Read an Excerpt
A Cry Unheard
New Insights into the Medical Consequences of Loneliness
By James J. Lynch
Bancroft Press
Copyright © 2000 James J. Lynch
All right reserved.
ISBN: 978-1-890862-11-4
Chapter One
An Overview
"Thirty years ago, anyone blaming loneliness for physical illness would have been laughed at," the editors of Newsweek observed in a March 1998 cover story. That issue described the rapidly accumulating medical evidence linking the disruption of human relationships and loneliness to a sharply increased risk of disease and premature death in all post-industrialized nations. Newsweek's assessment was most assuredly correct. The medical consequences of loneliness are far better understood now by health professionals than they were when my first book, The Broken Heart: The Medical Consequences of Loneliness, was published in 1977.
Although medical research on this topic began while I was still a boy running around in short pants, my own research journey in this area first began with a group of investigators at The Johns Hopkins Medical School in 1965. Since that time, there has been a veritable explosion in knowledge about the connections between social support and health, as well as an increased understanding of the links between human loneliness and the vulnerability to disease and premature death.
Slowly but surely over the past three decades, this growth in knowledge has led me to one inescapable conclusion: Dialogue is the elixir of life and chronic loneliness its lethal poison. Based on recent health trends, it is growing ever more apparent that New Age cultural forces that disturb, disrupt, and destroy human dialogue must be viewed with the same concern and alarm as has been brought to bear on other plagues, infectious diseases, viruses, bacteria, and cancers. For all of the recent health data suggest that if current trends persist, communicative disease, and its resultant loneliness, will equal communicable disease as a leading cause of premature death in all post-industrialized nations during the twenty-first century.
A wide variety of statistics suggest that large numbers of people fail to recognize the dangers, that they are unable to fully appreciate the potent health benefits derived from various forms of social support, including that provided by family, friends, neighbors, and loved ones. Signs of the disruption of human relationships and symptoms of human loneliness have grown ever more problematic in the past 35 years, indicating that attitudes about human relationships have changed, not only in America, but also throughout the rest of the Western World.
In 1900, for example, only 5 percent of American households consisted of one person living alone. By 1960, that figure had risen to 13 percent, and at the century's ebb it stood at 25 percent. Fifty percent of all marriages in America currently end in divorce, and over one million additional children annually are caught up in divorce. In addition, the number of children born to unmarried women rose 61 percent between 1980 and 1991—going from 18 percent of all live births in 1980 to 30 percent by 1991. The rate of increase has been particularly dramatic for white women, increasing over 94 percent in the last decade.
Rapid increases in single parent households, high divorce rates, declining marriage rates, increasing numbers of people living alone, and the rapid increase in the number of children born into single parent households represent only one dimension of what has been a truly profound shift in attitudes. Widespread violence, rapidly growing numbers of men and women held in US jails, drug addiction and alcoholism, and an ever-increasing use of anti-anxiety and antidepressant medications are but a few additional signs of growing interpersonal and communicative problems within our society.
At times it seems as if our nation, having reached its high-water mark of prosperity, is simultaneously awash and drowning in a sea of narcotics and prescriptive medications to help deaden the pain. It is almost as if we have agreed to submit voluntarily to a national, chemically-induced frontal lobotomy to cope with the loneliness and disconnectedness of our age.
There are, as well, a variety of phenomena not usually associated with communicative disorders or the destruction of interpersonal relationships, social isolation, loneliness, and premature death. One such source can be found in school failure, which scars legions of children with the "Mark of Cain" for the rest of their life. Unable to relate to, or communicate with, their fellow man because of the shame of their "failure" in school, they wander in emotional exile, dying prematurely decades later, out of society's sight and broken-hearted.
Health experts inform us that if death rates for those white Americans with less than ten years of schooling were the same as those who graduate from college, at least 250,000 fewer people would die in the United States each year. They further inform us that this "excess" mortality has more to do with social isolation and loneliness than it does with economic stress. And I should note that these quarter-million white Americans are casualties of a hidden plague that exacts a toll at least as lethal as any other medical problem facing our nation. The toll is equally devastating for Hispanic-Americans and African-Americans.
In this book, I describe these varied phenomena and clarify what school failure and other socially isolating childhood experiences have in common with adult experiences such as being single, widowed, and divorced, and how they are all linked to an increased risk of premature death. I explain how these ostensibly disparate human experiences are particularly linked to an increased risk of heart disease. And I explain, perhaps most importantly, the mechanisms that contribute to the greatly increased risk of premature cardiac death.
I also suggest a variety of steps that can be taken to help solve these problems. For in one way or another, all of these situations share in the absence, the breakdown, or the failure of human dialogue, reflecting an increased struggle with a recently understood hidden type of "communicative disease" that exacerbates social isolation and loneliness. The resultant physiological stress can be unbearable, and even break the human heart.
A NEW PERSPECTIVE: A CRY UNHEARD
Shortly after The Broken Heart was published in 1977, I had the good fortune to be among the first to come across a significant technological advance—one that revealed a dimension of the human cardiovascular system that had previously escaped attention. With the aid of what was then brand new computerized technology, I was able to monitor blood pressure automatically while continuing to engage patients in conversation.
This major technical advance permitted me and my colleagues to observe that a mode of human interaction previously considered "mental" in nature—ordinary, everyday human dialogue—could have profound effects on the human heart. Prior to the development of this technology, blood pressure was typically monitored with a stethoscope and mercury manometer. Since the physician had to listen with his stethoscope to the pulsation of the heart beat in the brachial artery, neither the doctor nor patient could talk during the measurement process. Silence was built-in.
With the new computerized technology, however, it was easy to engage patients in dialogue while their blood pressure was measured automatically. And that one simple procedural change in the measurement of blood pressure opened up an entirely new vista, completely altering my understanding of human dialogue and its links to loneliness and heart disease. My colleagues and I began to observe what we would come to call the "vascular see-saw" and "vascular rhythm" of all human dialogue. It was the predictable rise of blood pressure whenever a person began to talk, and then, just as predictable, its fall whenever a person became quiet and listened to others, or attended to the external environment. Thus produced were dramatic new insights into the links between human dialogue, loneliness, disease, and premature death.
For the first time, I was able to appreciate the devastating health consequences of varied life experiences, including school failure, which made human dialogue either difficult or impossible. In those situations, the normal rhythm of the "vascular see-saw" could be disrupted. In its place were rapid, marked surges in blood pressure, reflecting the hidden "vascular cries" of shame, anxiety, anger, and fear that had previously gone unrecognized, undetected, and unheard.
It also became easier to observe the potent health consequences of talk between and among adults who used language not to reach, understand, and share with each other, but to hurt, manipulate, control, and offend. These communicative problems, and the accompanying vascular cries, frequently occurred outside of the person's awareness. From all external appearances, patients were calm, cool, and collected, while internally their bodies were reacting in terrible distress.
Communicative difficulties of this sort frequently could be traced back to earlier training and traumatic experiences with parental use of language in childhood. Outside of their own conscious awareness, parents far too often instilled this type of dysfunctional and abusive rhetoric in their own children, who then carried it into adulthood, and passed it along to their own unwitting offspring.
The repetitive and cumulative exposure to language used to hurt, manipulate, control, and offend inexorably led to the serious wounding of self-esteem during childhood. If compounded by other traumatic developmental experiences such as school failure, the effects were both toxic and fatal. Irrespective of the original source of the wounding, however, the result was always the same—one that made it increasingly difficult for the victim to communicate with others without physiological distress. The greater the developmental damage, the greater the physiological distress whenever a person tried to communicate. Exposure to this "toxic talk" produced in its victims a hopelessness that language could be used in a constructive manner to reach others, and that, in turn, made human communication for them increasingly difficult and physiologically taxing. Exposure to such talk proved "toxic" precisely because it led to premature death.
Eventually, I came to realize that it was the repetitive activation of one of two opposing bodily states during everyday dialogue that either enhanced health or conversely contributed to the premature development of disease and death. One bodily state I label the physiology of inclusion, and the other the physiology of exclusion. In essence, dysfunctional dialogue, withdrawal from dialogue, or the type of dialogue that occurs in a social context where others are seen as a threat, triggers the repetitive activation of what scientists have long recognized as the "fight/flight response." It is this "wired-in" posture of exclusion towards others, one that is rooted in prior experience with toxic talk or linguistically-based injury, which activates the fight/flight response.
The "fight/flight response," regulated by the "autonomic nervous system," developed in higher level mammals over millions of years of evolution. It was designed to prepare the body for those emergency situations where physical activity was required for self-preservation. In the face of the proverbial "saber-tooth tigers and wooly mammoths" wandering about in the primeval forests, both human and non-human mammals alike had to have a way of reacting quickly to preserve their lives. They had to be able to respond to these threats in a way that would prepare them to either fight or flee.
The autonomic nervous system was designed to stimulate the cardiovascular system, which in turn was designed to deliver the energy needed to support the physical movements required in emergencies. In threatening situations, heart rate and blood pressure quickly increase, redistributing blood from the skin and various internal organs to the muscles involved in the physical activity. In addition, sugar and fat from bodily stores are released to provide energy for the movement, along with secretion of a highly active neurotransmitter, called catecholamines, that can affect almost any organ in the body and alter brain function. Various stress hormones, including adrenalin, also are released by the activation of this neurotransmitter from the cortex of the adrenal glands.
While the saber-tooth tigers, wooly mammoths, and primeval forests have long since disappeared from our lives, the autonomic nervous system still mobilizes in response to the perception of "symbolic saber- tooth tigers." Far too often, however, the perception of these dangers can be way out of proportion to the actual threat, leading to excessive emotional arousal, and fight/flight reactions in situations where there is no objective threat to life. Unfortunately, the repetitive mobilization of the cardiovascular system in a fight/flight response to situations not requiring either will eventually wear down and exhaust the human body.
It was the availability of the new blood pressure monitoring technology that first permitted us to observe the surprising frequency of fight/flight reactivity during everyday dialogue. It was surprising in part because words and dialogue are the stuff of human life, and it just did not seem possible that ordinary, everyday conversations could pose such a major threat to modern-day human beings. Because I was well aware that human loneliness was a major health risk, I first assumed, in a rather simplistic manner, that an increase in dialogue with others would be an obvious part of the solution.
Yet, the new technology helped to make it apparent that a chronic exclusion of others—an orientation where other human beings were seen as a threat, especially during everyday human dialogue—could trigger repetitive activation of the fight/flight response in situations where neither fight nor flight was necessary. These repetitive, undetected, maladaptive fight/flight reactions, frequently "wired-in" by exposure to toxic talk early in childhood, would inexorably lead to physiological exhaustion, creating a biologically-based need to withdraw from dialogue for one's "self-preservation." This communicative reflex of exclusion, in turn, would lead inexorably to an increased sense of loneliness and social alienation, and ultimately to disease and premature death.
By contrast, dialogue that included others—a dialogue that did not respond to others, or the living world around them, as a potential threat—would activate the physiology of inclusion, which I call a state of enhanced relaxation. This fosters precisely the opposite bodily state, one that produces health and longevity. It would help to draw people out of their own selves, and closer to others in dialogue, rather than exclude and seal them off. The new technology, at long last, gave us a way to help both children and adults to be more aware of these undetected and frequently unfelt physiological reactions to dialogue.
It also helped us teach them about these opposing reflexes, and guide them away from a "wired-in" communicative physiology of exclusion and toward one of communicative inclusion. The shift could help them embrace and touch others in dialogue in a way that at long last offered the hope of ending their communicative isolation, exile, and loneliness.
Understanding the paradoxical impact of human dialogue, one that could be physiologically inclusive or exclusive, provided an entirely new perspective on how to more effectively address and treat a variety of communicative diseases linked to human loneliness. It provided an entirely new perspective on school failure, too, and its links to premature cardiac death. It suggested new ways to help school children at risk. And the capacity to monitor blood pressure automatically also provided a new way to help couples communicate more effectively by permitting them to see the previously hidden, undetected, but heartfelt nature of their dialogue.
And most importantly, patients suffering from various cardiovascular disorders could utilize this new perspective to reduce the stress on their hearts, and increase their chances of living a longer and better life. Patients who literally had talked their way into heart disease could at long last be taught new ways to communicate in a less toxic manner, and to reduce the stress on their hearts.
(Continues...)
Excerpted from A Cry Unheard by James J. Lynch Copyright © 2000 by James J. Lynch. Excerpted by permission of Bancroft Press. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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