Social Intelligence: The New Science of Human Relationships
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37. On Borden, see Laura Hillenbrand, “A Sudden Illness—How My Life Changed,” The New Yorker, July 7, 2003.
38. The group centers on Janice Kiecolt-Glaser, a psychologist, and her husband, Ronald Glaser, an immunologist, and has also included William B. Malarkey, a physician at Ohio State College of Medicine and John T. Cacioppo, a founder of social neuroscience, now at the University of Chicago. See, for example, John T. Cacioppo et al., “Autonomic, Endocrine, and Immune Response to Psychological Stress: The Reactivity Hypothesis,” Annals of the New York Academy of Sciences 840 (1998), pp. 664–73.
39. On women caregivers, see William B. Malarkey et al., “Chronic Stress Down-Regulates Growth Hormone Gene Expression in Peripheral Blood Mononuclear Cells of Older Adults,” Endocrine 5 (1996), pp. 33–39.
40. On an earlier study of Alzheimer’s disease caregivers, see Janice Kiecolt-Glaser et al., “Slowing of Wound Healing by Psychological Stress,” Lancet 346 (1995), pp. 1194–96
41. On cell aging, see Elissa Epel et al., “Accelerated Telomere Shortening in Response to Life Stress,” Proceedings of the National Academy of Science 101 (2004), pp. 17, 312–15.
42. Suki Casanave, “Embracing this Imperfect Life,” Hope (March/April 2002), pp. 32–35.
Chapter 17. Biological Allies
1. On choosing pleasant relationships, see Robert W. Levenson et al., “The Influence of Age and Gender on Affect, Physiology, and Their Interrelations: A Study of Long-Term Marriages,” Journal of Personality and Social Psychology 67, no. 1(1994), pp. 56–68.
2. On emotional support and biological stress, see Teresa Seeman et al., “Social Ties and Support and Neuroendocrine Function,” MacArthur Studies of Successful Aging, Annals of Behavioral Medicine 16 (1994), pp. 95–106. Earlier studies have found the same relationship, emotional support lowering risk, with a range of other biological measures, including lower heart rate and blood pressure, lower serum cholesterol, and lower norepinephrine: Teresa Seeman, “How Do Others Get Under Our Skin?” in Carol Ryff and Burton Singer, eds., Emotion, Social Relationships, and Health (New York: Oxford University Press, 2001).
3. On older people and emotional complexity, see L. L. Carstensen et al., “Emotional Experience in Everyday Life Across the Lifespan,” Journal of Personality and Social Psychology 79 (2000), pp. 644–55.
4. On a supportive environment and cognitive ability in the elderly, see Teresa E. Seeman et al., “Social Relationships, Social Support, and Patterns of Cognitive Aging in Healthy, High-functioning Older Adults,” Health Psychology 4 (2001), pp. 243–55.
5. On loneliness and health, see Sarah Pressman et al., “Loneliness, Social Network Size, and Immune Response to Influenza Vaccination in College Freshmen,” Health Psychology 24 (2005), pp. 297–306.
6. On social engineering in homes for the elderly speeding neurogenesis, see Fred Gage, “Neuroplasticity,” paper presented at the twelfth meeting of the Mind and Life Institute, Dharamsala, India, October 18–22, 2004.
7. On newlyweds disagreeing, see Janice Kiecolt-Glaser et al., “Marital Stress: Immunologic, Neuroendocrine, and Autonomic Correlates,” Annals of the New York Academy of Sciences 840 (1999), pp. 656–63.
8. Ibid., p. 657.
9. There was little relationship between the verbal struggle and endocrine measures in the older husbands.
10. Tor Wagner and Kevin Ochsner, “Sex Differences in the Emotional Brain,” NeuroReport 16 (2005), pp. 85–87.
11. On the importance of personal relationships, see Carol Ryff et al., “Elective Affinities and Uninvited Agonies: Mapping Emotion with Significant Others Onto Health,” in Ryff and Singer, Emotion, Social Relationships. From middle age onward men place increasing importance on their relationships, but still to a lesser extent than women.
12. On women and caring, see R. C. Kessler et al., “The Costs of Caring: A Perspective on the Relationship Between Sex and Psychological Distress,” in I. G. Sarason and B. R. Sarason, eds., Social Support: Theory, Research and Applications (Boston: Martinus Nijhoff, 1985), pp. 491–507.
13. On women being more sensitive, see M. Corriel and S. Cohen, “Concordance in the Face of a Stressful Event,” Journal of Personality and Social Psychology 69 (1995), pp. 289–99.
14. On memories and biological shifts, see Kiecolt-Glaser et al., “Marital Stress.”
15. Numerous studies find that women show stronger immune, endocrine, and cardiovascular reactions to marital arguments than do their husbands. See, for example, Janice Kiecolt-Glaser et al., “Marital Conflict in Older Adults: Endocrinological and Immunological Correlates,” Psychosomatic Medicine 59 (1997), pp. 339–49; T. J. Mayne et al., “The Differential Effects of Acute Marital Distress on Emotional, Physiological and Immune Functions in Maritally Distressed Men and Women,” Psychology and Health 12 (1997), pp. 277–88; T. W. Smith et al., “Agency, Communion, and Cardiovascular Reactivity During Marital Interaction,” Health Psychology 17 (1998), pp. 537–45.
16. On women’s deaths from heart disease, see James Coyne et al., “Prognostic Importance of Marital Quality for Survival of Congestive Heart Failure,” American Journal of Cardiology 88 (2001), pp. 526–29.
17. On broken heart syndrome, see Ilan Wittstein et al., “Neurohumoral Features of Myocardial Stunning Due to Sudden Emotional Stress,” New England Journal of Medicine 352 (2005), pp. 539–48.
18. On satisfaction and women’s health, see Linda Gallo et al., “Marital Status and Quality in Middle-aged Women: Associations with Levels and Trajectories of Cardiovascular Risk Factors,” Health Psychology 22, no. 5 (2003), pp. 453–63.
19. On holding hands, see J. A. Coan et al., “Spouse, But Not Stranger, Hand Holding Attenuates Activation in Neural Systems Underlying Response to Threat,” Psychophysiology 42 (2005), p. S44; J. A. Coan et al., “Lending a Hand: Social Regulation of the Neural Response to Threat,” Psychological Science (2006), in press.
20. The circuitry encompasses the insula, hypothalamus, right prefrontal cortex, and anterior cingulate.
21. On neuroendocrinology and oxytocin, see C. Sue Carter, “Neuroendocrine Perspectives on Social Attachment and Love,” Psychoneuroimmunology 23 (1998), pp. 779–818. The data for the health benefits of oxytocin are strong, but in mapping biological impacts of relationships, researchers will undoubtedly find that other neuroendocrine pathways are also involved in the mix.
22. On the health benefits, see Kerstin Uvnäs-Moberg, “Oxytocin Linked Antistress Effects: The Relaxation and Growth Responses,” Acta Physiologica Scandanavica 161 (1997), pp. 38–42. While oxytocin has a short half-life—a matter of minutes—it seems to trigger a cascade of secondary mechanisms that have broad health advantages.
23. On blood pressure and oxytocin, see ibid.
24. Carole Radziwill, What Remains: A Memoir of Fate, Friendship, and Love (New York: Scribner’s, 2005).
25. On women and stress, see Shelley E. Taylor et al., “Female Responses to Stress: Tend-and-Befriend, not Fight-or-Flight,” Psychological Review 107 (2000), pp. 411–29. See also Shelley E. Taylor, The Tending Instinct (New York: Times Books, 2002).
26. On relationships as emotional regulators, see Lisa Diamond and Lisa Aspinwall, “Emotion Regulation Across the Life Span: An Integrative Perspective Emphasizing Self-regulation, Positive Affect, and Dyadic Processes,” Motivation and Emotion 27, no. 2 (2003), pp. 125–56.
27. Some argue that our overall pattern of cardiovascular and neuroendocrine activity varies to a significant degree as a function of the emotional status of our most major relationships. See, for example, John Cacioppo, “Social Neuroscience: Autonomic, Neuroendocrine, and Immune Responses to Stress,” Psychophysiology 31 (1994), pp. 113–28.
28. On stress and contagion, see Brooks Gump and James Kulik, “Stress, Affiliation, and Emotional Contagion,” Journal of Personality and Social Psychology 72, no. 2 (1997), pp. 305–19.
29. On patients and surgery, see James Kulik et al., “Stress and Affiliation: Hospital Roommate Effects on Preop
erative Anxiety and Social Interaction,” Health Psychology 12 (1993), pp. 118–24.
30. In this sense, the network of people who deeply care about a patient’s well-being is an underutilized health resource.
31. On brain activity in minimally conscious patients, see N. D. Schiff et al., “fMRI Reveals Large-scale Network Activation in Minimally Conscious Patients,” Neurology 64 (2005), pp. 514–23.
32. Mark Pettus, The Savvy Patient (Richmond, Va.: Capital Books, 2004).
Chapter 18. A People Prescription
1. On rates of burnout, see Sameer Chopra et al., “Physician Burnout,” Student JAMA 291 (2004), p. 633.
2. On the heart surgeon turned patient, see Peter Frost, “Why Compassion Counts!” Journal of Management Inquiry 8 (1999), pp. 127–33. The saga of the heart surgeon as told by Frost is loosely based on the story of Fitzhugh Mullan, a physician who wrote about his own shift from doctor-in-charge to helpless patient suffering from cancer in Vital Signs: A Young Doctor’s Struggle with Cancer (New York: Farrar, Straus and Giroux, 1982). I, in turn, have slightly modified and shortened Frost’s version.
3. David Kuhl, What Dying People Want (Garden City, N.Y.: Doubleday, 2002).
4. On rapport and lawsuits, see W. Levinson et al., “Physician-Patient Communication: The Relationship with Malpractice Claims Among Primary Care Physicians and Surgeons,” Journal of the American Medical Association 277 (1997), pp. 553–59.
5. Fabio Sala et al., “Satisfaction and the Use of Humor by Physicians and Patients,” Psychology and Health 17 (2002), pp. 269–80.
6. On patient satisfaction, see Debra Roter, “Patient-centered Communication,” British Medical Journal 328 (2004), pp. 303–04.
7. Doctors, it turns out, are not the best judges of how well their patients understand them. When patients being treated for myocardial infarction or pneumonia were surveyed about their posthospital treatment plans, just 57 percent said they comprehended the plans. But when the very physicians who made up those plans and had explained them to their patients were asked the same question, they said 89 percent understood. That gap showed up again when just 58 percent of patients knew when they could resume their normal activities, while their physicians assured the researchers that 95 percent knew. See Carolyn Rogers, “Communications 101,” American Academy of Orthopedic Surgeons’ Bulletin 147 (1999), p. 5.
8. On exit interviews, see ibid.
9. On the second-year medical students, see Nancy Abernathy, “Empathy in Action,” Medical Encounter (Winter 2005), p. 6.
10. On security and compassion, see Omri Gillath et al., “An Attachment-Theoretical Approach to Compassion and Altruism,” in P. Gilbert, ed., Compassion: Conceptualizations, Research, and Use in Psychotherapy (London: Routledge and Kegan Paul, 2004).
11. For the flowchart for caregiving, see William Kahn, “Caring for the Caregivers: Patterns of Organizational Caregiving,” Administrative Science Quarterly 38 (1993), pp. 539–63.
12. Lyndall Strazdins, “Emotional Work and Emotional Contagion,” in Neal Ashkanasy et al., eds., Managing Emotions in the Workplace (Armonk, N.Y.: M.E. Sharpe, 2002).
13. For a detailed study of leadership excellence in the medical sector and service professions generally, see Lyle Spencer and Signe Spencer, Competence at Work: Models for Superior Performance (New York: John Wiley, 1993).
14. On making the unbearable bearable, see Kenneth B. Schwartz, “A Patient’s Story,” Boston Globe Magazine, July 16, 1995.
15. The Kenneth B. Schwartz Center has a website at www.theschwartzcenter.org.
16. These rounds might be on any topic pertinent to the personal aspects of patient care, ranging from handling a difficult or hostile patient or family, to coping with the emotional price of caring for seriously ill patients. They are regularly scheduled at Mass General (as Harvard Medical School’s most renowned hospital is known) and have been adopted by more than seventy other hospitals. The Schwartz Center offers help to other hospitals interested in starting such rounds.
17. Mack Lipkin et al., The Medical Interview (New York: Springer-Verlag, 1995).
PART VI
Chapter 19. The Sweet Spot for Achievement
1. Amy Arnsten, “The Biology of Being Frazzled,” Science 280 (1998), pp. 1711–13.
2. That suggests the wisdom of Nature’s design in extreme situations—at least for people who have well-honed expertise to rely on. The problem arises when that same response gets triggered when there is no threat to life—just the symbolic perils of modern life. For the most part in those situations we need to call on the brain’s executive center, not our primal habits. To work at our best we need the low road to support the high—not to command it.
3. On stress intensity and impairment, see J. T. Noteboom et al., “Activation of the Arousal Response and Impairment of Performance Increase with Anxiety and Stressor Intensity,” Journal of Applied Physiology 91 (2001), pp. 2039–101.
4. Though that dysfunction holds for the brain’s temporarily crippled executive centers, the brain still makes a hedged bet that can work well. Consider studies of people under extreme stress in settings like firehouses, combat units, and basketball teams. Under dire pressure, the most seasoned leaders did best by relying on habits and expertise formed over years. A fire captain, for instance, could direct his firemen amid the chaotic uncertainty and terror of a blaze by trusting intuitions forged in a long history of similar situations. While old-timers instinctively know what to do in such high-intensity moments, for a novice the best theory can fail. See Fred Fiedler, “The Curious Role of Cognitive Resources in Leadership,” in Ronald E. Riggio et al., eds., Multiple Intelligences and Leadership (Mahwah, N.J.: Erlbaum, 2002).
5. On brain correlates of sadness and joy, see Antonio R. Damasio et al., “Subcortical and Cortical Brain Activity During the Feeling of Self-generated Emotions,” Nature Neuroscience 3 (2002), pp. 1049–56.
6. Sam Intrator, How Teaching Can Inspire Real Learning in the Classroom (New Haven, Conn.: Yale University Press, 2003).
7. Positive moods, for example, can make people more realistic; when people who are feeling good have an important goal that they want to achieve, they will seek out potentially useful information even when it might be negative and upsetting. See, for example, L. G. Aspinwall, “Rethinking the Role of Positive Affect in Self-regulation,” Motivation and Emotion 22 (1998), pp. 1–32. On the other hand, an elevated mood is not necessarily best for every task: being too giddy bodes poorly for detail work like checking a contract. Indeed, negative moods can sometimes make our perceptions more realistic rather than overly rosy. At the right time, it pays to get serious. For a further review, see Neal M. Ashkanasy, “Emotions in Organizations: A Multi-level Perspective,” in Neal Ashkanasy et al., eds., Emotions in the Workplace: Research, Theory, and Practice (Westport, Conn.: Quorum Books, 2000).