27. Stress and colorectal cancer: Joseph C. Courtney et al., "Stressful Life Events and the Risk of Colorectal Cancer," Epidemiology (Sept. 1993), 4(5).
28. Relaxation to counter stress-based symptoms: See, for example, Daniel Goleman and Joel Gurin, Mind Body Medicine (New York: Consumer Reports Books/St. Martin's Press, 1993).
29. Depression and disease: see, e.g., Seymour Reichlin, "Neuroendocrine-Immune Interactions," New England Journal of Medicine (Oct. 21, 1993).
30. Bone marrow transplant: cited in James Strain, "Cost Offset From a Psychiatric Consultation-Liaison Intervention With Elderly Hip Fracture Patients," American Journal of Psychiatry 148 (1991).
31. Howard Burton et al., "The Relationship of Depression to Survival in Chronic Renal Failure," Psychosomatic Medicine (March 1986).
32. Hopelessness and death from heart disease: Robert Anda et al., "Depressed Affect, Hopelessness, and the Risk of Ischemic Heart Disease in a Cohort of U.S. Adults," Epidemiology (July 1993).
33. Depression and heart attack: Nancy Frasure-Smith et al., "Depression Following Myocardial Infarction," Journal of the American Medical Association (Oct. 20,1993).
34. Depression in multiple illness: Dr. Michael von Korff, the University of Washington psychiatrist who did the study, pointed out to me that with such patients, who face tremendous challenges just in living from day to day, "If you treat a patient's depression, you see improvements over and above any changes in their medical condition. If you're depressed, your symptoms seem worse to you. Having a chronic physical disease is a major adaptive challenge. If you're depressed, you're less able to learn to take care of your illness. Even with physical impairment, if you're motivated and have energy and feelings of self-worth—all of which are at risk in depression—then people can adapt remarkably even to severe impairments."
35. Optimism and bypass surgery: Chris Peterson et al., Learned Helplessness: A Theory for the Age of Personal Control (New York: Oxford University Press, 1993).
36. Spinal injury and hope: Timothy Elliott et al., "Negotiating Reality After Physical Loss: Hope, Depression, and Disability," Journal of Personality and Social Psychology 61, 4 (1991).
37. Medical risk of social isolation: James House et al., "Social Relationships and Health," ScienceQuly 29,1988). But also see a mixed finding: Carol Smith et al., "Meta-Analysis of the Associations Between Social Support and Health Outcomes," Journal of Behavioral Medicine (1994).
38. Isolation and mortality risk: Other studies suggest a biological mechanism at work. These findings, cited in House, "Social Relationships and Health," have found that the simple presence of another person can reduce anxiety and lessen physiological distress in people in intensive-care units. The comforting effect of another person's presence has been found to lower not just heart rate and blood pressure, but also the secretion of fatty acids that can block arteries. One theory put forward to explain the healing effects of social contact suggests a brain mechanism at work. This theory points to animal data showing a calming effect on the posterior hypothalamic zone, an area of the limbic system with rich connections to the amygdala. The comforting presence of another person, this view holds, inhibits limbic activity, lowering the rate of secretion of acetylcholine, cortisol, and catecholamines, all neurochemicals that trigger more rapid breathing, a quickened heartbeat, and other physiological signs of stress.
39. Strain, "Cost Offset."
40. Heart attack survival and emotional support: Lisa Berkman et al., "Emotional Support and Survival After Myocardial Infarction, A Prospective Population Based Study of the Elderly," Annals of Internal Medicine (Dec. 15, 1992).
41. The Swedish study: Annika Rosengren et al., "Stressful Life Events, Social Support, and Mortality in Men Born in 1933," British Medical Journal (Oct. 19, 1993).
42. Marital arguments and immune system: Janice Kiecolt-Glaser et al., "Marital Quality, Marital Disruption, and Immune Function," Psychosomatic Medicine 49 (1987).
43. I interviewed John Cacioppo for The New York Times (Dec. 15, 1992).
44. Talking about troubling thoughts: James Pennebaker, "Putting Stress Into Words: Health, Linguistic and Therapeutic Implications," paper presented at the American Psychological Association meeting, Washington, DC (1992).
45. Psychotherapy and medical improvements: Lester Luborsky et al., "Is Psychotherapy Good for Your Health?" paper presented at the American Psychological Association meeting, Washington, DC (1993).
46. Cancer support groups: David Spiegel et al., "Effect of Psychosocial Treatment on Survival of Patients with Metastatic Breast Cancer," Lancet No. 8668, ii (1989).
47. Patients' questions: The finding was cited by Dr. Steven Cohen-Cole, a psychiatrist at Emory University, when I interviewed him in The New York Times (Nov. 13, 1991).
48. Full information: For example, the Planetree program at Pacific Presbyterian Hospital in San Francisco will do searches of medical and lay research on any medical topic for anyone who requests it.
49. Making patients effective: One program has been developed by Dr. Mack Lipkin, Jr., at New York University Medical School.
50. Emotional preparation for surgery: I wrote about this in The New York Times (Dec. 10, 1987).
51. Family care in the hospitaclass="underline" Again, Planetree is a model, as are the Ronald McDonald houses that allow parents to stay next door to hospitals where their children are patients.
52. Mindfulness and medicine: See Jon Kabat-Zinn, Full Catastrophe Living (New York: Delacorte, 1991).
53. Program for reversing heart disease: See Dean Ornish, Dr. Dean Ornish's Program for Reversing Heart Disease (New York: Ballantine, 1991).
54. Relationship-centered medicine: Health Professions Education and Relationship-Centered Care. Report of the Pew-Fetzer Task Force on Advancing Psychosocial Health Education, Pew Health Professions Commission and Fetzer Institute at The Center of Health Professions, University of California at San Francisco, San Francisco (Aug. 1994).
55. Left the hospital early: Strain, "Cost Offset."
56. Unethical not to treat depression in heart disease patients: Redford Williams and Margaret Chesney, "Psychosocial Factors and Prognosis in Established Coronary Heart Disease," Journal of the American Medical Association (Oct. 20,1993).
57. An open letter to a surgeon: A. Stanley Kramer, "A Prescription for Healing," Newsweek (June 7,1993).
PART FOUR: WINDOWS Of OPPORTUNITY
Chapter 12. The Family Crucible
1. Leslie and the video game: Beverly Wilson and John Gottman, "Marital Conflict and Parenting: The Role of Negativity in Families," in M. H. Bornstein, ed., Handbook of Parenting, vol. 4 (Hillsdale, NJ: Lawrence Erlbaum, 1994).
2. The research on emotions in the family was an extension of John Gottman's marital studies reviewed in Chapter 9. See Carole Hooven, Lynn Katz, and John Gottman, "The Family as a Meta-emotion Culture," Cognition and Emotion (Spring 1994).