Those Wisconsin grads who endured relentless stress in childhood now as adults had poor stress recovery abilities, staying overwhelmed longer once they were upset. But those people who had been exposed to manageable levels of stress during childhood were most likely as adults to have the better prefrontal ratio. For this outcome, a caring adult who provides a secure base for emotional recovery seems essential. 36
SOCIAL EPIGENETICS
Laura Hillenbrand, the author of the best-selling book Seabiscuit, has long suffered from chronic fatigue syndrome, a debilitating condition that can leave her feverish and exhausted, needing constant care for months at a time. While she was writing Seabiscuit, that care came from her devoted husband, Borden, who—even while struggling with his own work as a graduate student—somehow found the energy to be her nurse, helping her eat and drink, assisting her when she needed to walk, and reading to her.
But one night in her bedroom, Hillenbrand recalls, she “heard a soft, low sound.” She looked down the stairway to see Borden “pacing the foyer and sobbing.” She started to call out to him but stopped herself, realizing he wanted to be alone.
The next morning Borden was there to help her as usual, “cheerful and steady as ever.” 37
Borden did his best to keep his own anguish from upsetting his already-fragile wife. But like Borden, anyone who has to nurse a loved one day and night endures extraordinary, unabated stress. And that tension takes an inevitable toll on the health and well-being of even the most devoted caretaker.
The most powerful data on this point comes from a remarkable interdisciplinary research group at Ohio State University led by psychologist Janice Kiecolt-Glaser and her husband, immunologist Ronald Glaser.38 In an elegant series of studies, they have shown that the effects of continual stress reach all the way down to the level of gene expression in the immune cells essential for fighting infections and healing wounds.
The Ohio State group studied ten women in their sixties, all of them caring for a husband with Alzheimer’s disease.39 The caregivers were under relentless strain, on duty twenty-four hours a day—and feeling terribly isolated and uncared for themselves. An earlier study of women under similar stress had discovered that they were virtually unable to benefit from flu shots; their immune system could not manufacture the antibodies that the shot ordinarily stimulates.40 Now the researchers undertook more elaborate tests of immune function, revealing that the women in the Alzheimer’s caregivers group had troubling readings on a wide range of indicators.
The genetic data, in particular, made headlines. A gene that regulates a range of crucial immune mechanisms was expressed 50 percent less in the caretakers than in other women their age. GHmRNA, the impaired gene, enhances the production of lymphocytes and also boosts the activity of natural killer cells and macrophages, which destroy invading bacteria.41 That may also explain another earlier finding: stressed women took nine days longer to heal a small puncture wound than did women in a nonstressed comparison group.
A key factor in this impaired immunity may be ACTH, a precursor to cortisol and one of the hormones secreted when the HPA axis runs amok. ACTH blocks the production of the crucial immune agent interferon and diminishes the responsivity of lymphocytes, the white blood cells that mount the body’s attack against invading bacteria. The bottom line: the continual stress of tireless caregiving in social isolation impairs the brain’s control of the HPA axis, which in turn weakens the ability of immune system genes like GHmRNA to do their job fighting disease.
The toll of relentless stress also seems to strike the very DNA of the caretakers, speeding the rate at which cells age and adding years to their biological age. Other researchers doing genetic studies of DNA in mothers caring for a chronically ill child found that the longer they had been so burdened, the more they had aged at the cellular level.
The rate of aging was determined by measuring the length of the telomeres on the mothers’ white blood cells. Telomeres are a piece of DNA at the end of a cell’s chromosome that shrinks a bit each time the cell divides to duplicate itself. Cells reproduce repeatedly throughout their lifespan to repair tissue or, in the case of white blood cells, to fight disease. Somewhere after ten to fifty divisions (depending on the type of cell), the telomere becomes too short to replicate anymore, and the cell “retires”—a genetic measure of loss of vitality.
By this measure, the mothers caring for chronically ill children were, on average, ten years older biologically than others of their same chronological age. Among the exceptions were those women who, despite feeling overwhelmed in their lives, felt well supported by others. They had younger cells, even if they were caring for a disabled loved one.
Collective social intelligence can offer an alternative to the overwhelming toll of caregiving. Witness the scene in Sandwich, New Hampshire, where Philip Simmons sat in his wheelchair on a brilliant fall day, surrounded by friends and neighbors. At age thirty-five Simmons, a college English teacher with two small children, had been diagnosed with the degenerative neurological condition Lou Gehrig’s disease and given two to five years to live. He had already outlived his prognosis, but now the paralysis was moving from his lower body to his arms, making him unable to perform even routine tasks. At this point he gave a friend a book called Share the Care, which describes how to create an ongoing support group for someone with a severe illness.
Thirty-five neighbors rallied to help Simmons and his family. Coordinating their schedule largely by phone and e-mail, they acted as cooks, drivers, babysitters, home aides—and, as on that fall day, yard workers—for the last several years of Simmons’s life, until he died at age forty-five. This virtual extended family made an immense difference for Simmons and his wife, Kathryn Field. Not least, their help enabled Field to continue her work as a professional artist, easing the financial strain and giving the entire family, in her words, “a sense of being loved by our community.”42
As for those who formed FOPAK (Friends of Phil and Kathryn), as they called themselves, most agreed that they were the ones receiving the gift.
17
Biological Allies
When my mother retired from teaching college, she found herself with a large, empty house and no one to fill it: her children had all ended up living in other cities, some quite distant, and my father had died years before. A former professor of sociology, she made what, in retrospect, seems a smart social move: my mother offered a free room to graduate students from her university, with a preference for those from East Asian cultures, where older people are appreciated and respected.
It’s been more than thirty years since she retired, and this arrangement still continues. She has had a revolving series of housemates from places like Japan, Taiwan, and currently Beijing—with what seem to be great benefits for her well-being. When one couple had a baby while living with her, their daughter grew up treating my mother like her own grandmother. As a two-year-old, the toddler would go into my mother’s bedroom every morning to see if she was up yet and routinely gave her hugs through the day.
That baby was born when my mother was almost ninety—and with that bundle of delight roaming the house, my mother actually seemed for a few years to get younger, both physically and mentally. We’ll never know how much of my mother’s longevity can be attributed to her living situation, but evidence suggests hers was a wise bit of social engineering.
The social networks of the elderly are pruned for them, as one old friend after another dies or moves away. But at the same time older people also tend to cut back their social networks selectively, preserving positive relationships.1 That strategy makes good biological sense. As we grow old, our health inevitably becomes more fragile; as cells age and die, our immune system and other bulwarks for good health work less and less well. Dropping unrewarding social ties may be a preemptive move to manage our own emotional states for the better. Indeed, a landmark study of elderly Americans who were aging successfully found that the more emotionally supportive their relation
ships, the lower their indicators of biological stress like cortisol.2
Of course, our most meaningful relationships may not necessarily be the most pleasant and positive ones in our lives—a close relative can be someone who drives us crazy rather than delights us. Perhaps luckily, as older people prune away less significant social ties, many seem to develop a greater capacity for handling emotional complications, such as the mix of positive and negative feelings stirred up by a given relationship.3
One study found that when elderly people had an engaging, supportive social life, they displayed better cognitive abilities seven years later than did those who were more isolated.4 Paradoxically, loneliness has little or nothing to do with how much time people actually spend by themselves, nor how many social contacts they have in a given day. Instead, it’s the paucity of intimate, friendly contacts that leads to loneliness. What matters is the quality of our interactions: their warmth or emotional distance, their supportiveness or negativity. The sense of loneliness, rather than the sheer number of acquaintances and contacts a person actually has, correlates most directly with health: the lonelier a person feels, the poorer immune and cardiovascular function tends to be.5
There’s another biological argument for becoming more intentional about our interpersonal world as we age. Neurogenesis, the brain’s daily manufacture of new neurons, continues into old age, though at a slower rate than in earlier decades. And even that slowdown may not be inevitable, some neuroscientists suggest, but rather a side effect of monotony. Adding complexity to a person’s social environment primes new learning, enhancing the rate at which the brain adds new cells. For this reason some neuroscientists are working with architects to design homes for the elderly where occupants have to interact more with others in the course of their daily routines—something my mother arranged for herself.6
THE MARITAL BATTLEGROUND
As I leave the grocery store in a small town, I overhear two elderly men sitting on a bench outside. One asks how a local couple is doing.
“You know how it is,” comes the laconic reply. “They’ve only ever had one argument—and they’re still having it.”
Such emotional wear and tear in a relationship, as we’ve seen, takes its biological toll. Just why a marriage gone sour might sabotage health was found when newlyweds—all considering themselves “very happy” in their marriages—volunteered to be studied while they had a thirty-minute confrontation about a disagreement.7 During the tiff, five of six adrenal hormones tested changed levels, including increases in ACTH that indicate a mobilized HPA axis. Blood pressure shot up, and indices of immune function were lowered for several hours.
Hours later there were long-term shifts for the worse in the immune system’s ability to mount a defense against invaders. The more bitterly hostile their argument had been, the stronger the shifts. The endocrine system, the researchers conclude, “serves as one important gateway between personal relationships and health,” triggering the release of stress hormones that can hamper both cardiovascular and immune function.8 When a couple fights, their endocrine and immune systems suffer—and if the fights are sustained over years, the damage seems to be cumulative.
As part of the study of marital conflict, couples in their sixties (married an average forty-two years) were invited to the same laboratory for a closely monitored disagreement. Once again the argument spurred unhealthy declines in the endocrine and immune systems—the more rancor, the greater the drops. Since aging weakens the immune and cardiovascular systems, hostility between older partners can take a greater toll on health. Sure enough, the negative biological changes were even stronger in older couples than for the newlyweds during the marital battle—but only for the wives.9
This surprising effect held true for both newlywed and older married women. Understandably, the newlywed wives who showed the greatest decline in immune measures during and after the “fight” were the most dissatisfied with their marriages a year later.
For women, when husbands withdrew in anger during disagreements, stress hormones zoomed upward. On the other hand, wives whose husbands displayed kindness and empathy during the discussion reflected their relief in lower levels of the same hormones. But for husbands, whether the talk was harsh or pleasant, their endocrine systems did not budge. The sole exception was at the extreme, among those who reported the most abrasive arguments at home. For these embattled couples, both husbands and wives had poorer immune responses from day to day than did more harmonious couples.
Data from multiple sources suggest that wives are more vulnerable to suffer the health costs of a rocky marriage than are their husbands. Yet women do not seem to be more biologically reactive than men in general. 10
One answer may be that women put a greater emotional premium on their closest ties.11 Many surveys of American women show that positive relationships are their major source of satisfaction and well-being throughout life. For American men, on the other hand, positive relationships rate lower in importance than a sense of personal growth or a feeling of independence.
In addition, women’s instinct for caregiving means they take more personal responsibility for the fate of those they care about, making them more prone than men to getting distressed at loved ones’ troubles.12 Women are also more attuned to the ups and downs of their relationships and so are more susceptible to riding an emotional roller coaster.13
Another finding: wives spend far more time than their husbands ruminating about upsetting encounters, and they review them in their minds in more vivid detail. (They also remember the good times better and spend more time reminiscing about them.) Because bad memories can be intrusive, repeatedly popping into the mind unbidden, and because simply recalling a conflict can trigger the biological shifts that accompanied it, the tendency to mull over one’s troubles takes a physical toll.14
For all these reasons, troubles in a close relationship drive adverse biological reactions in women more strongly than in men.15 In the Wisconsin Study, for instance, women’s cholesterol levels were directly linked to the amount of stress in their marriages—far more so than for men in the Class of ’57.
In a study of patients with congestive heart failure, a stormy marriage was more likely to lead to an early death for women than for men.16 Women are also more likely to have a heart attack when they experience emotional stress from a severe relationship crisis like a divorce or death, while for men the trigger is more likely to be physical exertion. And older women seem more vulnerable than men to life-threatening rises in stress hormones in response to a sudden emotional shock, like the unexpected death of a loved one—a condition doctors are calling the “broken heart syndrome.”17
Women’s greater biological reactivity to relationship ups and downs begins to answer that long-standing scientific puzzle, why men, but not women, seem to experience a health benefit from being married. That finding appears over and over in surveys of marriage and health—and yet is not necessarily true. What muddied the waters has been a simple failure of scientific imagination.
A different picture emerged when a thirteen-year study of close to five hundred married women in their fifties asked the simple question, “How satisfied are you in your marriage?” The results were crystal clear: the more pleased a woman was with her marriage, the better her health.18 When a woman enjoyed the time she spent with her partner, felt they communicated well and agreed on matters like finances, enjoyed their sex life, and had similar interests and tastes, her medical data told the story. Levels of blood pressure, glucose, and bad cholesterol were lower for the satisfied women than for those unhappy in their marriages.
Those other surveys had lumped together data from miserable and happy wives. So while women appear to be more biologically vulnerable to the ups or downs in their marriage, the effects of that emotional roller coaster depend on the nature of the ride. When she has more downs than ups in her marriage, a woman’s health suffers. But when her relationship gives her more ups, her health—like her husband�
��s—benefits.
EMOTIONAL RESCUERS
Picture a woman in the maws of an MRI, lying on her back on a gurney that’s been wheeled into a human-shaped cavity, one that leaves just inches to spare, in the midst of this vast piece of machinery. She’s hearing the unsettling whine of huge electric magnets whirling around her and peering at a video monitor just inches above her face.
The screen flashes a sequence of colored geometric shapes—a green square, a red triangle—every twelve seconds. She’s been told that when a certain shape and color come on the screen, she’ll receive an electric shock—not very painful but unpleasant nonetheless.
At times she endures her apprehension alone. At other times a stranger holds her hand. And sometimes she feels the reassuring touch of her husband’s hand.
That was the predicament of eight women who had volunteered for a study in Richard Davidson’s laboratory, one designed to assess the extent to which the people we love can lend us biological assistance in moments of stress and anxiety. The results: when a woman held her husband’s hand, she felt far less anxiety than when she faced the shock alone.19
Holding a stranger’s hand helped a bit, though not nearly so much. Intriguingly, Davidson’s group found that it was impossible to conduct the study so that the women were “blind” to whose hand they were holding: on a trial run, wives always guessed correctly whether the hand was their husband’s or a stranger’s.
When the wives faced the shock alone, fMRI analysis showed activity in regions of the brain that drive the HPA axis into its emergency response, pumping stress hormones through the body.20 Had the threat been not just a mild shock but personal—say, a hostile job interviewer—these regions almost certainly would have been even more aroused.
Social Intelligence: The New Science of Human Relationships Page 28
