by Jo Marchant
She worked with colleagues to develop a project called Experience Corps, in which elderly adults spend 15 hours a week volunteering in deprived elementary schools, helping kids to read. Most health interventions, such as exercise programs, tend to have high drop-out rates even if they take only a few minutes each week. Fifteen hours was a “crazy” amount of time to ask people to commit to, says Carlson. Yet the volunteers stuck at it through the entire academic year. “We tell them we need them, their wisdom and experience,” she says. “They do it not for themselves but because the kids are waiting for them.”39
The volunteers formed close relationships with the children they were helping, creating a “magic,” according to Carlson, that isn’t always there with teachers or parents. Many of the students are from troubled backgrounds, she says, but the older volunteers have the patience and experience to see beyond difficult behavior to what children might be experiencing at home, at the same time as expecting them to succeed. “They really can sometimes connect with the child on a different level.”
The program significantly improved the academic achievement of the kids, but also the health of the volunteers. “It was like watering them,” says Carlson. A pilot trial published in 2009 suggested that over a school year, the volunteers’ activity levels increased and their legs got stronger—measures that normally decline with age.40 They also performed better on cognitive tests, and had increased activity in the prefrontal cortex.
Carlson is now completing a two-year randomized controlled trial of the program. She’s still writing up the results, but so far has published a brain imaging study of 123 volunteers, focusing on the hippocampus (which works with the prefrontal cortex and is important for learning and memory).41 The hippocampus usually shrinks with age and becomes impaired in the early stages of Alzheimer’s. Yet in the volunteers, it got bigger. Age-related damage in their brains was being reversed.
Results like this suggest that we should see aging differently, says Carlson. “We over-estimate all the negatives about aging, and we don’t sufficiently emphasize what gets better with age. What gets better is that we have accumulated a lifetime of wisdom and knowledge. And we don’t have a vehicle for giving it back.”
When we’re old, just as when we’re young, she argues, we still desperately want to have a purpose in society. Her comments make me think of Lupita, who has been active in politics and community her whole life. She’s witty, brave, bursting with stories and experience, but is now forced to sit on the sidelines, unable to do anything but pray.
What if we reshaped care for the elderly not around managing their decline, but harnessing their abilities? We could “use that aging brain to give back to a society that’s in great need,” says Carlson. The population is aging, she points out; within 20 years we’ll have more adults over 65 than children under 18. “We don’t know what the message does to a person when they are told aging is a time of deterioration. If we reframe it, and say aging is a time to give back to others, it might actually help them age better.”
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FHENA IS a large woman strikingly dressed in a voluminous mauve cloak. Her Afro has a splash of silver at the front, held back at the sides with black combs. She seems warm and happy, even radiant, and I tell her so.
You wouldn’t have thought that a few months ago, she replies. Fhena has two sons: Ahav, who is five, and Analiel, three. Ahav talked early, but when he was about 18 months old he stopped. Other skills, such as catching balls and potty training, went too. And he became violent. “It was beyond devastating,” she says. “To see such promise early on, then see it disappear and not be able to go in and get it back.”
In 2012, shortly after his younger brother was born, Ahav was diagnosed with autism. Occupational and speech therapy helped dramatically, and Fhena was just beginning to accept the situation when Analiel regressed too. “It was like having the same child twice.”
They would feed off each other, with up to ten intense meltdowns a day. “I’ve had a cracked nose, busted lip, I have teeth marks on my arm,” Fhena says. “I was getting two to three hours’ sleep a night.” As with Lisa, the mother we met in chapter eight, her marriage did not survive the pressure, so she was caring for the children alone and sometimes feared for her own safety. “I’ve had it so that one of them is sitting on me holding me down and the other one is choking me.”
Fhena is a singer and performance artist from Atlanta, Georgia; she’s naturally confident and gregarious. “I’ve performed in Israel, Ghana, Antigua, all across the U.S.,” she says. Before having kids, she performed live four to five times a week. She produced shows too, and released a CD, called Beauty from Ashez. But after her sons’ diagnoses, all that stopped.
Without access to her beloved stage or studio, she felt trapped and hopeless. She also suffered from chest pains, headaches and insomnia. “My body was in constant pain, I was walking like an old person. Some of it was because I was being punched and hit, but most of it was the stress lodged in my body.” Before the autism, she says she never took medication, not even during childbirth; now the first thing she reached for every morning was ibuprofen.
Then she took part in an experimental course being run at Atlanta’s Marcus Autism Center, and it changed everything.
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BRODY’S PARENTING course and the Experience Corps are striking examples of how strengthening social bonds within a community can improve people’s lives and health. But can we take a more direct approach? What happens if we train ourselves to see the world in a more socially connected way?
The technique Fhena learned was developed at nearby Emory University, but has its origins in India. Its creator, Lobsang Negi, was born in a remote Himalayan village near the border with western Tibet. He trained as a Buddhist monk in southern India before being sent to the U.S. in 1990 to set up a meditation center in northern Georgia. He then relocated to Emory as a PhD student, and eventually took a faculty position in the university’s religion department.
After a spate of suicides at Emory in 2003–4, a student came to Negi. She was concerned about mental health on campus and was impressed by some of the Buddhist principles Negi taught in his classes. Could he come up with an intervention that might help?
Negi came to the conclusion that what distressed, depressed people need most is a way to forge healthier relationships with those around them. Like Jon Kabat-Zinn, he took Buddhist principles and developed a secular course, but instead of focusing on mindfulness, Negi’s course centers on compassion.
When I meet Negi in a restaurant close to Emory’s campus, he’s immaculately dressed in a pressed blue shirt and well-cut jacket and looks just like a Western businessman, except for a string of amber-colored prayer beads that peek out from the cuff of his jacket. He speaks with a soft voice and slight accent as he tucks into mushroom ravioli.
Cultivating compassion for others is more important than ever, he argues. Throughout most of human history, we’ve lived in relatively small groups. But now, “We live in such a complex and ever-shrinking world. Each day we intersect with others who come with very different cultural, religious and socioeconomic backgrounds.” To cope with that shift, he believes that we must take the compassion we naturally feel for our loved ones, and learn to extend it even to those with whom we seem to have nothing in common.42
His course, called Cognitively-Based Compassion Training (CBCT),43 involves meditating on feelings of love and kindness but also thinking carefully about how we might see the world in a new way. However different people may look, deep down we are all living beings who want to be happy. Reflecting on what we all share creates a sense of connection, says Negi, which makes it easier for us to respond to others’ needs and difficulties.
The same is true for interdependence, “the idea that we can’t just survive by ourselves, with no help from others.” Even the simplest item we need to survive, like a sandwich, connects us with many other people, he points out—from farmers to supermarket workers. Ext
ending that analysis to all of the things we need to get through a day—such as heating, electricity, roads, cars, fuel—demonstrates that we’re dependent on a vast number of people.
If we spend some time thinking about all this, “It’s only natural for us to feel more grateful and more tenderly towards others,” Negi reckons. And that, he believes, is the foundation for healthy, meaningful social bonds. But does it work?
To find out, Negi teamed up with Charles Raison, an Emory psychiatrist (now at the University of Wisconsin–Madison), who studies the effects of inflammation on health. “I was very interested in [whether] you could train people to see the world in a way that looked like your social connectivity was enhanced,” says Raison. “I wanted to see if that would turn down inflammatory responses to stress.”
CBCT is generally taught as weekly sessions that include discussions, exercises and meditation, which attendees are also encouraged to practice at home. In the first trial, of 61 freshman students, the course didn’t significantly affect responses in the grueling Trier Social Stress Test, compared to a group of controls. But among those who took the course, the more time they had spent meditating at home, the less distress they felt during the test and the smaller their inflammatory response.44
Raison and Negi found the same thing when CBCT was taught to abused teenagers in the Atlanta foster care system. Simply being exposed to the class didn’t have a significant effect. But the more the kids practiced, the bigger their reduction in stress hormones and inflammation.45 There’s some preliminary evidence that CBCT helps to improve empathy and social relationships too. In a small brain imaging study, students who took the course were more accurate at reading emotions from photographs of facial expressions, with more activity in the relevant region of the brain.46
The team has also taught CBCT to five-to-eight-year-olds in a local school—breaking the discussion principles down into games and stories. “They got it faster than any adult group I’ve ever taught,” says instructor Brendan Ozawa–de Silva.47 The results are not yet published, but Ozawa–de Silva says that after compassion training, children had more than twice as many friends as those in a class that were taught mindfulness. The course also helped to break down the divide between “in groups” and “out groups”—the CBCT children had more mutual friends and more cross-gender friendships. And they scored better on a story-completion task that assesses the ability to appreciate others’ perspectives.
Larger trials are needed to confirm all of these results, and Negi and his colleagues are now studying the effects of CBCT in a range of communities at risk of stress, including Emory medical students, veterans with PTSD—and caregivers. For Fhena, the course, led by Marcus Autism Center psychologist Samuel Fernandez-Carriba, was a revelation. “The fog started clearing,” she says.
During the course, Fhena says she realized that autism had come to define her children in her eyes. “All you see is a burden. It was robbing me of so much I could give to them.” Instead of being overwhelmed by her own stress and misery, she started to view the world from her kids’ perspective, and to see them as individuals in their own right. “In the class, I released a feeling of entitlement,” she says. “The feeling that I was supposed to have a life without these challenges.” She had always tried to be a good person. “I thought, this isn’t what I put into the pot, why am I getting this out?
“Then I realized. These special beings were given to me because of what I put into the pot.”
And with that single thought, much of the stress in Fhena’s life disintegrated. Instead of feeling bitter and resentful, she says, “I’m enjoying being with them.” And her children have responded beautifully. “Every day there is a new blossoming,” she says. “Ahav is drawing cruise ships in 3D detail. Analiel is writing 25 songs a day.” And the best moment of all, when Ahav said, “Mommy, I’m so proud of you. Because I know that you love me even more now.”
We’ve been speaking in Fernandez-Carriba’s office at the Marcus center, and Fhena takes the pair of us downstairs to meet her boys, who have just finished a behavioral therapy session. They’re achingly cute, bouncing around with red anoraks and long, dark eyelashes. Analiel sings a song about a turtle and puts a green rubber band on my wrist. Ahav proudly shows me a red-and-blue Transformer, swiftly morphing it into a truck. Then he turns to Fernandez-Carriba. “Do you know how we hug in Hebrew?” he says, and gives the doctor a lopsided, one-armed cuddle.
This is no ordinary medical practice. I’m in a rambling farmhouse set among the frosty fields of Chard, Somerset. The consultation room is yellow and spacious, with sloping ceilings, a comfy sofa and a tall vase of fresh flowers. As I look out of the huge, triangular window, a horse trots past.
Patricia Saintey—petite, strawberry blond, with a peach frilly cardigan—clips a monitor onto my ear. It will monitor my pulse by detecting blood flow, she explains. “Now I’ll pop you onto the biofeedback.”
The computer screen promptly shows a black line: my heart rate. Although our hearts speed up when we’re stressed or when we exercise, I’ve always thought of my resting pulse as stable, making regular beats like a metronome. Now I discover that it constantly jumps around. Rather than a straight line, the graph shows a chaotic series of spikes, some large, some small. The amount my heart rate fluctuates, explains Saintey, is called “heart rate variability,” or HRV.
“You want to see if you can transform that jagged variation and make it into a coherent wave,” she says. A broad blue bar pops up on the left-hand side of the screen. It’s slowly pumping up and down, like a cylinder of water that fills and then empties. Saintey asks me to breathe in time with the blue bar—five seconds in as it fills, five seconds out as it drains.
Then something striking happens. Within a few seconds, the difference between my lowest and highest heart rate is much larger than before—varying from about 60 to 90 beats per minute. And the line on the graph transforms from ugly random spikes into a smooth, snake-like curve.
Saintey works in Somerset as a part-time GP, but she also runs this private alternative health practice out of her home. She calls it Heartfelt Consulting, and it is based around a technique called HRV biofeedback. The idea is that you use the heart rate monitor and computer display to practice getting your heart rate into this smooth curve, a state described as “resonance” or “coherence.” Once you’ve got that nailed, try to increase the height of the wave: the difference between lowest and highest heart rate. By practicing every day, says Saintey, we can learn to increase our heart rate variability and achieve this coherent state more often.
Proponents claim that this training has a range of benefits, strengthening our hearts, reducing stress, and even making us happier and more alert. Although Saintey offers the technique in the clinic, there’s a growing range of portable devices that people can use to practice HRV biofeedback at home, from the FDA-regulated “StressEraser” to the “Inner Balance” sensor, sold by the Institute of HeartMath, which works with a smart phone and claims to “reduce the negative effects of stress, improve relaxation and build resilience with just a few minutes of daily use.”
As a scientist, I like the idea of having an instant readout of what’s happening in my body. And the change I see on the computer screen is intriguing—by choosing to breathe more slowly, I’ve caused my heart to beat in a dramatically different pattern. But these wide-ranging claims for benefits ring alarm bells. It seems unlikely to me that this simple exercise would have such potent effects. Indeed, HRV biofeedback has been criticized by Steven Novella, a clinical neurologist at Yale University School of Medicine and a prominent skeptic of alternative medicine, as nothing but “bad tracings, technical artifacts and noise.”1 This smooth curve might look pretty, but I’m not convinced it can really improve health.
It turns out I’m in for a surprise. Investigating heart rate variability leads me much further than I expected, to another crucial link between the mind and the body; research that might challenge our relianc
e on chemical drugs; and a baby girl named Janice.
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MAY 3, 1985, started just like any other Friday. Cecilia was preparing spaghetti in the kitchen of her third-floor apartment in Brooklyn, New York, while her 11-month-old granddaughter, Janice, played happily on the floor. It was half past five, and Janice’s parents would soon be home from work.
Then came a split second that changed everything. When the spaghetti was cooked, Cecilia grabbed the heavy pan and turned towards the sink to drain it. But the baby had stopped just behind her feet. She tripped and dropped the pan, pouring its boiling contents all over her precious grandchild.
One of the doctors called to treat Janice when she arrived at New York Hospital was 27-year-old Kevin Tracey.2 It was his second year as a doctor, and he was training to be a surgeon. Although Tracey was used to seeing horrific injuries—gunshot wounds, head injuries—he was shocked by the sight of this tiny blond girl with blistered, oozing skin. Her face was spared but deep burns covered more than 75% of her body, including her back, arms and legs.
Trying to numb himself to her pain, he stripped her clothes and covered her in antibiotic cream—without intact skin, dehydration and infection are huge risks—and estimated that she had a 25% chance of survival. Then he transferred her upstairs, to a steel-barred crib on the burn unit.
There, Janice endured a grueling catalogue of interventions and treatments. Unable to eat, she was fed through a tube. She suffered daily sessions of agonizing wound care, just like the burn patients we met in chapter six. Then there were several rounds of major surgery to cut away the burned areas and cover them with skin grafts—at first shaved from her unburned buttocks, and when that ran out, from cadavers.
