“And in the sweetness of friendship let there be laughter and the sharing of pleasures.
For in the dew of little things the heart finds its morning and is refreshed.”
Kahlil Gibran, The Prophet
Is it possible that the quality of one’s friendships and social connections is as strong a predictor of health and longevity as blood pressure, cholesterol, and weight? Is it possible that the quality of your relationships with friends, neighbors, family and co-workers forms the foundation upon which your ability to remain resilient under stress resides? The answer is YES and YES! As I will suggest from some recent research, social isolation is both common and a formidable predictor of premature death and disease. In many respects this is a silent epidemic in our communities. Let’s briefly examine some of the evidence that supports how common loneliness is and how this ex translates into diminished quality of life and disease or as health, happiness, and longevity.
How highly an individual perceives their quality of life is a significant predictor of improved health outcomes. While many factors contribute to this, social satisfaction consistently rises to the top of the pyramid. The standardized instruments used to assess social satisfaction emphasize the quality of a person’s relationship both to self and others. Individuals who score high on these surveys rate supportive relationships with family and friends as a priority! The bottom line—support and connection to others fills a perpetual need for sustaining life satisfaction and for living well.
I should interject an important point here. In an age of “social networking” there is a BIG difference between being popular e.g. having lots of Facebook friends and being socially connected. The science linking social connection with health outcomes makes consistent note of the quality, depth, meaning, and trust that embody the connections. It’s about compassion and caring for others as much as it is feeling cared for and tended to. There are, for example, no shortages of cultural “stars” or popular icons, known by everyone with huge networks of followers who at the same time, are struggling with loneliness, despair, and isolation. And there are quiet, soft-spoken, salt of the earth human beings who may not be known to anyone but a few loving friends and family and who thrive in the satisfaction of those meaningful connections.
From an evolutionary biology perspective all mammals, when compared to all “non-mammals”, consistently display these distinguishing social behaviors:
• Nursing and maternal care.
• Communication for maintaining maternal-offspring control or the “separation cry”
• Cuddling and play
It would appear that we mammals are designed to thrive in family-like social networks. This has intuitive survival advantage as the ability to adapt to a changing environment may be better leveraged over a socially connected group. Research in rodents and primates connects lack of attachment and nurturing between mom and baby with altered genes for cortisol (Stress Hormone) receptors in the baby. Altered cortisol receptor activity is described in depression and PTSD. This is not seen in baby mammals when born in the context of loving touch and nurturing care. This is an example of a powerful gene-environment interaction now referred to as epigenetics. In other words, nurturing someone you love is good for his or her genes (and good – of course – for your genes as well)!
Research in the neurosciences suggests multiple areas of activation in the brain when humans are engaged in meaningful relationship. For example, consider what happens inside your brain and body when you embrace (or close your eyes and picture) someone you adore:
• Medial cortex of the frontal lobe (behind the forehead) increases serotonin responsiveness enhancing mood, feelings of joy, and positive emotions
• Endorphins are enhanced, modifying pain, improving comfort, and generating a satisfying state of bliss and contentment.
- Your “mirror neurons”, specialized brain cells that tune you in to what others are feeling are sharpened and strengthened. As a consequence, not only do you feel others but you “feel felt”. Most people experiencing loneliness need to be felt by others. This emerging research examines mirror neurons as specialized structures in the brain that connect us with others. Children on the autism spectrum tend to have disruption in these highly evolved structures.
• Your limbic system (emotional-memory centers) networking with your prefrontal cortex (reasoning centers) enhances a dopamine (pleasure messenger)-oxytocin (bonding-attachment messenger) “dance” of love, attachment, and positive emotions. It can be a beautiful symphony.
• Your fight-flight response, always poised to react to threat, is rendered more relaxed, resulting in decreased cortisol production. This reduces the “stress response,” enhancing mood, cognition, immune function, lowering blood pressure, inflammation, risk of diabetes, anxiety, etc.
• Your brain produces less norepinephrine and adrenalin, reducing heart rate, blood pressure, anxiety, and oxygen demand.
…and all of this from hugging, cuddling, or mindful attention with someone you care about.
Consider these stunning statistics. A 2010 report from AARP titled Loneliness Among Older Adults surveyed several thousand people over the age of 45. Almost 40% considered themselves lonely! Many noted that as they got older they had fewer friends and were engaged in fewer social-community activities and networks. A 2016 review of 148 research studies involving over 300,000 individuals found a 50% greater likelihood of survival in individuals with stronger social relationships! If this were a drug it would be all the buzz and marketing – advertising efforts would be saturating the media outlets! Weak social ties are more harmful than not exercising and twice as risky as being obese, the researchers found. Perceptions of loneliness, when prolonged and enduring, dramatically increases the risk of most studied “age-related” diseases like heart disease, cancer, Alzheimer’s, etc. This has profound implication for self-care and community health.
Dan Buetner, a writer for National Geographic wrote an interesting book called The Blue Zones (National Geographic, Mar 2008). He carefully studied a handful of areas on Earth with the longest life expectancies (often 100+ years). These special longevity zones included Okinawa, Japan; Sardinia in Italy; Nicoya, Costa Rica; Icaria in Greece, and interestingly Loma Linda, California (home to Seventh Day Adventists). Eating whole, unprocessed foods, lots of movement, meaningful and rich, dynamic, social connections with community celebration were the threads woven through these communities of healthy living and purpose.
If you compare self-care as measured by healthy behaviors e.g., good nutritional habits, regular activity, non-smoking, effective coping strategies—a significant difference emerges between the socially attached and the socially disengaged. One simple explanation for these differences is that there are healthy people (the “lucky ones”) and unhealthy people (the “unlucky ones”). People who are healthy will naturally be more upbeat and energized and have a desire to connect with others. “I’d walk, too, if I was in good health.” “I’d volunteer with Habitat for Humanity if I felt better.” “I would have more social activity if my health was better.” Anyone whose health is poor confronts a risk of isolation as a consequence of losing independence, autonomy, and being infirm. The relationship between loneliness and health behaviors appears to be a vicious cycle where one perpetuates the other. The worst I feel, the less wanting I am to be around others, the worst I feel, etc..
Social Isolation and Our Immune System
For more than thirty years there has been a growing body of evidence in the field of psychoneuroimmunology (PNI) connecting psychosocial stress with illness and alteration in immune function. For example, researchers at Carnegie Mellon University and Ohio State University have shown that people who report strong social supports have more “robust” immune responses. Conversely, studies have also demonstrated that social disengagement affects aspects of immune function and inflammation. Redford Williams, MD, Professor of Psychiatry and Behavioral Sciences at Duke University, has long studied the relationship between hostility and poor cardiovascular health. As a result, he’s recognized the need and potential for training individuals to develop and apply more effective social skills through his “Life Skills” programs and workshops. Dr. Williams’ work, and that of others in this field, has provided growing evidence that points to an association between social isolation and hostility and increases in adrenaline driven or “sympathetic (fight-flight) activity.” The stress response may be turned on to a greater extent when individuals are isolated, depressed, and anxious. And as seen in other states characterized by an unchecked fight-flight stress response, increased cardiovascular risks, diminished quality of life and shorter life expectancy are reported. In fact, a 2013 study in the Annals of Internal Medicine titled Social isolation: A Predictor of Mortality Comparable to Traditional Clinical Risk Factors followed 16,849 adults over several years. The authors concluded that the strength of social isolation and loneliness as a predictor of mortality is similar to other established risk factors like smoking and high blood pressure!
An international study involving more than fifty countries demonstrated much worse health outcomes when individuals rated their degree of social satisfaction (at home, work, and community) to be poor. High-risk behaviors like smoking and poor diet were more prevalent. There were also differences in endocrine and immune function when marital conflict was present and associated with hostile behavior. A large survey from Sweden, a country with a national database that is capable of tracking the health of all its citizens, looked at how often dementia (like Alzheimer’s) was diagnosed in people over the age of seventy-five. Broader networks of friends and support were associated, as an independent factor, with a significantly lower risk of acquiring dementia. In individuals with end-stage kidney disease, a journey characterized by enormous and unrelenting health challenges, self-rated quality of life was clearly connected to how highly they rated their support network and spiritual beliefs. We begin to see these connections emerge as one of the many potential healing benefits of religion and spiritual practice, as those involved with a spiritual or religious community tend to form more social networks and attachments.
In an Australian longitudinal study of aging that followed 1,500 people over the age of seventy for ten years, a strong network of friends was linked to a 22 percent reduction in mortality, greater resilience, better mood, coping, and self-esteem.
From research done by Redford Williams at Duke and others, we know that individuals who tend to get angry at the little things had accentuated fight-flight responses compared to those less easily provoked. Does this sound like anyone you know? Social competence (highly suggest Daniel Goleman’s book Social Intelligence) and effective supportive networks are associated with reductions in anger and hostility and render a more “controlled” response to imposed stressful events. Evidence from studies in animals and humans link neurotransmitters like oxytocin, dopamine, and endorphins to feelings of romance, attraction to others, and bonding. Trust, a feeling that defines meaningful relationships (and a seemingly scarce commodity these days), shares the same neurobiological pathways and is a critical dimension to motivation, reward, and behaviors that reinforce connection with others. Connection with another, even a stranger, can occur in an instant. A sincere smile and warm eye contact shared with another can prime these systems in a matter of moments. This is an ongoing opportunity not to be lost!
STRATEGIES FOR CULTIVATING SOCIAL CONNECTION
While it makes perfect sense that being immersed in a supportive network of friends and family can foster resilience, improve quality of life, and make more likely better health outcomes, the obstacles to full cultivation of this innate tendency to bond are sometimes not easily overcome. Here are some action steps to help you increase your social connections or, perhaps more importantly, to help someone you care about who is at risk of social isolation.
- The first step from loneliness requires loving who you are and finding compassion to be kind and forgiving to YOU and those you are close to! Whatever unique circumstances brought you to this place, your life is a miracle! The past is history. That you are here in this time, against all odds, is a true miracle!
- Make a list of three enjoyable social activities in your life that mean a lot to you. If you don’t have three, think about possibilities that might connect you socially to your areas of interest. For me it might include participation in Special Olympics, our local schools sports programs, connecting with my closest friend regularly, and a yoga class. The options are practically endless, but here are some additional ideas to get you started.
- Loving kindness meditation: Sit in a quiet spot for five minutes as you close your eyes, slow and deepen your breath (e.g. 4 breaths/minutes), and picture a person or pet that you love more than words can express. Allow the calm and positive emotions to wash over you throughout the day.
- Adopt a pet from your local shelter.
- Consider growing more plants, a garden, or more frequent walks in the woods. The Japanese see this as powerful medicine and refer to it as shin rin yoku or forest bathing.
- Take a class—yoga, meditation, tai-chi, zoomba, aerobics, or arts and crafts
- Volunteer at a soup kitchen, food pantry, hospice, hospital, or any number of local nonprofit groups such as Habitat for Humanity
- Join a recreational group —bridge, bowling, pottery, art class, or coaching a youth league
- Participate in a book club
- Become active in your children’s school
- Join a faith community or participate in a local mission project
- If you confront a chronic health ailment, figure out if your community has resources that support you and your needs. The fellowship and sharing of information provides many benefits. Support groups commonly organize themselves around such health issues as cancer, chronic pain, prior heart attack, fibromyalgia, and diabetes, to name a few. In addition, cardiac rehabilitation programs (usually available at hospitals) offer superb physical, social, and emotional support. You might Google this for your community; Contact your doctor, hospital, or Department of Social Service to find a support group that meets your needs.
- Consider an important relationship in your life that has become “undone.” Write a letter, email or call the individual as a courageous (and health-promoting) extension of your desire to “forgive and let live.”
There is no shortage of great causes and opportunities out there to share your time and talent, which as you’ve seen, reward health and quality of life in countless ways. Remember, the paradox––that which you feel would be great, but for which you have little time or energy, will reward you with more energy and more opportunity once you dive in. You will also likely be rewarded with more time…more time for living.
I would make the case that you are in fact, born to bond! And that is good news, as it seems, in this fast-paced cacophony of modern living, we need each other more than ever. Your journey is meant to be shared journey! Love yourself, smile, cultivate a forgiving heart, look others in the eye, and allow the energy that is you to connect as many people, pets, and plants as possible!
~ Mark Pettus, MD, FACP, ABHM - Medical Director