Cure: A Journey into the Science of Mind Over Body

by Jo Marchant

  By giving people something to practice long-term, might mindfulness have more lasting effects? There are now lots of studies suggesting that mindfulness meditation does reduce signs of physiological stress in the body, such as the hormone cortisol, and markers of inflammation. Meanwhile some small studies, including a three-month meditation retreat studied by Elissa Epel and Elizabeth Blackburn, hint that meditation can protect or even lengthen telomeres, potentially slowing aging in our cells.28

  That’s a dramatic finding, but not everyone is convinced. David Gorski, an oncologist at Wayne State University and critic of alternative medicine, warns that early results regarding the benefits of meditation are being oversold, particularly because with meditation, as with other mind–body therapies, it is impossible to carry out double-blind trials. “Are you doing it rigorously?” he says. “It is easy to be led astray. Nobel Prize–winners are not infallible.”29

  Some scientists are still “very uncomfortable” with the idea of studying meditation, responds Blackburn. She says she always emphasizes that her studies so far are preliminary, but people “see the newspaper headings and panic.”30 To persuade the skeptics, she’ll have to show the effects in larger studies. She and Epel are now working on a two-year trial of more than 180 mothers of children with autism (Lisa is one of them), to see whether a mindfulness course helps to protect their telomeres against the effects of stress.

  Other evidence of meditation’s effects on physical health is mixed. Kabat-Zinn reported in 1998 that the autoimmune skin disease psoriasis cleared more quickly when conventional treatments were combined with MBSR.31 Other trials have suggested that MBSR boosts the response to flu vaccine,32 for example, and reduces the number of colds that people suffer over the winter.33 But most of these findings still need to be replicated before they can be believed.

  Very few studies have looked at mindfulness for MS. A 2014 meta-analysis found just three trials; they showed significant benefits for quality of life and mental health as well as depression, anxiety and fatigue.34 None has yet looked directly at disease progression, but the author of that meta-analysis, Robert Simpson of the Institute of Health and Wellbeing at the University of Glasgow, says it’s something he’d love to look at in the future.35

  Whether or not mindfulness turns out to influence the physical progression of his disease, however, Gareth says the psychological benefits alone make it worthwhile. In fact, despite suffering from a condition in which a very high proportion of patients become clinically depressed, Gareth insists he’s happier now than at any time in his life. “My wellbeing is wonderful,” he tells me over our coffee. “MS makes some things very, very difficult. But life is difficult. I prefer to focus on the good things, and I have so many of them.”

  He recalls the day he tried to walk down to that stream with his baby son: when his fear of the future sent him into a spiral of despair; when the happiness of an entire day was wiped out by just one thought. “Now if that happened, I’d say, ‘Okay, it’s just a thought,’ ” he says. “And I’d struggle down to the stream and enjoy that moment.”

  The Nicoya peninsula in northwestern Costa Rica is one of the most beautiful places on the planet. This 75-mile sliver of land, just south of the Nicaraguan border, is covered with cattle pastures and tropical rain forests that stretch down to the crashing waves of the Pacific Ocean. The coastline is dotted with enclaves of expats who fill their time surfing, learning yoga and meditating on the beach.

  For the locals, life is not so idyllic. They live in small, rural villages with limited access to basics such as electricity, linked by rough tracks that are dusty in the dry season and often impassable when it rains. The men earn a living by fishing and farming, or work as laborers or sabaneros (cowboys on huge cattle ranches), while the women cook on wood-burning stoves. Yet Nicoyans have a surprising claim to fame that is attracting the attention of scientists from around the world.

  Their secret was uncovered in 2005 by Luis Rosero-Bixby, a demographer at the University of Costa Rica in San José. He used electoral records to work out how long Costa Ricans were living, and found that their life expectancy is surprisingly high.1 In general, people live longest in the world’s richest countries, where they have the most comfortable lives, the best health care and the lowest risk of infection. But that wasn’t the case here.

  Costa Rica’s per capita income is only about a fifth that of the U.S., but if its residents survive the country’s relatively high rates of infections and accidents early in life, it turns out that they are exceedingly long-lived—an effect that is strongest in men. Costa Rican men aged 60 can expect to live another 22 years, Rosero-Bixby found, slightly higher than in Western Europe and the U.S. If they reach 90, they can expect to live another 4.4 years, six months longer than any other country in the world.

  The effect is even stronger in the Nicoya peninsula,2 where 60-year-old men have a life expectancy of 24.3 years—two to three years longer than even the famously long-lived Japanese. Nicoya is one of the country’s poorest regions, so their secret can’t be better education or health care. There must be something else.

  Another longevity expert, Michel Poulain of the Estonian Institute for Population Studies in Tallinn, traveled to Nicoya with the journalist Dan Buettner in 2006 and 2007 to investigate Rosero-Bixby’s findings.3 The pair were working for the National Geographic Society, identifying long-lived communities around the world—which they dubbed “Blue Zones”—and attempting to work out their secrets. Other examples included Sardinia, Italy, and Okinawa, Japan.

  In Nicoya, Poulain and Buettner met people like Rafael Ángel Leon Leon, a 100-year-old still harvesting his own corn and beans and keeping livestock, with a wife 40 years his junior. Living nearby was 99-year-old Francesca Castillo, who cut her own wood and twice a week walked a mile into town. And there was 102-year-old Ofelia Gómez Gómez, who lived with her daughter, son-in-law and two grandchildren. When Buettner’s team visited, she recited from memory a six-minute poem by Pablo Neruda. All of the elderly people they saw were still mentally, physically and socially active, despite their advanced age.

  Poulain and Buettner drew up a list of things that might be helping Nicoyans to age so well. They have active lifestyles, even in old age. They have strong religious faith. The lack of electricity for lighting means they go to bed early, sleeping an average of eight hours a night. They drink calcium-rich water (which is good for the heart) and eat antioxidant-rich fruits.

  Although the project was intriguing, it couldn’t narrow down the crucial factors. But Rosero-Bixby has recently carried out a study aiming to do just that. He teamed up with David Rehkopf, an epidemiologist at Stanford University in California. The pair took blood samples from around 600 elderly Costa Ricans, including more than 200 from Nicoya. They sent the blood samples to Elizabeth Blackburn’s lab in San Francisco, where she measured the length of their telomeres. If the Nicoyans really were aging more slowly, it should show up in her results.

  The team reported in 2013 that Nicoyans’ telomeres are indeed longer than those of other Costa Ricans.4 Their impressive life expectancy isn’t a statistical fluke but a real biological effect, in which their cells look younger than expected for their age. The size of the effect was equivalent to changes caused by behavioral factors such as physical exercise or smoking.

  To investigate why the Nicoyans’ telomeres are so long, Rosero-Bixby and Rehkopf analyzed the effects of everything from the residents’ physical health and level of education to their consumption of fish oils. Diet makes no apparent difference, and the Nicoyans are worse off than other Costa Ricans when it comes to health measures such as obesity and blood pressure. Their slower aging doesn’t seem to be a consequence of genes either—Nicoyans lose their longevity advantage if they move from the region. And it isn’t money: richer individuals actually have shorter telomeres.

  But there are some clues. Rehkopf and Rosero-Bixby found that Nicoyans are less likely than other Costa Ricans to live alo
ne, and more likely to have weekly contact with a child. Such social connection seems crucial. The telomere length difference is halved among Nicoyans who don’t see a child each week, and if they live alone, they lose their advantage completely.

  Other studies have found that Nicoyans have greater psychological attachment to family than residents of Costa Rica’s capital, San José. So Rehkopf and Rosero-Bixby speculate that close family ties might protect Nicoyans against life stress that would otherwise shorten telomeres. Despite their poverty, strong social bonds keep them young.

  It’s a startling finding, and to confirm it will take studies that collect more detailed data about the Nicoyans’ social connections. But Poulain says the theory fits with his own observations. He emphasizes (as does Rehkopf) that there is no single secret to long life, and that residents of longevity hotspots such as Nicoya probably enjoy a lucky combination of genetic and environmental factors. Yet he has seen unusually strong social networks in other Blue Zones too. “The social aspects are crucial,” he says. “There’s terrific support for the elderly.”5

  The idea is also bolstered by decades of evidence from communities suffering the reverse phenomenon: the gradual loss of social ties.

  —

  THE SOUTH LONDON public housing where 69-year-old Lupita Quereda lives is grim and gray, all paving slabs and concrete. I’m visiting her with a staff member from the charity Age U.K., which sends volunteers to chat with isolated elderly people. The shared stairwell up to Lupita’s home is covered in dirt and cobwebs, and there are multiple locks on her door.

  But she opens it with a huge smile, welcomes us in, and ushers us to a plain wooden table in her tiny kitchen. The flat is neat and tidy, with walls painted warm orangey-red. There’s an old-fashioned stove, and the kitchen shelves hold piles of audiotapes, a few pumpkins and squashes, and a South American wooden doll. Lupita wears a nightdress (she finds loose clothes more comfortable after a recent fall) and a maroon housecoat. She has graceful hands and elegant features but her appearance is now dominated by thick, gray hair and sunken, half-closed eyes.

  Lupita grew up in Santiago, Chile, where she trained as a journalist. After the dictator Augusto Pinochet took power in a U.S.-backed coup d’état in 1973, she worked for the resistance, publishing pamphlets about the regime’s atrocities. Her colleagues were imprisoned, her father was tortured, and in 1978 she was evacuated by the United Nations and taken to the U.K.

  Her English wasn’t good enough to continue work as a journalist, so after studying, she found a job as a social worker for Lambeth’s local government. She enjoyed reading, painting, but more than anything she loved to travel. She reels off the places she has visited—Scandinavia, India, China, Egypt, Ireland, Latin America. “I loved to be there, with the people,” she says. “Eating in the markets, feeling, seeing, being with their culture.” Then, over a period of six months, when she was 58, she went completely blind.

  When Lupita was a child, she suffered from the infection toxoplasmosis, which made her shortsighted. The parasite had stayed dormant in her body, and then it destroyed her sight entirely. Lupita was divorced, and living alone. Completely self-reliant before she became blind, she now couldn’t even make a sandwich—she ate by taking bread in one hand and cheese in the other.

  “I was in shock. Sitting in this chair for a year,” she says. But gradually she restarted her life, getting to know her flat—every corner, every pipe—by touch. She stripped out unnecessary items—all the plants, her collection of traditional hats from around the world, even her favorite woven rug from Mexico, in case she tripped on it. She kept only a few treasured possessions, including the framed poster on the wall behind her, precious even though she can no longer see it; a joyful pattern of stripes and splashes by the English painter Howard Hodgkin. It looks like the view through a window onto blue sky, I say. “Exactly, my bedroom window!” she laughs.

  Lupita has her independence back. She has learned to shop for herself, clean, bake bread, and even sew, if she has help threading the needle. But what still distresses her more than anything is her lack of social contact. Once her sight went, she realized that her hearing, because of the lifelong toxoplasmosis, was also very poor. Without being able to compensate by using her eyes, she feels that her deafness separates her terribly from others. “People relate beautifully to eyesight,” she says. “But dealing with a person who cannot hear is very annoying.” She finds being isolated within a group even more painful than being alone, so she avoids social events, from her granddaughter’s birthday party to the lectures and concerts she used to enjoy.

  Her only outings are to the supermarket. “I stay many days on my own and do nothing,” she says. She spends her time with taped audio books turned up loud; right now she’s listening to Bruce Chatwin’s In Patagonia. She appreciates our visit today and sees her son and his family each weekend, but says, “Next week probably I will be on my own all day, every day. With food, with water, but completely on my own.”

  I ask how that feels. Things hurt more, say if she traps her finger in the door, when there’s no one around to share her pain. And small everyday problems—a drawer that won’t open, or a visitor who’s late—“For me, it’s like a drama.” She tries to deal with it by laughing at herself, singing songs like “What Shall We Do with the Drunken Sailor?” But loneliness changes your pattern of thoughts, she says. “I worry about the most stupid things.”

  Worst of all, she feels cut off—from people around her, and from events around the world. The pitch of her voice shoots up and she pulls a tissue from her sleeve. “I feel completely on the side, looking in.” She hates that she struggles to hear the news, and when she does hear about problems elsewhere, “You get so frustrated. The inability to do anything but pray.”

  “To me, the universe is connection, it’s communication,” she says. “If you start to lose that, you start to die.”

  —

  THERE’S A growing body of evidence that Lupita is right about that. The realization that social connection literally keeps us alive began in the 1950s, when James House, an epidemiologist at the University of Michigan, dreamed up an ambitious project: to follow the health of an entire town.

  House and his colleagues tracked the residents of Tecumseh, southeast Michigan, and in 1982 they reported an unsettling result. After adjusting for age and other risk factors, adults who reported fewer social relationships and activities were around twice as likely to die over the next decade.6 Their lack of social bonds, it seemed, was killing them early.

  Six years later, House and his colleagues wrote an analysis for the journal Science, reviewing the Tecumseh project but also subsequent studies of thousands of people living everywhere from Evans County, Georgia, to Gothenberg in Sweden, as well as lab tests and animal trials.7 They concluded that social isolation is as dangerous for health as obesity, inactivity and smoking. The evidence was as strong as in the landmark U.S. government report that in 1964 officially linked smoking with lung cancer.

  House’s paper had a dramatic impact. At a time when scientists were only just beginning to realize that the mind could affect health, the idea that our social life could be as important as physical factors such as diet or smoking was revolutionary. Since then, epidemiologists have compiled more evidence supporting House’s finding. In 2010, U.S. researchers analyzed 148 studies following more than 308,000 people and concluded that lacking strong social bonds doubles the risk of death from all causes.8 That confirms House’s finding that in Western societies, at least, social isolation is as harmful as drinking and smoking, and suggests that it is actually more dangerous than lack of exercise or obesity.

  Of course, when we have social support, we live more healthily. We have someone to cook us meals, take us to the doctor and nag us not to drink or smoke. This has a powerful effect, but the difference in death rates persists even after accounting for it. People who have warm relationships, rich social lives, and who feel like they are embedded in a group “
don’t get as sick, and they live longer,” says Charles Raison, a psychiatry professor and mind–body medicine researcher at the University of Wisconsin–Madison. “It’s probably the single most powerful behavioral finding in the world.”9

  Back in 1988, when House and his colleagues published their landmark analysis, they warned that Western society was changing in a way that could have dire consequences for health. Compared to the 1950s, they pointed out, U.S. adults in the 1970s were less likely to belong to voluntary organizations, less likely to visit informally with others and more likely to live alone.

  Rates of marriage and childbearing were falling too, meaning that the twenty-first century would see a steady increase in the number of older people without spouses or children. “Just as we discover the importance of social relationships for health,” the researchers warned, “their prevalence and availability may be declining.”

  House’s predictions were correct. Western society has continued to fragment. During the past two decades, the average household size in the U.S. has shrunk. According to the 2011 census, 32 million people in the country now live alone; that’s 27% of households, up from 17% in 1970.10 When researchers asked a representative sample of Americans in 1985 how many confidantes they had, the most popular answer was three. When the study was repeated in 2004, the most popular answer—given by 25% of respondents—was none.11

  —

  WHEN WE’RE AWAY from someone we love, we say that it hurts. You might think of this description as metaphorical; brain-scanning experiments suggest, however, that it’s uncannily accurate.

  It turns out that experiences of social exclusion or rejection—such as being shunned in a game, receiving negative social feedback, or viewing images of deceased loved ones—activate exactly the same regions of the brain as when we are in physical pain.12 When we’re socially rejected or isolated, we don’t just feel sad. We feel injured and under threat.