The Village Effect: How Face-to-Face Contact Can Make Us Healthier and Happier (5 page)

Social isolation not only increased the number and size of breast tumors, it also exaggerated the animals’ biological stress responses. In another experiment, McClintock and Conzen isolated a group of female lab rats for three months right after birth. Then the researchers put them in a cage liberally sprinkled with fox urine, a signal that a predator was lurking nearby. In response, the social isolates secreted ten times more corticosteroids (hormones released from the adrenal gland when mammals are stressed out) than a control group of female rats raised in social groups. This exaggerated biological response changed their behavior, making the rats less willing to explore their environment. It also had epigenetic effects, altering the way genes were expressed in their mammary glands.

If you’re a rat, the scent of fox urine is unnerving. If you’re a human, you’re likely to be stressed out by something else, such as public speaking, being bullied by your boss, or missing the last train to Clarksville. Whatever makes you sweat, Martha McClintock’s research tells us that as mammals we need stable social contact at the beginning of life in order to cope with stress later on. Being denied secure, steadfast relationships predisposes us to overblown biological reactions to stress, which by disrupting the
gene pathways that suppress tumor growth, add to our existing risk factors for breast cancer.
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This suite of experiments also reveals how critical early social contact is to our ability to handle stress as we age. It also suggests one reason why children placed in orphanages as infants—where they’re usually deprived of regular contact with parental figures—often experience enormous developmental challenges, even when they’re adopted by stable families later on.

A socially isolated female rat (left) compared to one raised in a group
. (Image and Figure Credits
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)

LONELINESS KILLS

Now that I’ve shown how a lack of social contact can cause tumors in rats, let’s return to those population sweeps I mentioned earlier to see what these findings might mean for humans. One such study, led by Californian public health researcher Candyce Kroenke and her colleagues, followed about three thousand nurses who had recently been diagnosed with invasive breast cancer who had also filled out a detailed questionnaire about their social lives. A team of epidemiologists then followed their progress for the next twelve years. Knowing how many friends and family members these nurses hung out with
before
they received a breast cancer diagnosis (as opposed to after, when a cancer patient may suddenly face boosted contact with social workers, medical staff, and hospital volunteers), the researchers then asked these pivotal questions: Was there any difference between the health of the nurses who were deeply immersed in their social lives and those with sparser social connections? And did nurses with lots of friends live any longer than those who were more solitary?

The answer is yes, and yes. By the time the study ended, four times as many solitary women had died of breast cancer than had women with active social lives. The survivors were more likely to be women like Sylvie. They weren’t necessarily extroverts, but they were surrounded by people they saw week in and week out. (In fact, there is evidence that introverts have a greater mortality risk from cancer, and even an increased susceptibility to catching colds.)
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The type of contact varied, ranging from the ropelike bonds between intimate friends and family members to the weaker threads that tied them to colleagues and neighbors. The critical factor? The women who survived the longest weren’t lonely. And while the more face-to-face contact the women had, the rosier their breast cancer prognosis, they needed just a few close friends to protect them from premature death.

Interestingly, though women with big families lived longer than those with small families, when it comes to living a long life after cancer, friends were the most protective social bond of all.
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Socially isolated women were 66 percent more likely to die of breast cancer than women who had at least ten friends they could count on. Those friends not only helped by providing information and concrete assistance, they also provided that neuroendocrine flush that comes with spending time with people you like and who care about you. And that means spending time
with
them, hearing the sounds of their voices and perhaps being touched. A hug, a squeeze on the arm, or a pat on the back lowers one’s physiological stress responses, which in turn helps the body fight infection and inflammation. Being there in person is key.

Of course, electronic communities help people stay in touch who are separated by geography or who have rare or virulent forms of a disease. The Internet has an astonishing capacity to aggregate like-minded people, and is a rich source of information that can help them feel more proactive about their illness. Indeed, online forays can radically alter many cancer patients’
lives.
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But unless joining an online community is just a first step—one that allows people to meet and form meaningful relationships—there is no decent scientific evidence showing that online activity can transform our health prospects the way face-to-face social networks can.
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That’s because social isolation kills. Behind the scenes, one of the effects of loneliness is that it can alter our genetic response to disease. In other words, chronic loneliness—the subjective experience of feeling isolated and alone for long periods—alters the expression of genes in every cell of your body. As incredible as it sounds, feeling isolated creates a “lonely” fingerprint on every cell. That genomic fingerprint, or identifying stamp, confuses the body’s usual reactions to disease and stress, instructing some cells to turn on the fireworks of inflammation while instructing other cells to turn off the body’s usual immune defenses. Under normal circumstances these processes would protect cells from being damaged by disease. But feeling lonely for long periods throws a monkey wrench into the complex genetic code we’ve developed as a social species, making us more vulnerable by switching off antibodies that would protect us from viruses and infection, and bamboozling leukocytes (white blood cells) so they can’t attack their targets.
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Interestingly, individuals differ in the amount and type of social contact they need to avoid feeling lonely. John Cacioppo has discovered that the subjective state of loneliness—and its power to erode our natural resilience—is very much like other biological appetites, like the need for sleep, food, and sex. How often we need to be in close contact with our friends and family in order to stay healthy and happy varies from person to person, and has a powerful genetic component.
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We can inherit the destructive capacity for loneliness from our parents. Given that it runs in families, it seems to be a feature of their family histories people should know, much the way you’d want to know whether hypertension or kidney disease is in your family background. Just as different plant
varieties need different amounts of water to survive and thrive, introverts need less social contact while extroverts need more. But everyone needs a certain amount of meaningful face-to-face contact in order to maintain their own unique social metabolism.

Still, even if face-to-face contact can help protect us from maladies ranging from the common cold to cancer, there is no evidence that people bring cancer on themselves, nor that the right type of thinking or mood can prevent it. The idea that you can control your own health with the right attitude has been promoted in New Age books, in popular magazines, and on talk shows, and the vast majority of people believe it.
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But it’s a pernicious untruth. Not only does the idea have no scientific basis, it shifts blame for the disease onto the victims and away from the biochemical mechanisms that are still, for the most part, maddeningly beyond their control.

LET’S GET METAPHYSICAL

One of the studies that tried to show that you can control the direction of breast cancer with your thoughts and feelings (but failed to prove the connection) drew my attention because the “Let’s Get Physical” pop star and breast cancer survivor Olivia Newton-John funded it. The study worked this way: More than seven hundred young Australian women diagnosed with non-metastatic breast cancer filled out detailed questionnaires about their anxiety levels, their adjustment to their cancer diagnosis, and the extent to which they suppressed or expressed their feelings about it. Then the women’s health was tracked for eight years.

What did they find? There was no connection between mood and breast cancer outcomes. Teaching women with breast cancer to think positively and proactively about their illness doesn’t cure them. The coaching does make them feel less anxious and depressed—which is valuable and important in its own right—but it doesn’t help them live any longer.
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The thinking at the end of the twentieth century was that healing the mind would heal the body—and many
preliminary studies suggested that psychotherapy might extend cancer patients’ survival. But none of the more rigorous studies that followed have shown that to be true.
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Psychotherapy can relieve emotional distress, but it can’t extend your lifespan.
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Chemotherapy and radiation can improve your lifespan, but they certainly can’t relieve your distress. Only your friends can do both.

STRESS, CANCER, AND ELIZABETH EDWARDS

This raises what I’ll call the Elizabeth Edwards question—one of the touchier aspects of the social-support-affects-cancer-survival idea. While I was researching this chapter, Elizabeth Edwards, the estranged wife of former presidential hopeful John Edwards, died of breast cancer at sixty-one. Her death shook up cancer survivors who had long seen her as a model of tenacity or, as one
New York Times
reporter put it, “the cancer patient who would not be defined by her disease.”
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Edwards had written candidly about tragedy and resilience in two memoirs that described how she faced her son’s accidental death at sixteen and what it was like to live in the political spotlight while fighting chronic illness. Controversially, she had stepped up her campaign schedule instead of pruning her commitments when, in 2006, it was discovered that her cancer was spreading.

The day before Edwards died, in early December 2010, her family announced that her cancer was no longer treatable. She posted the following statement on her Facebook wall: “I have been sustained throughout my life by three saving graces—my family, my friends, and a faith in the power of resilience and hope. The days of our lives, for all of us, are numbered. We know that.” Within minutes the airwaves and blogosphere were awash with tributes, but also with suggestions that marital stress and lack of support had triggered her metastatic breast cancer.
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This question had surfaced before, in light of lurid revelations of her husband’s infidelity in the run-up to his 2008 campaign for the Democratic nomination. Though the cancer had metastasized to her bones and was considered
untreatable in 2006, had his subsequent affair relaunched his wife’s cancer, just when she seemed to be getting the better of it?

We will never know. But Elizabeth Edwards’s three public struggles—first with her son’s tragic death, then with breast cancer, and finally with her husband’s infidelity—seemed to support the widespread belief that stress causes cancer. One study about women’s attitudes shows that nearly half the women who have had breast cancer attribute their diagnosis to hard times in their lives: a separation or a divorce, a death in the family, workplace stresses, financial struggles—or all of the above. And 87 percent chalk up their remission to their efforts to think positively and reduce stress.
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My swim-team friend Sylvie had linked the arrival of her cancer to “stress I was unable to control,” and her mother’s and grandmother’s experiences with breast cancer to sudden stressful events in their lives (as opposed to, say, a breast cancer gene).
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But does facing hardship or thinking negative thoughts really cause cancer? And does maintaining a sunny disposition while trying to lead a stress-free life prevent it? The answer to both questions is no. There is no good scientific evidence that stress causes cancer, even though studies have repeatedly tried to establish the connection.

Many of these studies asked people to look in the rearview mirror to identify stressful events that could be linked to the onset of their cancer. But human memory is highly selective. We’re more likely to remember dramatic events that give a narrative arc to our life stories rather than think that our flame will be blown out due to some random cell mutation (scientific jargon for “shit happens”). The Stanford biologist and renowned stress researcher Robert Sapolsky doubts the stress-causes-cancer connection, noting that “someone with a cancer diagnosis is more likely to remember stressful events than someone with a bunion.”
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Other problems with these studies include using very small samples and neglecting to control for a whole host of other factors that could be affecting
women’s cancer outcomes, such as whether they smoke, drink too much or are overweight, the stage of their disease, and how old they are at the time they are diagnosed (the longer you live, the more likely it is you’ll get cancer, because that’s what happens when other disasters haven’t killed you first). Whether people faced adversity before their cancer diagnosis or are possessed with a fighting spirit thereafter are red herrings. Most adults, in good health or ill, have faced some hard knocks.
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Still, when confronting cancer, most of us look back on our own life stories to try to answer the “Why me?” question. Our minds don’t seem built to comprehend multiple factors and statistical probabilities; our minds are built to look for the ping-pong of cause and effect.
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