Social Intelligence: The New Science of Human Relationships

by Daniel Goleman

  Yet this volatile circuitry was pacified strikingly with the calming clasp of a husband’s hand. The study fills in an important blank in our understanding of just how our relationships can matter biologically for better or for worse. We now have a snapshot of the brain undergoing emotional rescue.

  Just as telling was another finding: the more highly satisfied a wife feels with her marriage, the greater the biological benefit from holding hands. This clinches the answer to that old scientific mystery of why some marriages appear to challenge women’s health, while others protect it.

  Skin-on-skin touch is particularly soothing because it primes oxytocin, as do warmth and vibration (which may explain much of the stress relief that comes from massage or a cozy cuddle). Oxytocin acts as a stress hormone “down-regulator,” reducing the very HPA and SNS activity that, when sustained, puts our health at risk.21

  When oxytocin releases, the body undergoes a host of healthy changes.22 Blood pressure lowers as we slide into the relaxed mode of parasympathetic activity. That shifts metabolism from the ready-to-run large muscle boost of stress arousal to a restorative mode where energy goes into storing nutrients, growth, and healing. Cortisol levels plummet, signifying decreased HPA action. Our pain threshold rises, so that we are less sensitive to discomforts. Even wounds heal faster.

  Oxytocin has a short half-life in the brain—it’s gone in just a matter of minutes. But close, positive long-term relationships may offer us a relatively steady source of oxytocin release; every hug, friendly touch, and affectionate moment may prime this neurochemical balm a bit. When oxytocin releases again and again—as happens when we spend good time with people who love us—we seem to reap the long-term health benefits of human affection. The very substance that draws us closer to the people we love, then, converts those warm connections into biological well-being.23

  Back to the Tolstoys. Despite all the rancor recorded in their journals, they managed to have thirteen children. That horde means they lived in a household that was bustling with abundant opportunities for affection. The couple did not have to rely only on each other; they were surrounded by emotional rescuers.

  POSITIVE CONTAGION

  Just forty-one, Anthony Radziwill lay dying in the intensive care unit of a New York hospital from fibrosarcoma, a deadly cancer. As his widow Carole tells it, Anthony was visited by his cousin John F. Kennedy, Jr., who was himself to die just months later when the plane he was piloting crashed off the island of Martha’s Vineyard.

  John, still in a tuxedo from the black-tie event he had just left, got the news as he entered the ICU that the doctors had given his cousin just hours to live.

  So taking hold of his cousin’s hand, John quietly sang “The Teddy Bears’ Picnic,” a song his own mother, Jackie Onassis, had sung to them both as a lullaby when they were small.

  Anthony, near death, joined in softly.

  John, as Radziwill recounts, “had taken him to the safest place he can find.”24

  That sweet touch surely eased Radziwill’s final moments. And it bespeaks the sort of connection that intuitively seems the best way to help a loved one in such dire moments.

  That intuition now has solid data to support it: physiologists have shown that as people become emotionally interdependent, they play an active role in the regulation of each other’s very physiology. This biological entrainment means that the cues each partner receives from the other have special power to drive their own body, for better or for worse.

  In a nourishing relationship, partners help each other manage their distressing feelings, just as nurturing parents do their children. When we are stressed or upset, our partners can help us rethink what’s causing our distress, perhaps to respond better or simply to put things in perspective—in either case short-circuiting the negative neuroendocrine cascade.

  Being separated from those we love for long periods deprives us of this intimate help; the longing for people we miss expresses in part a yearning for this biologically helpful connection. And some of the utter disorganization we feel after the death of a loved one no doubt reflects the absence of this virtual part of ourselves. That loss of a major biological ally may help explain the heightened risk of disease or death after a spouse passes away.

  Again, an intriguing gender difference emerges. Under stress, a woman’s brain secretes more oxytocin than a man’s. This has a calming effect and moves women to seek out others—to take care of children, to talk to a friend. While women tend or befriend, as psychologist Shelley Taylor at UCLA discovered, their bodies release additional oxytocin, which calms them even more.25 This tend-and-befriend impulse may be uniquely female. Androgens—male sex hormones—suppress the calming benefits of oxytocin. Estrogen, the female sex hormone, enhances it. This difference seems to lead women and men to very different reactions when they are facing a threat; women seek out companionship, while men go it alone. For instance, when women were told they would receive an electric shock, they chose to wait for it with other participants, while men preferred being by themselves. Men seem better able to calm their distress through sheer distraction; TV and a beer may suffice.

  The more close friends women have, the less likely they are to develop physical impairments as they age, and the more likely they are to lead a joyful life in their later years. The impact appears to be so strong that friendlessness has been found to be as detrimental to a woman’s health as smoking or obesity. Even after experiencing an enormous blow, like the death of a spouse, women with a close friend and confidante are more likely to escape any new physical impairments or loss of vitality.

  In any close relationship, our own toolkit for managing our emotions—everything from seeking comfort to rethinking what’s upsetting us—gets supplemented by the other person, who can offer advice or encouragement or help more directly via positive emotional contagion. The primal template for forming a tight biological link with those closest to us was set in early infancy, in the intimate physiology of our earliest interactions. These brain-to-brain mechanisms stay with us throughout life, connecting our biology with the people to whom we are most attached.

  Psychology has an infelicitous term for this coalescing of two into one: a “mutually regulating psychobiological unit,” a radical relaxing of the usual psychological and physiological line separating I and You, self and other.26 This fluidity of boundaries between people who feel close allows a two-way coregulation, influencing each other’s biology. In short, we help (or harm) each other not just emotionally but at a biological level. Your hostility bumps up my blood pressure; your nurturing love lowers it.27

  If we have a life partner, a close friend, or a warm relative on whom we can rely as a secure base, we have a biological ally. Given the new medical understanding of just how much relationships matter for health, patients with severe or chronic disease may well benefit from tuning up their emotional connections. In addition to following the medical regimen, biological allies are good medicine.

  A HEALING PRESENCE

  When I was living in rural India many years ago, I was intrigued to learn that hospitals in my area typically provided no food for their patients. More surprising to me was the reason: whenever a patient was admitted, their family came along, camping out in their room, cooking their meals, and otherwise helping care for them.

  How wonderful, I thought, to have the people who love a patient there with him day and night to ward off the emotional toll of his physical suffering. What a stark contrast with the social isolation so often found in medical care in the West.

  A medical system that deploys social support and caring to help boost patients’ quality of life may well enhance their very ability to heal. For example, a patient lying in her hospital bed, awaiting major surgery the next day, can’t help but worry. In any situation, what one person feels strongly tends to pass to others, and the more stressed and vulnerable someone feels, the more sensitive they are, and the more likely to catch those feelings.28 If the worried patient shares a room wit
h another patient who also faces surgery, the two of them may well make each other more anxious and fearful. But if she shares a room with a patient who has just come out of surgery successfully—and so feels relatively relieved and calm—the emotional effect on her will be more soothing.29

  When I asked Sheldon Cohen, who led the studies on rhinovirus infection, what he recommended for hospital patients, he suggested they deliberately seek out biological allies. For example, he told me that it can pay, he argues, to “graft new people on to your social network, especially people you can open up to.” When a friend of mine got the diagnosis of a probably fatal cancer, he made a smart medical decision: he started seeing a psychotherapist he could talk with as he and his family went through the subsequent maelstrom of angst.

  As Cohen told me, “The most striking finding on relationships and physical health is that socially integrated people—those who are married, have close family and friends, belong to social and religious groups, and participate widely in these networks—recover more quickly from disease and live longer. Roughly eighteen studies show a strong connection between social connectivity and mortality.”

  Devoting more time and energy to being with the people in our lives whom we find most nourishing, Cohen says, has health benefits.30 He also urges patients, to the extent possible, to reduce the number of emotionally toxic interactions in their day, while increasing the nourishing ones.

  Rather than having a stranger teach a heart attack victim how best to avoid a recurrence, Cohen suggests, hospitals should enlist the personal networks of patients on their behalf, educating those who care most about the patient to become allies in making the necessary lifestyle changes.

  As important as social support is to the elderly and sick, other forces work against the fulfillment of their need for warm connection. Not least is the awkwardness and anxiety that friends and families often feel around a patient. Particularly when the patient has a condition that carries social stigma, or when a patient faces death, people who are ordinarily close can become too wary or anxious to offer help—or even to visit.

  “Most of the people around me stepped backward,” recalls Laura Hillenbrand, the author who was bedridden for months at a time with chronic fatigue syndrome. Friends would ask other friends how she was, but “after one or two get-well cards I stopped hearing from them.” When she took the initiative to call old friends, the conversations were often awkward, and she ended up feeling foolish for calling.

  And yet like anyone cut off by illness, Hillenbrand yearned for contact, for connection with those missing biological allies. As Sheldon Cohen says, the scientific findings “absolutely send a message to patients’ family and friends not to ignore or isolate them—even if you don’t know quite what to say, it’s important just to go visit.”

  This advice suggests to all of us who care about someone suffering medically that, even if we feel at a loss for words, we can always offer the gift of a loving presence. Mere presence can matter surprisingly, even to patients in a vegetative state with severe brain damage who seem utterly unaware of what people say to them—who are in what medical jargon labels a “minimally conscious state.” When someone emotionally close reminisces with such a patient about events from their past or touches them lightly, the patient activates the same brain circuitry in response as do people with intact brains.31 Yet they appear totally out of touch, unable as they are to signal so much as a glance or word in response.

  A friend tells me that by chance she read an article about people who had recovered from coma; they reported that they often could hear and understand what people said even as they lay there unable to move a muscle. She happened to read that article on a bus as she traveled to be with her mother, who was minimally conscious following resuscitation from congestive heart failure. This insight transformed her experience sitting at her mother’s bedside as she drifted away.

  Emotional closeness helps most when patients are medically fragile: when they have a chronic disease, or an impaired immune system, or when they are very old. While such caring is no panacea, emerging data suggests that it may sometimes make a clinically meaningful difference. In this sense, love is more than just a way to improve the emotional tone of a patient’s life—it is a biologically active ingredient in medical care.

  For that reason Mark Pettus, a physician, urges us to recognize the subtle messages that signal a patient’s need for even a moment of caring connection, and to act on the “invitations to enter” that take the form of “a tear, a laugh, a look, or even silence.”

  Pettus’s own young son was in the hospital for surgery, overwhelmed, scared, confused—and unable to understand what was happening because, developmentally slow, he had not yet learned to talk.32 After surgery his young son lay in bed dwarfed by a web of tubes attached to him: an IV in his arm taped to a board; a tube through his nostril into his stomach; oxygen tubes in his nostrils; another sending anesthesia into his spinal canal; yet another running through his penis to his bladder.

  Pettus and his wife felt heartbroken that their sweet child had to go through all this. Yet they could see in his eyes that they were able to help him through small gestures of human warmth: reassuring touches, heartfelt looks, simple presence.

  As he says, “Love was our language.”

  18

  A People Prescription

  A medical resident in the spine clinic at one of the world’s best hospitals was interviewing a woman in her fifties who was in great pain from severe disk degeneration in her neck. She’d had the problem for years, but she had never before consulted a physician. Instead, she had been going to a chiropractor whose manipulations brought her only temporary relief. The pain was gradually increasing, and she was afraid.

  The woman and her daughter peppered the resident with their questions, doubts, and fears. For twenty minutes or so the resident tried to address their concerns and allay their fears, but he had not quite succeeded.

  At that point the attending physician entered the room and briskly described the facet joint injections that she recommended to calm the inflammation, as well as the physical therapy that should follow to stretch and strengthen the neck muscles. The daughter could not understand how these treatments would help and started directing a stream of questions toward the physician, who by then had stood up and was backing toward the door.

  Ignoring the physician’s tacit cue that the conversation was ending, the daughter kept right on asking one question after another. After the attending physician left the room, the resident stayed with them another ten minutes, until the patient finally agreed to have the injection.

  A short time later the attending physician took the resident aside and said, “That was nice of you, but you can’t afford the luxury of that kind of prolonged conversation with a patient. We are scheduled for fifteen minutes per patient, and that includes dictation time. You’ll be cured of this after you spend a few sleepless nights dictating your notes and have to come back early the next morning for a full day at the clinic.”

  “But I care about my connection with patients,” the resident protested. “I want to establish rapport, really understand them—I’d spend a half hour with each one if I could.”

  At that the attending physician, a bit exasperated, closed a door so they could talk in private. “Look,” she said, “there were eight other patients waiting—it was selfish of that woman to stay so long. You just can’t spend more than ten minutes with each patient. That’s all we have time for.”

  She then walked the resident through the mathematics at that hospital of time per patient, and the portion of each payment that finally reaches the doctor after “taxes” are taken—cuts deducted for malpractice insurance, for hospital overhead, and for other privileged parties. The results: if a doctor billed $300,000 each year to patients, he would be left with about $70,000 for his salary. The only way to make more money was to cram in more patients in less time.

  The too-long waits and too-short doctors’
visits that increasingly typify medicine please no one. It’s not just the patients who suffer from the creeping takeover of medicine by the accountant’s mentality. Increasingly, physicians complain that they just can’t take the time they want with patients. This problem is not confined to the United States. As a European neurologist, who works for his country’s national health plan, lamented, “They’re applying the logic of machines to people. We report what procedures we do when, and they then compute how much time we should spend with each patient. But they don’t include any time to talk to patients, to relate, to explain, to make them feel better. Lots of doctors are frustrated—they want to have time to treat the person, not just the disease.”

  The prescription for physician burnout is written during the notoriously grinding hours of medical school and residency. Combine that relentless workload with medical economics that demand more and more from physicians, and it’s small wonder that a creeping desperation is growing. Surveys find signs of at least some degree of burnout in 80 to 90 percent of practicing physicians—a quiet epidemic.1 The symptoms are clear: work-related emotional exhaustion, intense feelings of dissatisfaction, and a depersonalized I-It attitude.

  ORGANIZED LOVELESSNESS

  The patient in 4D had been admitted for multidrug resistant pneumonia. Given her advanced age and a host of other medical problems, the outlook was dire.

  Over the weeks she and the night nurse had struck up something of a friendship. Other than that she had no visitors, not a soul listed to notify in case of death, and no known friends or relatives. As he dropped by on his night rounds, the nurse was her only visitor, and the visits were limited to the short conversations she could manage.

  Now her vital signs were failing, and the nurse recognized that the patient in 4D was near death. So he tried to spend every spare minute on his shift in her room, just being present. He was there to hold her hand during her last moments of life.