Perhaps the most telling testimony to the healing potency of emotional ties is a Swedish study published in 1993.41 All the men living in the Swedish city of Goteborg who were born in 1933 were offered a free medical exam; seven years later the 752 men who had come for the exam were contacted again. Of these, 41 had died in the intervening years.
Men who had originally reported being under intense emotional stress had a death rate three times greater than those who said their lives were calm and placid. The emotional distress was due to events such as serious financial trouble, feeling insecure at work or being forced out of a job, being the object of a legal action, or going through a divorce. Having had three or more of these troubles within the year before the exam was a stronger predictor of dying within the ensuing seven years than were medical indicators such as high blood pressure, high concentrations of blood triglycerides, or high serum cholesterol levels.
Yet among men who said they had a dependable web of intimacy—a wife, close friends, and the like—there was no relationship whatever between high stress levels and death rate. Having people to turn to and talk with, people who could offer solace, help, and suggestions, protected them from the deadly impact of life's rigors and trauma.
The quality of relationships as well as their sheer number seems key to buffering stress. Negative relationships take their own toll. Marital arguments, for example, have a negative impact on the immune system.42 One study of college roommates found that the more they disliked each other, the more susceptible they were to colds and the flu, and the more frequently they went to doctors. John Cacioppo, the Ohio State University psychologist who did the roommate study, told me, "It's the most important relationships in your life, the people you see day in and day out, that seem to be crucial for your health. And the more significant the relationship is in your life, the more it matters for your health."43
The Healing Power of Emotional Support
In The Merry Adventures of Robin Hood, Robin advises a young follower: "Tell us thy troubles and speak freely. A flow of words doth ever ease the heart of sorrows; it is like opening the waste where the mill dam is overfull." This bit of folk wisdom has great merit; unburdening a troubled heart appears to be good medicine. The scientific corroboration of Robin's advice comes from James Pennebaker, a Southern Methodist University psychologist, who has shown in a series of experiments that getting people to talk about the thoughts that trouble them most has a beneficial medical effect.44 His method is remarkably simple: he asks people to write, for fifteen to twenty minutes a day over five or so days, about, for example, "the most traumatic experience of your entire life," or some pressing worry of the moment. What people write can be kept entirely to themselves if they like.
The net effect of this confessional is striking: enhanced immune function, significant drops in health-center visits in the following six months, fewer days missed from work, and even improved liver enzyme function. Moreover, those whose writing showed most evidence of turbulent feelings had the greatest improvements in their immune function. A specific pattern emerged as the "healthiest" way to ventilate troubling feelings: at first expressing a high level of sadness, anxiety, anger—whatever troubling feelings the topic brought up; then, over the course of the next several days weaving a narrative, finding some meaning in the trauma or travail.
That process, of course, seems akin to what happens when people explore such troubles in psychotherapy. Indeed, Pennebaker's findings suggest one reason why other studies show medical patients given psychotherapy in addition to surgery or medical treatment often fare better medically than do those who receive medical treatment alone.45
Perhaps the most powerful demonstration of the clinical power of emotional support was in groups at Stanford University Medical School for women with advanced metastatic breast cancer. After an initial treatment, often including surgery, these women's cancer had returned and was spreading through their bodies. It was only a matter of time, clinically speaking, until the spreading cancer killed them. Dr. David Spiegel, who conducted the study, was himself stunned by the findings, as was the medical community: women with advanced breast cancer who went to weekly meetings with others survived twice as long as did women with the same disease who faced it on their own.46
All the women received standard medical care; the only difference was that some also went to the groups, where they were able to unburden themselves with others who understood what they faced and were willing to listen to their fears, their pain, and their anger. Often this was the only place where the women could be open about these emotions, because other people in their lives dreaded talking with them about the cancer and their imminent death. Women who attended the groups lived for thirty-seven additional months, on average, while those with the disease who did not go to the groups died, on average, in nineteen months—a gain in life expectancy for such patients beyond the reach of any medication or other medical treatment. As Dr. Jimmie Holland, the chief psychiatric oncologist at Sloan-Kettering Memorial Hospital, a cancer treatment center in New York City, put it to me, "Every cancer patient should be in a group like this." Indeed, if it had been a new drug that produced the extended life expectancy, pharmaceutical companies would be battling to produce it.
BRINGING EMOTIONAL INTELLIGENCE TO MEDICAL CARE
The day a routine checkup spotted some blood in my urine, my doctor sent me for a diagnostic test in which I was injected with a radioactive dye. I lay on a table while an overhead X-ray machine took successive images of the dye's progression through my kidneys and bladder. I had company for the test: a close friend, a physician himself, happened to be visiting for a few days and offered to come to the hospital with me. He sat in the room while the X-ray machine, on an automated track, rotated for new camera angles, whirred and clicked; rotated, whirred, clicked.
The test took an hour and a half. At the very end a kidney specialist hurried into the room, quickly introduced himself, and disappeared to scan the X-rays. He didn't return to tell me what they showed.
As we were leaving the exam room my friend and I passed the nephrologist. Feeling shaken and somewhat dazed by the test, I did not have the presence of mind to ask the one question that had been on my mind all morning. But my companion, the physician, did: "Doctor," he said, "my friend's father died of bladder cancer. He's anxious to know if you saw any signs of cancer in the X-rays."
"No abnormalities," was the curt reply as the nephrologist hurried on to his next appointment.
My inability to ask the single question I cared about most is repeated a thousand times each day in hospitals and clinics everywhere. A study of patients in physicians' waiting rooms found that each had an average of three or more questions in mind to ask the physician they were about to see. But when the patients left the physician's office, an average of only one and a half of those questions had been answered.47 This finding speaks to one of the many ways patients' emotional needs are unmet by today's medicine. Unanswered questions feed uncertainty, fear, catastrophizing. And they lead patients to balk at going along with treatment regimes they don't fully understand.