Part V: Stress is Social

Medical science has begun to detail the biological pathways through which others get under our skin, for better or worse.

Love can make a medical difference. Among men undergoing angiography for coronary heart disease, those reporting strong marriages had 40% less blockage than those with tenuous relationships. Toxic relationships can be major risk factors for disease and death – as threatening as smoking, high blood pressure or cholesterol, obesity and physical inactivity.

Prolonged high levels of stress hormones contribute to cardiovascular disease, impair immune function, exacerbate diabetes and hypertension, even harm memory. How a given relationship affects our health will depend on the sum total of how emotionally toxic or nourishing it has been over months and years.

“I don’t have ulcers, I give ulcers!” People in lower employment positions are four times as likely to develop cardiovascular disease as top executives. An affront from peers can be challenged, an apology demanded. But when the insult comes from the boss who holds the power, subordinates suppress their anger. People who respond to insults with silence experience significant hikes in blood pressure. Of all the sorts of stress, the worst by far was when someone was the target of harsh criticism and was helpless to do anything about it.

The lonelier a person feels, the poorer immune and cardiovascular function tends to be. The aging brain continues to manufacture new neurons daily – a process that monotony seems to slow down. Adding complexity to the environment of elderly persons and stimulating daily interaction with other people enhances the rate at which elderly brains manufacture new cells.

“They’ve only had one argument and they’re still having it!” Marital battles are particularly hard on wives. For women whose husbands simply withdrew in anger during arguments, stress hormones zoomed. Women whose husbands displayed kindness and empathy during disagreements experienced lower levels of stress hormones. Either way, husbands’ hormone levels didn’t budge much, unless the argument was about control.

The new neuroscience continues to explore how women are emotionally different from men. For American women, positive relationships are their major source of satisfaction and well-being throughout life. For American men, a sense of personal growth and independence are more important than positive relationships.

Women take more responsibility for the fate of those they care about. The ups and downs of those relationships can be emotional roller coasters. Women spend much more time than men ruminating about upsetting encounters, mentally replaying them in vivid detail. For all these reasons, troubles in a close relationship drive adverse biological reactions in women more strongly than in men. Stormy marriages are more likely to lead to early death for women than in men. Women’s cholesterol levels are directly linked to the amount of stress in their marriages. In women, a severe emotional crisis is more likely to trigger a heart attack; in men, the trigger is more often physical exertion.

On the positive side, women seem to experience more positive health benefits from a good marriage than their husbands. The more pleased a woman is with her marriage, the more likely she is in better health. For both sexes, the very substance that draws us closer to people we love, converts warm connections to biological well-being. People who become emotionally interdependent play an active role in each other’s very physiology.

The more close friends women have as they age, the less likely they are to develop physical impairments. Friendlessness is as detrimental to women’s health as smoking or obesity. Socially integrated people – who are married, have close family and friends, belong to social and religious groups, and participate widely in these networks – recover more quickly from disease and live longer.

The medical profession suffers from “organized lovelessness”. Revenue guides how medical services are handled. For the most part, compassion is an impediment. Yet physicians whose patients felt more rapport sued them less. Those who took just a few minutes longer in office visits were less likely to be sued. The more satisfied the patient, the better they could recall physicians’ instructions and the greater their compliance.

Caregivers who take time to express compassion are healthier, happier in their work and experienced less “compassion fatigue”. Lacking emotional refills, caregivers run on empty. A burned-out social worker, doctor or nurse has no emotional resources to draw on. Unfortunately, the motive to connect with people that draws so many into medicine gets slowly supplanted by the hospital culture – a biomedical orientation, technology-driven and geared to getting patients in and out as quickly as possible. The question is not whether empathy can be taught to medical caregivers, but what is being done to drive it out of them.

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