CHAPTER 5
Staying Healthy
We have inherited our miraculous bodies from our great, great ancestors, the hunter-gatherers. As we mentioned earlier, the amygdala was absolutely essential for our survival early in our history because it alerted our bodies to the many environmental threats of the time, such as charging lions and hostile spears. Although it is not impossible to encounter such challenges these days, civilization has now protected most of us from these frequent, life-threatening emergencies. There are exceptions of course. We have all, at some point or another, found ourselves suddenly jamming on our brakes to prevent running into the car in front of us, or reaching out desperately to catch some precious object that has just slipped through our fingers. Most of the time, however, our threats unravel slowly, lasting hours, days, weeks, or months at a time rather than the seconds or minutes it would take for a lion to catch and consume us. Because of this, our fight or flight response (which we now know is fear) becomes constant and our alarm systems stay on for long periods of time, causing a high risk of physical damage to the very areas of the body designed to escape danger. This persistent state of activation is what we call a stress disorder.
When the amygdala is activated for long periods of time, our immune responses are lowered and our bodies become more vulnerable to intruders such as germs and viruses, as well as other more insidious, less obvious illnesses. It is thought that the immune system is impaired during times of stress (persistent fear) because the ancient amygdala believes we are fighting off dangers such as poisonous snakes. It sends all of our protective energy to the bodily functions necessary to respond to those sorts of attacks, and is much less interested in providing energy to the systems that fight illness and disease. To achieve and sustain physical health, then, we must shut the amygdala down and prevent it from doing further damage. This allows our immune and other underlying systems (for example, the heart, liver, brain, etc.) to go back to protecting our bodies from truly invasive threats.
Reaching for support accomplishes this. It shuts off the various physical and chemical processes that work to destroy our health, giving us back our cortex (the thinking brain) and allowing us to think through our problems. The brain then does its part once again in trying to help us correct the system. It signals the pituitary gland to secrete a powerful hormone called oxytocin. According to Christopher Cardoso, researcher in Concordia’s Center for Research in Human Development, “Previous studies have shown that natural oxytocin is higher in distressed people … In distressed people, oxytocin may improve one’s motivation to reach out to others for support.”1 As a side benefit, it can help us heal. For example, in the heart, oxytocin can heal damaged cells and strengthen them. As this hormone secretes, it increases our desire to seek out others for comfort. It lowers the fear response and makes us more likely to want to trust, help, and be helped by others, which decreases fear even more. A brilliant cycle for supporting good health!
You might be wondering whether reaching for support to succeed in the area of physical health is something new. Actually, it was noted early on in our species’ history because it was necessary for survival, once again due to our biology. As you may have noticed, the human body evolved to walk erect. To support the added weight in gravity, our pelvises became thicker, which left less room in the canal for infants to arrive. As a result, humans emerge from the womb less developed than almost any other mammal on Earth.
The need to protect and raise such vulnerable infants required us to develop considerable cooperation among adults. It became necessary to share food, for example, and hunting and gathering enough food to sustain groups, small or large, required the organized efforts of many. Reaching out to others allowed us to survive and, as a result, we have become accustomed to collaboration at a degree greater than any other species, including our primate cousins. Consider chimpanzees and gorillas, for example. They rarely let another mother hold their babies, unlike human mothers. In almost every culture studied, this is an acceptable behavior among humans and an extraordinary feat that we take for granted. As one author, Daniel Goleman, powerfully stated: “… to become a cooperatively breeding ape, and to persuade a bunch of smart, hot-tempered, suspicious, politically cunning primates to start sharing child care and provisioning, now that took a novel evolutionary development, the advent of this thing called trust.”2
The necessity of reaching for support to insure survival across so many millennia seems to have created within us a persistent biological need to continue doing so, especially when we encounter fear. There is a tremendous amount of research that demonstrates the powerful effect of reaching for support on our physical health. These studies address health issues as varied as cardiac wellness, cancer, surgical and maternal outcomes, psychological health, and more. By sampling just a few of them, you’ll begin to recognize how essential our connections with others are and how consistently they impact our physical health.
Most of us are generally aware that diet, exercise, and good sleep can affect the health of our heart, right? What may be less obvious, however, is that a willingness to reach for support can impact the heart just as powerfully as any other factor. Two brilliant cardiologists, Meyer Friedman and Ray Rosenman, referenced the importance of reaching out for support in their book, Type A Behavior and Your Heart. “Peculiarly,” they wrote, “an anxiety state of severe degree—that is one in which the subject is profoundly depressed and seeks the help of others rather than relying upon his own possible powers for coping with his situation—is extraordinarily likely to reduce serum cholesterol to unusually low levels. This phenomenon has not been widely recognized.”3 It is believed that the mechanism for this physical improvement is that, when we reach for support and shut off the amygdala, the blood supply that it had been sending to the muscles returns to its normal flow, giving the liver the blood it needs to lower the cholesterol we feed it. If we re-read the previous quote and substitute the words fear for “anxiety” and sad for “depressed,” we have strong evidence supporting the assertion that the most crucial skill for achieving and maintaining success in physical health is to reach out to others for support.
Additional cardiac studies have reached the same conclusions. Cardiologist Redford Williams, author of the book Anger Kills, followed 1,300 cardiac patients for five years after their initial diagnosis. He found that patients who were unmarried and reported that they had no one to confide in experienced a 50 percent death rate within five years. Those who were married or who indicated that they had someone to confide in, on the other hand, experienced only a 17 percent death rate. Similar findings were noted in older patients who were hospitalized with congestive heart failure. Those who said they had no one they could rely on for emotional support were three times more likely to have subsequent complications requiring re-hospitalization than those reporting that they had emotional support.4 What these findings suggest is that reaching for support is an essential factor in improving and sustaining good heart health.
Surgical outcomes also improve when patients reach for and receive various types of support. One noteworthy study done by James Kulik and Heike Mahler at the University of California, San Diego investigated whether or not one’s roommate prior to heart surgery could have a meaningful impact on the outcome of this very technical procedure.5 Half of the patients were assigned a roommate who was also scheduled for bypass surgery the following day, whereas the other half shared rooms with postoperative patients who were already successfully recovering from the same surgery. Which group do you predict had the best outcomes? If you guessed that having a recovering postsurgical roommate was most helpful, you are correct. The group of patients rooming with these “experienced mentors” ended up walking twice as far per day after the operation compared to those patients with pre-operative roommates, and they were out of the hospital a full day and a half sooner.
Cardiac and surgical studies weren’t the only ones to clearly demonstrate the importance of connection in achieving and sustaining health during medical challenges. Outcomes for women receiving support prenatally or when in labor have also been well-documented. One study that was reported in the New England Journal of Medicine followed 40 women who came into a hospital in labor alone, with no partner, parent, or friend accompanying them.6 Half of the study participants, the control group, received the standard medical support routinely offered by the hospital. The other half, the experimental group, received “constant support from an untrained layperson from admission to delivery; one woman was present during the day and another at night. The support consisted of physical contact (for example, rubbing the mother’s back and holding her hands), conversation, and the presence of a friendly companion whom the mother had not met before.” The outcomes were telling. For the women in the control group, the average time from admission to delivery was 19.3 hours, whereas the average time from admission to delivery for the experimental group was only 8.7 hours.
In a similar maternal study, 465 first-time, healthy pregnant women were randomly assigned to one of two groups.7 For the first group, it was arranged that a woman unacquainted with the soon-to-be mothers would come to the hospital to provide emotional support during labor and delivery. For the second group, the new mothers were scheduled to go through labor and delivery alone. Given what you now know about the importance of reaching for support, can you guess what the outcome was? As you might suspect, the group provided the supportive stranger fared best. They experienced fewer overall complications during labor, their labor time was halved, and fewer of their infants required intensive care after delivery. Additional maternal studies have reported a 60 percent reduction in pain medication and a 25 percent reduction in Caesarean sections when delivering mothers are provided support.
It has also been demonstrated that mutual, or simultaneous, support has a powerful effect on health habit changes and success with compliance as well. A study through the University College London followed 3,722 couples, all over age 50, who were either married or living together.8 As might be expected, researchers found that when one partner was trying to make a change in his or her health behavior, that person was more likely to succeed if his or her partner was also making the change. What was most compelling in the findings, however, was the staggering difference in the rates of success. They found that if a woman was trying to quit smoking, she had a 50 percent chance of succeeding if her partner was also trying to quit, but had only an 8 percent chance if her partner remained a smoker.
Other important investigations have probed the quality of people’s close relationships and the impact of this on a variety of physical health factors as well. Beginning in the 1950s, investigators randomly selected 126 Harvard undergraduates and asked them to answer a single question: “Would you describe your relationship to your mother and your father as (check one): very close, warm and friendly, tolerant, strained and cold?”9 Thirty-five years later, the medical records of the 126 subjects were analyzed and findings were compared with their answers to this one question. The results were striking. Of those undergraduates who answered “strained and cold” regarding their relationship with the mother 35 years earlier, the chance of being diagnosed with a major medical problem such as heart disease or alcoholism was 90 percent, whereas of the study participants who had indicated that they were “very close to their mothers,” only 45 percent had experienced a serious medical problem. For the students reporting distance from fathers, the risk of health problems was 82 percent compared to 50 percent for those with a warm relationship. Even more heartbreaking, for those students who answered “strained and cold” regarding their relationship with both parents, the risk of severe illness was 100 percent! A similar study was conducted at John Hopkins University in the 1940s in which 1,100 male medical students were also asked about their closeness to their fathers.10 Their answers to this question turned out to be the best predictor of which subjects would develop cancer 50 years later. It was not thought that relationships with parent(s) prescribed destiny, but instead that subjects who could not reach out to their parents for support were unlikely to have created the loving, supportive relationships as adults that would prevent them from putting themselves at risk for health challenges.
Case Example
Sandra is a highly educated executive at a high tech firm in the Silicon Valley, with a jaw-dropping resume packed full of impressive accomplishments. Although she dates occasionally, she insists that she has no time in her life right now for a relationship. She came to see me looking for help with weight loss. “I keep gaining and losing the same 30 pounds,” she remarked, a tinge of self-loathing and desperation evident in her voice. She said that it angered her that she could be so self-disciplined and successful at work, but could not control her eating and nutrition. It wasn’t for lack of effort on her part, however. Sandra had repeatedly tried intensive exercise programs, restricted diets, and even medication. But, despite these efforts, the cycle of weight loss and gain persisted.
As we began to explore her pattern of eating, it became apparent that Sandra was already aware that she was “a stress eater.” When she was upset, she consoled herself with food; and when she was excited about a work success, she rewarded herself with food. I began our conversation by asking her if we could explore just a few aspects of her childhood. I approached this topic gingerly, because she had pointedly told me she had not wanted to see a psychologist “to talk for hours about her childhood.” I promised her that I just wanted to understand a few aspects of her upbringing that might be influencing her relationship with food and she guardedly agreed.
I asked first whether she’d gone to her parents with her problems as a child. She quickly answered, “No. They were both so tired when they came home from work. I took care of my two younger sisters, and my parents always said, ‘You’re a smart girl, you can figure it out on your own.’ ” She added that her mother had always seemed depressed and she didn’t want to burden her. From these circumstances, Sandra learned to be hard-working and self-reliant. These two qualities, no doubt, were tremendously helpful in the highly competitive, male-dominated world of high tech firms. I asked her if there was anyone that she currently confides in, shares her problems with, or calls with her successes. There was a long silence, then her eyes began to fill. “No … no one at all.” A pause. “Not ever.” She seemed surprised by the tears that fell slowly along her cheeks and wiped them away. “I do have a lot of friends … and I go out a lot,” she asserted. Then, as if realizing it for the first time, “But no one knows me. Not really.”
Sandra, like many successful people, had achieved excellence and rewards in her work by hard work and competitive skills. However, she’d grown up without much emotional support, so she wasn’t conscious of the basic human need to truly connect with others. I pointed out how powerful this need was by reminding her of what children do when they have a nightmare and what parents do in response. I then added an example she might relate to more easily: “So, consider things from this perspective. You’ve mentioned that you have 30 people who report to you. If any one of them, or your whole team, are facing a really difficult problem with a customer, would you want them to make their best guess and act or consult you before taking action?” She didn’t hesitate. “Of course I’d want my staff to bring the issues to me.” I paused to let her consider her response, then asked: “And you would want them to do this so you could monitor their work and compliment them or criticize their plans?” She responded quickly, “Of course not! I’d just want to be available so they could talk through things, brainstorm, and know they weren’t in it alone.”
As she said this, she immediately noticed the contradiction between her desire to have her staff bring issues to her and her own fiercely guarded self-reliance. I quickly tried to connect this budding awareness with her concerns about eating before she could accuse me of wanting to blame everything on her parents. “So,” I suggested, “Since the healthy response to doubt, uncertainty, and stress [I assumed she would prefer this familiar word to the term fear] is to ask for help, and you feel you have no permission or channel to do this, where do you go instead?” She smiled wryly at her awareness that food had become her friend and her source of comfort when she was upset or stressed.
With this fresh perspective, she was ready to take on her weight management challenges once again. The steps we designed may appear simple to you, but they weren’t easy for her. We started with a phone call. Every time she felt like overeating, or when her food choices would not help her to achieve her goals, she would call my voice mail and leave a basic message, “Hi this is Sandra” and then hang up. That this was difficult for her may seem foolish. However, to Sandra’s emotional brain, reaching out to another person for support was dangerous. So, protectively, she had walled off her basic human need for support. Simply calling someone before reaching for food was inviting the rejection she had feared as a child.
Sandra was surprised at how difficult this was as well. I explained to her the importance of working to reprogram the brain in very small increments in order to side-step her instinctive fears and achieve lasting progress. (If you’re interested in how to design “small steps” for any challenge you might be facing, please see my book One Small Step Can Change Your Life, which provides specific information on this important strategy and its underlying rationale.) It took more than a month before this habit became consistent and easy for Sandra, but eventually it did.
At that point, we added another step. She continued to call, but her voice mails now included a short description about how she was feeling prior to using food for comfort or to mask her feelings. Opening up in this way was again a challenging task. However, we both noticed that it became easier for her much more quickly. After a few weeks, with Sandra’s habit of reaching out firmly established, we started developing an inventory of her friends and acquaintances. We looked through the list to carefully identify individuals she knew who were nurturing and supportive. We then role-played how Sandra might share various life challenges and successes, as well as her difficulty in opening up to others, with those friends. In this way, her fears of leaning on another person could become a bridge for connection rather than a wall.
Initially, Sandra selected one friend to reach out to—and she chose well. She asked this friend if they could connect more often to share successes and challenges, and she found that her friend was more than just willing, she was interested in growing the friendship as well. Although Sandra still had more work to do in order to achieve her weight-management goals, through this initial process her underlying relationship with food, along with her fundamental sense of herself in connection to others, was changed forever.
Sandra’s situation addresses one specific health challenge. However, the approach reflects the important principles that underlie success in any health challenge. In order to achieve and sustain excellence in health, it is critical that we take three steps: 1) become aware of our own willingness to reach for support, or our fear of doing so; 2) identify people we can reach out to who will support us in achieving our health goals; and 3) reach out.