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14 - The Strength of the Heart

I have met on the street a very poor man who was in love. His hat was old, his coat was out at the elbows, the water passed through his shoes, and the stars through his soul.

—Victor Hugo

Love’s mystery and wonder, of course, are not reserved only for those who are married. But there is a special way that love can touch two people in an intimate relationship who commit themselves wholeheartedly to the journey together.

Such relationships take us through whatever we need to learn to become more conscious, loving people. They open our hearts, break our hearts, and heal our hearts—sometimes all at the same time. They give us opportunities to develop courage, patience, and resilience. They teach us to be compassionate and forgiving. They give us the strength to fulfill the purposes for which we are alive.

And now modern science is recognizing that loving and intimate relationships also keep us healthy.

It is a striking fact that mortality rates for all causes of death in the United States are consistently higher for divorced, single, and widowed individuals of both sexes and all ages. Such statistics explain why life insurance companies recognize people’s marital status as one of the best indicators of how long they are likely to live.

The Hammond Report was the study that followed the smoking habits of nearly half a million Americans and led ultimately to the warning printed on every cigarette package that smoking is hazardous to your health. If you look at the table above, extracted from the Hammond Report, you’ll see something that may astonish you.

As you can see, the premature death rate for smokers in each category is roughly double that for nonsmokers. What I find most remarkable, though, is that the premature death rate for nonsmokers who are divorced is almost equal to that for married smokers. For men, apparently, the breakup of a marriage can be nearly as lethal as a lifelong habit of smoking.

THE EVIDENCE CONTINUES TO MOUNT

One of the first, and still one of the most remarkable, of the many studies exploring the influence of love and social connectedness on human health was conducted by epidemiologist Dr. Lisa Berkman beginning in 1965. Now the chair of the Department of Health and Social Behavior at the Harvard School of Public Health, Dr. Berkman led an intensive study of seven thousand men and women living in Alameda County, California. She found that people who were disconnected from others were roughly three times more likely to die during the nine-year study than people with strong social ties. The kinds of social ties didn’t appear to matter. What mattered was being involved in some social network, whether it was family, friends, church, volunteer groups, or marriage.

This dramatic difference in health outcome and survival rates was found to occur regardless of people’s age, gender, health practices, or physical health status. But what most astounded researchers about this study was that those with close social ties and unhealthful lifestyles (such as smoking, obesity, and lack of exercise) actually lived longer than those with poor social ties but more healthful living habits. Needless to say, people with both healthful lifestyles and close social ties lived the longest of all. Is this study some kind of aberration? No, it is not. Many other studies have come to similar conclusions. When seventeen thousand people in Sweden, for example, were examined and followed, it was found that those who were the most lonely and isolated at the beginning of the study had nearly four times the risk of dying prematurely in the ensuing six years. For another example, an analysis of the medical risks of social isolation published in the journal Science in 1988 concluded that lack of emotional support was a greater risk factor for disease and death than smoking.

These studies and many others like them are warning us that the medical consequences of loneliness are real and can even be fatal. At the same time, they are providing us with compelling evidence of the scientific basis for the healing powers of friendship, love, and positive relationships.

Studies have even shown that having a companion animal can make a huge difference. It’s no secret that children often love pets, but recent research has taken it a step further, proving that children raised with pets are less likely to become asthmatic, more likely to be kind to other children, and more likely to have healthy self-esteem once they reach their teens. Researchers are also finding that having pets positively influences children’s physical and emotional development and even their scholastic achievement. One of the most celebrated “pet studies” was undertaken by Erika Friedmann and her co-workers at the University of Pennsylvania. They found an unmistakable association between pet ownership and extended survival in patients hospitalized with coronary heart disease. Those patients who had pets at home were far more likely to survive, even after accounting for differences in the extent of heart damage and other medical problems. The medical value of pets became unexpectedly apparent to researchers who were conducting the Cardiac Arrhythmia Suppression Trial. They were studying the effects of two pharmaceutical drugs (encainide and flecainide) on men who had had heart attacks and were now experiencing irregular heartbeats. Paradoxically, the drugs were found to cause an increase in cardiac deaths. At the same time, however, it was found that those patients who had dogs were only one-sixth as likely to die during the study as those who did not have dogs. Can you imagine what would have happened if the drugs rather than the dogs had been shown to cause a sixfold decrease in deaths? The drugs would be prescribed for every heart attack patient in the country with an irregular heartbeat, and drug companies would be spending hundreds of millions of dollars telling physicians and the public how great the drugs were. But because the loyalty and loving friendship of a dog cannot be bottled and sold, there has been no such publicity campaign, and most people to this day do not realize how much healing can be found in loving relationships—including ones with companion animals.

In another study called the Beta-Blocker Heart Attack Trial, researchers followed more than 2,300 men who had survived a heart attack, to see whether there would be an increase in survival for those taking a beta-blocker drug. There was, but the researchers ended up discovering something far more significant. Stunningly, those patients who had strong connections with other people were found to have only one-quarter the risk of death—even when controlling for other factors such as smoking, diet, alcohol, exercise, and weight. In fact, the decrease in death risk due to social connectedness was found to be far stronger than that for the beta-blocker drug being tested. Partly as a result of this study, physicians today widely prescribe beta-blocker drugs for people who have survived a heart attack. Ironically, doctors typically issue these prescriptions during appointments with patients that last all of fifteen minutes, during which they never mention the far greater proven importance of friendship and social support.

HOW MUCH WE MATTER TO EACH OTHER

Rachel Naomi Remen, M.D., tells of the difference in health outcomes human relationships can make:

Many years ago when I was a teaching pediatrician at a major medical school, I followed six young teenagers with juvenile diabetes. Most of them had diabetes since they were toddlers and had responsibly followed strict diets and given themselves injections of insulin since kindergarten. But as they became caught up in the turmoil of adolescence, desperate to be like their peer group, this disease had become a terrible burden, a mark of difference. Youngsters who had been in diabetic control since infancy now rebelled against the authority of their disease as if it were a third parent. They forgot to take their shots, ate whatever the gang ate, and were brought to the emergency room in coma or in shock, over and over again. It was frightening and frustrating, dangerous for the youngsters and draining for their parents and the entire pediatric staff.

As the associate director of the clinics, this problem was brought to my door and I decided to try something simple. I formed two discussion groups, each consisting of three youngsters and the parents of the other three. Each group met to talk once a week.

These groups turned out to be very powerful. Kids who could not talk to their own parents became articulate in expressing their needs and perspectives to the parents of other children. Parents who could not listen to their own children hung on every word of other people’s children. And other people’s children could hear them when they could not hear their own parents. People, feeling themselves understood for the first time, felt safe enough to cry and found that others cared and could comfort them. People of all ages offered each other insights and support, and behaviors began to change. Parents and their own children began to talk and listen to each other in new ways. We were making great progress in the quality of all the family relationships, and the number of emergency room visits was actually diminishing. These children and parents were finding that they had something important to offer each other. They were discovering that our care and compassion for others often make more difference than we realize.

TOXIC RELATIONSHIPS

Relationships are powerful, and can be enormously important to health and longevity. But as so often is true in life, there is also a shadow side to this power. While good intimate relationships are deeply supportive of health, it’s also true that bad ones can cause considerable damage. Sometimes people’s hearts ache with loneliness even in the company of their spouse.

In an article published in The Journal of the American Medical Association in 2000, a research team headed by Kristina Orth-Gomer, M.D., Ph.D., found that marital discord dramatically increases the risk of cardiac death in women. The study found that women with heart disease tripled their risk of recurrent heart trouble if they were involved in a stressful relationship. Realizing that many issues could cloud their results, the researchers specifically factored out age, sedentary lifestyle, estrogen status, smoking, lipid levels, education, and a host of other variables that could have altered the outcome of the study.

What is it about unhappy relationships that so undermines the health of women? Another study, presented in 2005 at the American Heart Association’s Second International Conference on Women, Heart Disease, and Stroke in Orlando, Florida, provided further in-sight. This ten-year study followed 3,600 men and women aged 18 to 77, all of whom were married or living “in a marital situation.” The researchers collected data on marital discord and tracked the health of the participants to see who developed heart disease or died of any cause during the study.

The greatest health risk was seen in women who kept quiet when conflicts arose with their spouses. Though they might have thought they were keeping the peace by remaining silent in such situations, they paid dearly for it. Women who did not express themselves in marital conflicts had four times the risk of dying during the study compared to women who spoke their minds.

Men, on the other hand, suffered in their hearts when they saw their working wives burdened by job stress. Men who said that their wives came home upset fom work were nearly three times more likely to develop heart disease than men whose wives didn’t work or were happy in their work.

Relationships that help you to feel acknowledged, safe, and loved are a great boon to your health. But it is also true that relationships that make you feel frightened, hurt, or despised can be poisonous.

Andrew Weil, M.D., bestselling author and director of the Program in Integrative Medicine at the University of Arizona in Tucson, relates a particularly dramatic case of healing that took place for “a bank president with chronic hypertension, whose blood pressure normalized one day after his wife filed for divorce. It dropped to 120/80 and stayed there.” Somehow I suspect that this man’s relationship with his wife had not been a source of love, joy, and healing in his life.

In another case, author Brendan O’Regan writes of a medical journal article describing the astonishing case of a woman with metastasized cancer of the cervix who was considered close to death. Her condition changed dramatically when, in the words of the case report, “her much-hated husband suddenly died, whereupon she completely recovered.”

THE IMPORTANCE OF PARENTING

Among the most important relationships of our lives, of course, are those with our parents. One of the foremost pioneers in understanding the influence of relationships on health is James J. Lynch, Ph.D. In his 2000 book, A Cry Unheard: New Insights into the Medical Consequences of Loneliness, Dr. Lynch draws particular attention to the formative role of parent-child relationships. It is widely recognized that the way parents treat their children can have a huge impact on whether they become confident, joyful, and responsible people, or grow up insecure, frightened, and dysfunctional. Lynch’s work, however, goes further and shows that how parents treat their children has enormous medical implications.

It’s thankfully becoming ever more widely recognized that physical abuse of children is harmful and indefensible. But verbal abuse can also cause great damage. Negative words can hit as hard as a fist, and can leave deep and lasting scars. It is abusive to destroy a child’s sense of self-worth with such debilitating phrases as “You’re hopeless,” “You’re good for nothing,” “You can never do anything right,” “You’ll never amount to anything,” or “I can’t wait until you grow up and get out of this house.” According to Dr. Lynch, parents who use language to hurt, control, and manipulate their children rather than to reach out and be present with them cause the youngsters to feel depressed and lonely. The kids then carry these feelings with them into their interactions with others in their lives. They tend to be socially isolated, and, Lynch shows, to end up with illnesses that reduce both the quality and the length of their lives. Lynch presents a wealth of data to support his conclusion that exposure to this kind of parenting proves “toxic” precisely because it leads to premature death. Loneliness in childhood, he says, has “a significant impact on the incidence of serious disease and premature death decades later in adulthood.” When I first learned of Dr. Lynch’s theories, I was skeptical. I didn’t doubt that a bleak childhood environment could predict mental illness in adult life. But could the way our parents treated us when we were children have that much impact on our later physical health? But then I learned of a truly remarkable long-term study conducted at Harvard University. It began in the early 1950s, when researchers randomly chose 125 undergraduate students and asked them to rank their relationships with their parents on a four–point scale as to the degree of their emotional closeness. The scale was as follows:

  • Very close
  • Warm and friendly

  • Tolerant

  • Strained and cold

Thirty-five years later, the researchers examined the medical histories of these volunteers and found that an astounding 91 percent of those who had rated their relationship with their mothers as either “tolerant” or “strained and cold” had, by the time they reached their late fifties, suffered serious medical crises. They actually had more than twice the risk of having serious diagnosed disease by that time compared to those who, thirty-five years before, had said they had either a “very close” or a “warm and friendly” relationship with their mothers. Similarly, 82 percent of participants who had rated their relationship with their fathers as either “tolerant” or “strained and cold” had developed serious diseases by midlife.

Even more amazing was that 100 percent of those who had reported that their relationships with both their parents were “strained and cold” had experienced serious medical problems by their late fifties.

There is another aspect to this study that I find fascinating. The students were asked “What kind of person is your mother?” and “What kind of person is your father?” The researchers simply counted the number of positive and negative words the students wrote down in describing their parents. A simple score reflecting the total number of positive words was found to be profoundly predictive of these students’ health thirty-five years later.

The correlation between these descriptions of parental relationships and future health was independent of family history of illness, smoking, emotional stress, subsequent death or divorce of parents, and the students’ marital history. And it was immensely powerful. Fully 95 percent of students who had used few positive words to describe their parents developed serious diseases in midlife, whereas only 29 percent of those who had used many positive words developed comparable diseases. I find this fascinating, because this indicates that having had a difficult relationship with one’s parents is a greater risk factor for major adult disease than smoking, obesity, and high blood pressure combined.

I could not agree more with the surgeon and author Bernie S. Siegel, M.D., who asserts, “The greatest disease of mankind is a lack of love for children.”

Could the Harvard study have been an isolated instance? Not likely, because many other studies have confirmed these findings. In a similar study, for example, researchers at Johns Hopkins Medical School asked more than thirteen hundred healthy medical students in the 1940s to fill out a questionnaire called the “Closeness to Parents Scale” to assess the quality of the students’ relationships with their parents. Fifty years later, it was found that those students who had described a lack of closeness with their parents were far more likely to have developed cancer. The predictive value of parental relationships that were not close did not diminish over time, and was not explained by any other known risk factor, such as smoking, drinking, or radiation exposure. In fact, the strongest predictor of which men would get cancer decades later turned out not to be smoking or obesity, but rather the lack of a close relationship with their fathers fifty years before.

MY FATHER, MY SON

How we raise our children is so important. We’ve all got our wounds, of course, but if we can face them and heal them, then we have a chance not to pass them on to our children. If we are going to build a healthy and loving world, few tasks are more crucial.

When my wife, Deo, was pregnant with our son, Ocean, I was overjoyed. But I was also concerned, because I wasn’t sure what kind of father I would be.

As a boy, I had been taught that to show any kind of vulnerability or suffering was a weakness. Like many males in the modern world, I had learned to equate being strong with being stoic, and to believe that to ask for help or to cry was unmanly. I had been taught that life was a battle and you had to be armored to succeed. I didn’t understand why I felt so lonely. I didn’t understand my feelings much at all.

My father was a very self-assured and successful man who worked long hours and provided well for his family, yet I did not grow up feeling emotionally close to him or feeling that my love made much difference to him. When he was feeling playful he would sometimes punch me in the stomach, encouraging me to tighten my abdominal muscles to brace for the blows, and then compliment me on how tightly my stomach muscles were clenched.

On the verge of becoming a father, I was coming to realize that my childhood had left me with an unwillingness to experience and show my feelings. This emotional disconnection kept others from knowing me or being close to me, and also kept me from really knowing or being close to anyone else. I was beginning to see that what I had been taught was a strength was actually a form of fear—a fear of being open, real, and connected to others.

I wanted my son to have a different kind of childhood experience from the one I had known. I wanted to be not only physically present with him, but also emotionally present. I wanted to have a relationship with him in which he could show me who he was and not have to pretend he was anything he was not, and, most important, in which he could have the experience of knowing his worthiness, knowing how important he was to me, knowing that his love mattered infinitely to me. I wanted our feelings to be a source of contact and honesty between us. But for that to happen, I had to learn how to let down my walls.

When Ocean was about eighteen months old, his mother went away for a week, and I was left solely responsible for the little guy. We got along fabulously, but slowly the effort of taking care of his every need began to wear on me. I felt sad that it wasn’t easier for me, and that I was beginning to feel overwhelmed. One evening the sadness swelled inside me to the point that it filled me with grief. My own childhood wounds were clearly being reactivated. I lay down on the bed and began to cry for all the children, myself included, who have ever been raised by parents unable to affirm their value and worthiness.

Ocean was, at that moment, sitting in his high chair eating his dinner. Seeing me crying so bitterly, he began asking to be removed from his high chair. At the time, he knew how to say only a few words, but one of them was “down.” As I was crying on the bed, he looked at me with great earnestness, and began saying “Down! Down!” “I’ve been looking after your every need twenty-four hours a day,” I wailed. “Can’t you just let me cry?”

“Down! Down!” he insisted.

“Okay,” I thought, “you win.” I sighed, went over to the high chair, gently picked him up, and put him down on the carpet. I kissed him, then went back to the bed, lay down, and began again to cry.

My eyes were closed when I felt a gentle pressure on my chest. Startled, I opened my eyes to see Ocean’s loving gaze looking down upon me. He had made his way over to the bed, climbed up on it, crawled over beside me, and placed his hand on my heart, looking into my eyes with tender concern. He had so persistently wanted down from his high chair not because he was a ball of selfish instincts and desires, but because he wanted to be close to me in my grief. He spoke, ever so gently, with deep concern pouring through his eyes: “Johnny hurt.”

This was the first time he had ever put two words together. It was the first sentence he ever spoke.

I felt relief at that moment, because I realized that I had taken a step in the journey of breaking the cycle. There would be many more steps to take, but I was beginning to discover that I could be emotionally available to my son, and that even with all my flaws and wounds, I still had much love and nurturance to give to him.

As more than thirty years have gone by since then, I’ve time and again been struck by Ocean’s kindness and compassion. His seemingly infinite love has continued to guide and inspire me. Being his father has been an unending source of joy and the greatest privilege of my life.

STRONG AT THE BROKEN PLACES

If you were lonely, neglected, or abused as a child, it can be an immensely difficult journey to seek love and healing within yourself. But it is possible to overcome such a hurtful legacy and reclaim your life. A key is to learn to treat yourself differently now than you were treated then, and to surround yourself with people who see and affirm your worthiness, and in whose presence you can be your whole and loving self. You don’t have to continue the legacy of hopelessness that you received, and you don’t have to pass it on to your own children. Instead, you can express your uniqueness and discover the healing powers of your own way of loving.

Ernest Hemingway wrote, “The world breaks everyone and afterward many are strong at the broken places.” A heart that has been broken is still alive. One of the most healing things you can ever do is to find strength in your wounds and emerge with deeper wisdom, creativity, compassion, and connection to yourself and to others.

If you are able to use your pain for self-transformation rather than self-pity, if you are able to use your loss and grief to awaken new life and compassion within you, then it ceases to matter so much how cold or dysfunctional your parents might have been. If you can be the kind of parent to yourself and to the children in your life that you have always wanted, then you will learn everything you need to know about the healing power of unconditional love.

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