of the car when his parents are arguing in the front. And someone like former President Bill Clinton can say, “I feel your pain,” and really mean it. These are all examples of how our nervous systems are interconnected and not discrete.
Research shows that from birth onward, on a neurological level, people are quite affected by and absorb the feelings of those around them. That’s the basis of empathy, compassion, and learning. These findings lead to the conclusion that in some ways (which most people can’t detect), their bodies and brains are physiologically attuned to the people around them. And this connection is even stronger when they take the time to create a bond.
In a famous, although controversial series of studies, researchers took seven pairs of individuals who were strangers to each other and attached them to an electroencephalogram (EEG), a device that senses electrical stimuli in the brain. In the first experiment, the individuals of each pair were kept separate from each other. They were then put into individual cubicles (A and B) called Faraday boxes that block out all electromagnetic waves, which the EEG would detect as brain activity. The person in box A was stimulated by a strobe light and his brain waves were tracked. Then the researchers wanted to see whether they could pick up similar brain waves in the person in box B, even though he sat in darkness. As one might expect, the brain waves of the person in box B were unaltered.
The scientists then changed the experiment. They asked the dyads to get to know each other and “feel each other in meditative silence for 20 minutes.” After establishing this kind of intuitive connection, they separated the pair into their respective A and B Faraday boxes and asked them to maintain that feeling of connection. Then they flashed the light into box A. In 25 percent of the cases, which is statistically significant, when the strobe light stimulated the brain of the person in box A, a similar brain wave pattern was detected in the person sitting in box B, even though he was in an environment that prevented him from seeing or otherwise experiencing the light.1 This is the science of distant intentionality. The researchers were studying the effect of one person on another over distance. For example, if an identical twin can sense that something is wrong with her sibling when she is in Colorado and her sister is in Massachusetts, that would constitute intentionality over distance.
In a follow-up study nine years later, eleven pairs of people who “felt close with an empathic connection” were used to study the potential of distant intentionality. The researchers wanted to determine whether the thoughts of one person could impact the brain activity of another. Working with native Hawaiian healers (who had practiced healing traditions for an average of twenty-three years), they put the “healer” in an electromagnetically sealed room while his or her connected counterpart was slid into an fMRI machine that lights up specific, activated areas of the brain. The healers were told to turn on and off their intention of positive regard at random, unpredictable two-minute intervals to see whether this would correlate with activity registering in their partner’s brain on the fMRI. Imagine parents sending loving thoughts to their son or daughter lying calmly in a scanner. Although the recipients did not feel anything, there was a consistent correlation between the distant intentions from the healer and their close comrade in the scanner. The fMRI showed a connection between the brains of the receivers and the thoughtful intentions of the givers that was statistically significant.2
This effect is directly related to the strength of the connection. It is more likely to occur if people care for each other. It is also more likely to occur if we take cells that arise from the same living organism and then divide and study their reactions. In Milan, Italy, for instance, Rita Pizzi and her colleagues separated human neurons into two shielded boxes. When a laser light stimulated the neurons in one box, the distant cells in the other box registered the same reaction.3 Another lab run by Ashkan Farhadi at Rush University in Chicago showed similar results. Dr. Farhadi and his colleagues took epithelial cells that line the gut and separated them in a shielded way that would prevent communication. When the cells in the first box were negatively influenced by toxic hydrogen peroxide, the cells in the second box (which were not exposed to the chemical) were similarly damaged.4 This study can give us insight into the power of a “gut feeling.”
Although physicists try to explain these phenomena through quantum mechanics and complicated hypotheses such as entanglement, it will likely be a while before they figure out how this works. But it does give researchers a way of conceiving how a mother’s intuition can perceive whether her child is unhappy. Unfortunately, the negative emotions are often more powerful than the positive ones.
These investigations show how brains may connect to other brains, but what about the heart? At the Institute of HeartMath, widely publicized research has shown that the beating heart, which gives off a certain amount of electromagnetic energy as measured on an electrocardiogram (ECG), resonates within others’ brains and elsewhere in their bodies—especially if people are in close proximity to each other or are touching.5 This is also true for mothers holding their infants as well as a couple sleeping together. In fact, other studies have shown that the closer a married couple synchronizes physiological systems such as heart rate, pulse, skin conductance (an indirect measure of anxiety), and body movements in a phenomenon called coregulation, the more likely they are to report marital satisfaction, and the healthier they tend to be.6
This kind of connection goes beyond simple electrical impulses. Attunement and coregulation change the body so that the physiology of one person aligns with what he or she is seeing and feeling in others. For instance, after a group of 132 college students watched a film of Mother Teresa ministering to abandoned, dying children and lepers, the students’ immune function (as measured by the level of antibodies in their saliva) improved and stayed at an elevated level for at least an hour. According to the researchers who undertook this intriguing study, during that hour, the students were asked to continue dwelling on personal loving relationships such as those characterized in the film.7 Simply observing someone creating a connection and holding that in mind has a positive effect on one’s body and health.
Others have found that physiological responses influence those of others during social interactions—even if the people are strangers to one another. For instance, research has revealed that feeling cold is actually “contagious.” In one study, participants watched videos that depicted actors placing their right or left hand into buckets of warm or icy water. In a phenomenon called somatic simulation, the participants’ own hands became significantly colder when they watched the actors plunge their hands into the cold water.8
THE ROLE OF MIRROR NEURONS
How are these reactions possible? After all, the students weren’t personally benefiting from Mother Teresa’s kindnesses. The research subjects didn’t put their hands in the cold water—they only watched other people who did. To answer that question, we have to look to scientists who have recently identified what are called “mirror neurons” in the brain. These specialized cells fire in response to individuals’ observation of others’ intentional actions, thereby evoking the same sensations in themselves. This kind of shared activation and the simulated responses in the brain constitute a biological basis for how to understand what’s going on in another person’s mind9—and is likely fundamental to learning by imitation and, by extension, to human survival as a species since our earliest learning is based on emulating behaviors. (Think of babies mimicking their parent’s tongue thrusts and the subtle mouth movements that are observed when a parent talks to them.)
Mirror neurons have always existed, but they were first recognized in 1992 by chance at a lab in Parma, Italy. A team of scientists there had prepared a chimpanzee for brain research, implanting thin probes in the regions known for planning and executing movements. They connected the wires leading from the probes to a computer that would determine which neurons fired when the chimp grabbed a nut or banana. The scientists went about their business, but when one of them started placing food pellets in a box, he happened to glance at the computer screen. There he was astonished to see that the monitor attached to the wires indicated that the chimp had moved, when in fact, it hadn’t so much as twitched a muscle. The animal had simply observed the scientist. Even though it remained motionless, the same brain circuits that would have been activated had the chimp grabbed the pellets itself were firing.10
This unexpected finding spawned a new arena of research on mirror neurons, which has proceeded from the study of other primates to humans. It is now well established that when people observe others’ facial expressions, their faces move in the same ways, though often quite subtly. (By contrast, when they are prevented from mimicking the expression, they are less apt to understand the emotions they’re observing.) In France, scientists have been studying the brain patterns that underlie what they call interactional synchrony: During social exchanges, both participants alter their own actions in response to their partner’s continuously shifting behavior.11 In effect, brains become synchronized and through this process, important information is exchanged and a sense of trust is developed. However, lately this important process is being disrupted by technology. As electronic health records become a central part of the patient encounter, the computer screen is drawing more and more attention. The same occurs with smartphones as teenagers increasingly interact with this nonemotional object rather than have face-to-face encounters with their friends. This reliance on computers large and small creates a barrier that prevents interactional synchrony from developing. This conditioning will likely reduce our children’s emotional intelligence and intuition.
Research has also moved beyond the understanding that people mirror others’ movements to the discovery that they also mirror emotions. Mirror neurons exist in the emotional centers of the brain such as the amygdala. This means that feelings are contagious. The structures involved in their integration and control respond not only to direct stimulation—for example, the pleasure experienced at seeing a close friend—but also to the observation of those emotions in others.12 This permits people to understand firsthand what someone else is experiencing . . . to literally feel their physical and/or emotional pain. Mirror neurons underlie our capacity to have empathy and compassion for another.13 Conversely, studies show that when an observer notices her listener isn’t mirroring her expressions or having appropriate responses, trust declines.14
Of course, this can work in both directions—people pick up on the feelings of those around them—positive or negative, perhaps giving proof to the aphorism: “A family is only as happy as its unhappiest member.” Emotional contagion is a well-known, deleterious phenomenon in which mass hysteria can grip a group of people, causing them to believe erroneously that they are in mortal danger or that they have spontaneously developed the same ailment.
The good news here is that sensitized mirror neurons can be cultivated and activated to communicate positive feelings, too. The more people get out of their own clutter (a concept I’ll explain in Chapter 6), the more powerfully their mirror neurons will work to connect them to the emotions of those whom they seek to help. Positive emotions are contagious.15 If a caregiver has confidence that a patient can heal, the patient will synchronize with those feelings and start believing she can heal, too. The caregiver’s intention drives the energy of the interaction, which can influence the patient’s belief that she can get better. Seeing her as potentially healthy and well creates the positive expectancy in her that results in better health.
Breast cancer advocate Lillie Shockney provides an example of how a connected synchronicity can be strategically used toward a positive outcome. This two-time breast cancer survivor is an author, nurse, and administrative director of the Johns Hopkins Breast Center.
Imagine a woman has found a lump in her breast and is waiting to see the oncologist. She is frightened about the “what ifs” and the potential loss of control in her life—not to mention her breasts. Then a vibrant, strong, and confident nurse walks through the door and makes her feel as if she is the most important person in the world. The nurse says calmly and directly, “Hi, my name is Lillie Shockney. I’ve sat where you’re sitting. I know what you’re feeling. I’m going to help you get through this. I’ve had breast cancer twice. And I’ve had two mastectomies.”16
Understanding that all of the explanatory pamphlets in the world won’t assuage the anxiety a breast cancer diagnosis can evoke, Shockney opens her blouse to show this new patient her reconstructed breasts. “Feel that,” she says, confident that her breasts are relatively natural. This type of plastic surgery relies on transplanted abdominal fatty tissue. “The bonus tummy tuck is a silver lining,” Lillie adds with a laugh. She then touches the woman’s knee and proclaims, “This is doable.” Soon they are both talking about future treatments and laughing.
Why is Shockney so good at this interaction? She has insight into what the patient is experiencing. She makes her feel special and devotes her full attention. She shows the patient that they have something in common, and that she is not alone in this struggle. She uses appropriate humor to lighten the fear. And most importantly, Lillie gives the woman confidence that she can pull through this, too. That statement, “This is doable,” is so important. In a matter of minutes, her art of interactive synchrony creates neuropeptides and hormones in the patient’s brain that travel throughout her body, facilitating confidence. There is less fear and more optimism, and the immune system works stronger. Much like participating in a support group, having someone like Shockney on their team gives people hope and direction that they can get to a better place.
In order to motivate people to make healthful changes or support them through a difficult time, often the tipping point is this connection with someone who believes they can heal. And that connection can be found in shared brain circuits.
THE POSITIVE EFFECTS OF THE HORMONE OXYTOCIN
Hormones are chemical messengers secreted by the brain, reproductive organs, and elsewhere in the body that travel in the bloodstream to other organs where they exert an effect. In a graceful, reciprocal dance, hormones influence behavior, but behavior also influences the release of hormones. For example, if a person stands waving his arms and pumping his fists in the air as if he’d just won a race, his testosterone levels will rise.17
When it comes to making the connection, oxytocin is a wonder-hormone. Originally, it was understood to primarily be a muscle-contracting agent. Secreted during childbirth, it causes uterine contractions during labor and triggers milk ejection when women are breast feeding. (The drug Pitocin is a form of oxytocin that is administered to induce labor and speed along a lagging delivery.)
Because oxytocin is abundant in a new mother’s bloodstream when she first gazes into the eyes of her infant, it is also thought to play an important role in mother-infant bonding. An early experiment with virgin female rats helped to prove this. These rats, which are not known for their motherliness (they’re anxious around newborn pups and can ignore or even eat them), were injected with blood from a female that had just given birth. The otherwise hostile virgins suddenly behaved like nurturing mothers, licking the pups and protecting them. It is believed that oxytocin helped to alter the virgin rats’ behaviors.18
Oxytocin has been found to enhance intimacy not just between mother and child, but also among strangers, lowering the activity of the amygdala (the fear center in the brain) so that people can get to know one another—say at a party or bar—without stress.19 With partners, it is secreted in both genders during sexual activity (albeit in higher levels among women), after orgasm, and when sleeping together. Dubbed “the love hormone,” it increases a person’s desire to be physically connected with others, and that connection is good for one’s health and well-being. Hugging releases oxytocin, which also lowers blood pressure, regulates heart rate, and reduces stress hormones like cortisol—especially in women.20 One recent investigation found that it helped men lose weight.21 It’s also thought to drive women’s tendency to huddle with other women and children when danger is near (to “tend and befriend” as compared with the fight-or-flight impulse so prevalent in men).22 Researchers have found that people with higher oxytocin levels are apt to be calmer, more empathic and sociable, and less anxious. In another graceful, reciprocal dance, everyone wants to be around individuals who exhibit these attributes. Perhaps that’s because, by engaging others’ mirror neurons, people with high oxytocin levels may trigger those positive feelings in them.
In addition to these really important social benefits, recent research has demonstrated that oxytocin can also have pain-relieving effects. In one study testing whether oxytocin enhances the healing (placebo) response, scientists in Germany sprayed either the hormone or saline solution (plain salt water) into the nostrils of eighty male volunteers. Then they applied two patches of ointment on these men’s forearms. The volunteers were told that one cream had an anesthetic in it and the other did not. But, in fact, neither of these creams had any active ingredients; they were both inert. The next step was to wait fifteen minutes while the “anesthetic” cream took effect. During this time, a calibration procedure was performed on each person to identify the intensity at which a twenty-second painful heat stimulus was perceived as a 60 on a scale of 0 to 100. Then the heat stimulus was applied ten times to each spot on the arm. The researchers found that even though both ointments were inactive, the volunteers reported less pain in the area rubbed with the “painkiller” cream. This is in line with other studies that demonstrate the healing effect that I discussed earlier. But even more interesting, the people who had received the oxytocin nose spray felt almost 58 percent less pain than those who’d gotten the saline.23 The oxytocin had greatly enhanced the pain-relieving effects of the inert creams. In essence, it rendered the pain less painful.
Bear in mind that oxytocin itself does not act like an opioid—any woman in labor can attest to that. Nevertheless, after I deliver a baby, the most effective pain reliever I can give a mother to keep her from feeling the repair of a vaginal tear is her new baby in her arms. The take-home message for me from this research is that since oxytocin is released when people connect, that alone reduces pain, suffering, stress, and anxiety. Indeed, hugs and hand-holding may actually work in ways that scientists are still exploring.
In one such study, Sheldon Cohen at Carnegie Mellon University found that the number of meaningful relationships a person has is inversely related to his or her susceptibility to the common cold.24 In 2014, Dr. Cohen and his team took this one step further: they counted how many hugs and how much conflict their 404 research subjects experienced over a two-week period. They then exposed their subjects to a cold virus and monitored them in quarantine. Perhaps not surprisingly, the people who had higher levels of conflict and less support in their lives were more likely to become ill. However, among infected participants, those with greater support and more frequent hugs were protected against stress and had less severe colds.25 Could this be true because oxytocin levels increase with touching and hugging? I would venture that it is. Yet, paradoxically, one would expect more colds with hugging due to close physical contact during which the virus could be spread.
Consider this: Oxytocin levels go up in sorority houses when women cycle their menses together. They go up in wolf packs when a pup is born. They go up when we hold hands and hug. The more connected we are, the more there is a rise in the “love hormone,” the better we feel, and the stronger our immune defenses become.
NEUROPLASTICITY
As researchers have been able to peer into brains in action using fMRIs that track activity, they have learned that the adult brain is not static, as was once believed. Instead, it continues to grow and develop over a person’s lifetime in a process called neuroplasticity. It’s never too late to change or learn something new.
For instance, investigations of people who had been blind since birth have found that the occipital (visual) lobe, the part of the brain normally used for seeing, is now recruited by fingers feeling and interpreting Braille letters.26 Research conducted by Edward Taub, a behavioral neuroscientist at the University of Alabama at Birmingham, evaluated people who suffered paralysis of one side of the body due to a stroke. He showed that when the functional arm was bound up and prevented from moving for several weeks, the “paralyzed” arm started to work. Essentially, engaging the process of neuroplasticity, the stroke patient’s brain created workarounds to bypass the area that was injured, either by relying on adjacent areas to take over or a complete reorganization of function.27 A number of other case studies have shown that when one part of the brain is removed to treat severe seizures, another area adapts to perform the functions of the missing neurons.28
The same concept is at work when ophthalmologists patch the good eye of a child with strabismus, a condition in which the eyes aim in different directions. Strabismus is the most common cause of amblyopia, also known as “lazy eye,” which occurs when the brain ignores some or all of the input from one eye. Patching the more functional eye stimulates the brain to develop new neuro-networks in the occipital lobe, which help the lazy eye to “see.” And other research has found that specialized parts of the brain grow bigger than “normal” when people engage in certain activities—for example, the motor cortex area dedicated to moving the left fingers is much larger in violin virtuosos than in people who don’t play the instrument. This brain growth can even occur with mental activity alone. At Harvard University, for instance, research conducted by Alvaro Pascual-Leone found that the motor cortex of volunteers playing an easy five-finger piano piece increased after a week of intensive practicing, as expected. But perhaps surprisingly, the motor cortex of the control group also grew, even though their instructions were only to imagine that they were playing the piece. Simply thinking about the music changed these volunteers’ brains.29
It’s also true that neuroplasticity can play a negative role. For instance, the brain shrinks when someone is in chronic pain.30 But when that person works with a therapist to explore his or her issues more deeply, the therapeutic connection is associated with the regrowth of brain tissue in the prefrontal cortex, the area associated with higher thought such as planning, decision making, and the expression of personality.31
These studies point to the brain’s plasticity—its ability to re-create itself—depending on environment and stimulation. As my friend and colleague, neuroscientist Richard Davidson has so eloquently stated, “Nature has endowed the human brain with a malleability and flexibility that lets it adapt to the demands of the world it finds itself in. The brain is neither immutable nor static but continuously remodeled by the lives we lead.32
What does this mean for people who want to connect with others to help in their healing? When it comes to the connection, the simple brain plasticity principle is If we use it, we build it. Just like the person mastering the violin, the compassionate part of one’s brain—the left frontal lobes—grows and develops with practice, as Richard Davidson showed in his research with Tibetan monks who practiced compassionate mindful meditations.33 If individuals desire to become good at serving and healing others, they must reinforce these parts of their brain. They have to “practice the violin,” so to speak.
As caregivers master the art of connecting, they create change in the neuroplasticity potential of their own brains. Once they do this, they can bring to bear their own sense of hope, empathy, and optimism to help their patients or loved ones develop and reinforce new and more healthful neural pathways.
This is why human connection is the remedy for burnout. A study at the Mayo Clinic found that 54.4 percent of physicians have at least one symptom of burnout.34 This is related to trying to fit the complexity of a patient’s life and health into a fifteen-minute office visit, during which most of the time is spent focusing on a computer and not a human being. Such a lack of connectedness can cause physical pain, just as it did for me when I interacted with the young girl whom we called patient number 406 in our study.
Caregivers have the power to positively influence neuroplastic potential in themselves and others, but in order to do this, they must modify their own brains through epigenetic influences.
THE ROLE OF EPIGENETICS
Similar to the changes to neurons in the brain due to neuroplasticity, our genes also listen and respond to the choices we make. Today, researchers are finding that genes do not necessarily dictate one’s destiny, as was previously believed. Although people can’t alter the genes they inherit, variations in their expression can be caused by external or environmental factors that switch them on or off to trigger or halt the production of specific proteins. The new scientific discipline that investigates how genes express themselves is called epigenetics. It is the study of what happens around one’s genes.
Consider how this works with the honeybee. All the bees in a hive are genetically identical. But the hive chooses one bee to become the queen. They bathe this potential queen in royal jelly, which is high in nutrient value. She grows 20 percent larger than her fellow worker bees, and she lives 20 percent longer even though her DNA is no different from her former peers’.35
Many epigenetic studies have been conducted with rodents. For instance, in a side-by-side comparison of brain cells, the dendrites (the branching ends of the cells that communicate with other neurons) of rat pups that were consistently licked and groomed grew much more than those that had more neglectful mothers. It was shown that the pups with attentive mothers grew into adults with better cognitive functioning and enhanced learning in stressful environments.36 In other experiments, rats that had been born of anxious, fearful, negligent mothers but raised by calm, attentive ones also became calm . . . and raised mellow pups themselves. The reverse was also true. Those born to nurturing mothers but raised by jumpy ones became skittish and gave birth to similar pups. This wasn’t just learned behavior. Upon further examination, it was discovered that the mother’s attentiveness or fearfulness caused genes that altered stress receptors in the pups’ brains to be turned on or off.37 Other well-known studies have shown that when researchers fed pregnant mice nutrient-rich diets, their offspring maintained a normal weight throughout their lifetimes, despite the mice being bred for a genetic predisposition for diabetes and obesity. We can nurture nature.
Now consider research conducted by well-known physician Dean Ornish on people. He studied how environment and diet affect heart disease and early prostate cancer in men. His findings regarding prostate cancer are impressive. Men with low-grade prostate cancer in an experimental group of forty-four volunteers followed a low-fat, plant-based diet; enjoyed sixty minutes of a stress reduction activity daily; exercised regularly; and continued to have strong social connections. These activities had a positive influence on the genes that coded for prostate cancer. The growth of cancer cells in the men who were part of the experimental group was inhibited almost eight times as much as those in the control group.38 Essentially, the interventions that Dr. Ornish recommended turned off the genes for prostate cancer. After one year, none of the men in the experimental group needed conventional treatments compared with six of the forty-nine men in the control group. Prostate specific antigen (PSA), a blood marker for prostate cancer, decreased 4 percent in the experimental group as compared to a 6 percent increase in the control group. These results indicate that intensive lifestyle changes may affect the genetic progression of early, low-grade prostate cancer.
What does all of this mean for caregivers? We know that genes can be activated or deactivated by environment and lifestyle—whether people eat health-enhancing foods, whether they exercise sufficiently, whether they have experienced trauma, whether they forgive someone who has hurt them or carry around a big grudge. All of these factors can influence genes’ production of healthy or diseased proteins. Some scientists have predicted that as much as 98 percent of the gene-related diseases that occur in the industrialized world are associated with factors that are outside the actual chromosomes. What surrounds the gene can turn it on or off.
How does epigenetics work? Take the gene called RS993609, which is a variant of FTO, a gene associated with fat mass and obesity. People with the FTO gene are more likely to become overweight while people without it are less likely. But in a study of Amish people who carried this gene,39 most were slim. The fact that they averaged eighteen thousand steps a day (nearly nine miles) might have had something to do with it. In this case, genetic risk did not lead to an unfavorable outcome because environmental factors intervened.
Another group of researchers evaluated the weight variations in participants of the Framingham Heart Study, originally a database of 5,209 adults who lived in Framingham, Massachusetts, that was collected in 1948 to better understand the risks of heart disease. These researchers identified the original participants and their children and grandchildren who carried the FTO gene and noticed a significant increase in obesity rates after World War II. Environmental changes such as modern conveniences and tech advances (which have reduced the need for physical activity), coupled with increased caloric intake due to reliance on processed foods, have resulted in a significant increase in obesity.40 It’s not that more people have the FTO gene, but that gene is now being expressed more often because of lifestyle influences. What people do influences the expression of their genes.
How does this relate to the connection?
Our medical system focuses on a person being sick and broken. The current physicians’ diagnostic code book, the International Statistical Classification of Diseases and Related Health Problems (ICD-10) lists more than 68,000 possible diagnoses. The previous iteration, the ICD-9, which is nearly 20 years old, had merely 13,000 codes. Are people getting sicker? Well, that depends on whom you ask. New medical conditions found in the updated code book include such disorders as “being struck by a duck” and “burn due to water skis catching on fire.” The same is true for the psychologists’ diagnostic manual, the DSM, which classifies psychiatric conditions. The first edition began with 106 entries. There are now more than 500 when you add subsets of psychiatric diagnosis from the latest edition. Is the increase in possible diagnoses really improving the treatment of mental illnesses? I think not. It is helping clinicians better catalog disease, attach treatments to specific conditions, and extract payments from medical insurance or other sources. But the concerning aspect of this labeling trend is worsening fragmentation of care.
How? If reimbursement is tied to what is wrong with patients, that becomes the principal focus. This coding system does not encourage the exploration of how people’s lives are related to the diagnostic labels they are given. It may matter more to patients to have someone who cares and wants to help them than the drugs they take or the labels they are given. If they have a compassionate person in their lives, the drugs are likely to work better, and they will need to be labeled not as “recurring depression,” but as “Betty with a unique story who once had depression.” The process of connecting should drive the system, not the diagnostic labels given to broken parts. Imagine if we change the neuroplasticity of the health care system. What effect could that have on the epigenetic potential of human beings?
Besides, all of this attention to diagnosis focuses on the wrong aspect of health. We set intention by what we give attention to. These thousands of diagnoses highlight what’s wrong with us. The health system is in need of a shift from just focusing on what’s the matter with people, to what matters to people . . . and how we can use what is meaningful as motivation toward health.
Epigenetics teaches that one’s intentions can influence physical reality. From my experience, how caregivers are with people—the environment they create around them—could impact the genetic expression of their genes. Once caregivers see another person as potentially healthy instead of broken, they redirect their own energy toward health. Belief in someone’s self-healing potential is the first, most important step in stimulating their neuro-networks and chemicals to facilitate healing.
Once caregivers believe in this self-healing potential, others feel and believe it, too, just like the mirror neurons and the synergistic effects in the brains of those with whom we have a connection. This mind-set, in itself, creates an intention that can have an epigenetic influence on one’s DNA that moves patients toward the healing process.
WIRED FOR COMPASSION
Social psychologist Dacher Keltner tells us that “Compassion is a biologically based emotion rooted deep in the mammalian brain, and shaped by perhaps the most potent of selection pressures humans evolved to adapt to—the need to care for the vulnerable.”41 This feeling is so strongly ingrained in our species, we see it from birth. We have all observed newborns crying in the hospital nursery in response to other wailing babies around them—a very early expression of mirror neurons and emotional contagion.
In fact, three- and six-month-old infants have been shown to react to compassion and turn away from negativity—long before their parents have socialized them to be kind, sharing, or helpful. In a series of ingenious studies, J. Kiley Hamlin at the University of British Columbia and her team tested eleven infants to observe their reactions to helping or hindering situations. As the babies sat in an infant seat or were held on a parent’s lap, they looked at a stage with a white background and the image of a green hill that had a plateau about one-third of the way up. The babies watched a “climber”—a red circle with googly eyes—try to make it up the hill. It failed twice, partially sliding back down. During a third try, it was either pushed up the hill by a “helper” shape or bumped to the bottom by a “hinderer.” The researchers measured how long the infants looked at the various characters and whether they reached out for them—well established signs of infants’ preferences. They found that the babies preferred the character that helped the climber over the one that impeded its progress. All eleven infants ultimately reached for the helper, and ten of them looked longer at it.42
We are, indeed, wired to be caregivers. Neuroscience shows that people take pleasure in helping others. The brain’s reward center (the nucleus accumbens, which is rich in dopamine receptors) is quite active when we are giving and cooperative.43 But perhaps the most interesting neurological underpinning of compassion is the vagus nerve. Psychophysiologist Stephen Porges, currently “Distinguished University Scientist” at the Kinsey Institute at Indiana University Bloomington, found that this large system of nerves, a part of the autonomic nervous system, connects to a network of oxytocin receptors. It also helps slow the heart and breathing and controls some facial nerves and vocal apparatus—initiating the short, soothing sigh that people always emit when they’re concerned about others’ suffering.44
At the University of California, Berkeley, then-student Chris Oveis sought to prove the involvement of this nerve. As he showed a group of participants slides of people who were suffering undeservedly (starving children, for instance) to elicit compassion and a second group of slides that would evoke pride (landmarks at the university), he measured the activation of the vagus nerve. He found that feelings of compassion for the anguished increased the activity of this nerve.45 Other researchers have now linked the vagus nerve to altruistic behaviors. As social psychologist Dacher Keltner explains, “It is an active concern for others, and not a simple mirroring of others’ suffering, that is the fount of compassion, and that leads to altruistic ends.”46
We humans are wired from birth to connect and to be of service to others. The vagus nerve travels through the diaphragm and is naturally stimulated with simple, deep breathing exercises as would occur during yoga or other meditations. Caregivers who are sitting with a person in a difficult situation can activate their own vagus nerve by breathing deeply (as if they’re blowing up a balloon inside their bodies beneath their belly button) to release dopamine, stimulate the relaxation response, and improve immunity within themselves.
But the innate ability to connect erodes or is hidden if we have been hurt, abused, or deprived of love and support. Our inborn compassion is a seed that needs to be nourished and watered. If unsupported, its potential neither grows nor blooms. But the potential is always there, waiting for the right conditions to set it into motion.
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Prompted by human biology, people can create the intention to move together toward a better place. Caring for others through connection is the most powerful tool. It results in the release of positive neurochemicals, brain growth, and genetic manipulation that can bring everyone closer to a more meaningful and healthier life. This is how people create an optimally healthy environment for those they care about and themselves.
We get what we give. And when we care for others, we get just as much out of it as they do. Just like the twelve-year-old patient number 406 in our cold study tried to reach out to me in a kind, compassionate way. She could see that I needed more help than she did, and she was the one with the cold in the doctor’s office! We all have an innate ability to want to help others that sets in motion our own innate ability to heal ourselves.