When Ann Norman of Takoma Park, Maryland, was diagnosed with breast cancer in 1991, she had already been through a series of painful events. Her only child, Olivia, is blind, having been born prematurely, and Norman was later left infertile following another complicated pregnancy. To make matters worse, she and her husband, Colin, immigrants from Great Britain, have no family nearby to help during a crisis. She tried a support group but felt she didn't connect well with the other participants.
As she struggled to battle cancer, Norman found that her friendships were invaluable. "The way people rallied around touched me most of all," she says. "I didn't have to worry about food — for three weeks people showed up with dinners for us. Olivia's Braille teacher offered to take care of her. That kind of practical help was incredible." Norman feels that her friends' support may even have been a factor in her survival. "If I'd been lonely, I think it would have affected my recovery," she says.
Science is validating Norman's belief that her circle of friends helped in the healing process. A growing body of research confirms that having compassionate friends is beneficial not only for your psychological and spiritual well-being but also for your physical health. To the familiar recommendations for a healthy lifestyle — eat a low-fat diet, exercise, don't smoke — we should now add: have friends.
In a 1988 review of the medical literature, James S. House, the chair of sociology and a researcher at University of Michigan's Institute for Social Research, found that "social relationships, or the relative lack thereof, constitute a major risk factor for health — rivaling the effects of well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity, and physical activity." House added that the evidence on social relationships was as strong as the case against smoking when the U.S. Surgeon General issued his 1964 report on tobacco and health.
Since House wrote this, the evidence continues to grow. Over the last 25 years, hundreds of studies on the relationship between physical health and friendship, loneliness, and social networks have been conducted. One pioneering researcher, Janice Kiecolt-Glaser of Ohio State University, calls the connection between satisfying personal relationships and better immune function "one of the most robust findings" in psychoneuroimmunology, the study of the biological mechanisms by which emotions, stress, and behavior affect resistance to disease.
Having a strong social network is linked to lower mortality rates for both healthy and unhealthy people, including those with heart disease and some types of cancer. In cases of terminal illness, having close friends is associated with longer survival rates. There may also be a protective effect from illness.
Among the findings:
Scientists are still unraveling the precise mechanisms as to why all this is so, but the benefits of companionship appear to be part of our genetic inheritance. "We're programmed to want to be around each other," says Seymour Levine, who directs the neuroscience program at University of Delaware.
- One early study looked at a group of men who were thrown out of work suddenly when the local industry shut down. Those with strong social ties were significantly less likely to get arthritis.
- Kiecolt-Glaser and colleagues measured the immune function of a group of medical students during the stressful time of taking exams. Those who scored higher on a loneliness scale had lower levels of natural killer cells, the part of the immune system that defends against cancer and viruses. In another study, researchers found that students with adequate social support had stronger immune functioning during exams than those without such support.
- A study by Yale epidemiologist Lisa Berkman followed 194 elderly men and women who had suffered a heart attack. Of those who said they had two people on whom they could count, 27 percent died within a year; of those who had no one to turn to, 58 percent died.
- A 17-year follow-up study of nearly 7,000 adults in Alameda County, California, found that women who were socially isolated were at a significantly higher risk of dying of cancer. The data suggested that contacts with friends was a more significant factor that marital status.
Levine conducted experiments subjecting monkeys to a stressful situation, such as an unpleasant noise or light. If the monkeys were isolated, they registered high levels of stress hormones. But when the experiment was repeated with other monkeys nearby, the stress hormones were more stable. Moreover, monkeys seemed to do better with their "friends" around; lower levels of stress hormones were measured when the group was made up of familiar rather than unknown monkeys.
Even chickens — not typically thought of as having intimate relationships — may be programmed for social support. Studies of chickens injected with tumors found that cancerous growths were more likely to develop when the birds were with stranger chickens, rather than their usual companions.
Much of the research on friendship flows from our growing understanding of the toll that stress takes on the body. The American Institute of Stress, based in Yonkers, New York, points out the serious health consequences of loneliness, social isolation, and feelings of worthlessness. Such insidious causes of stress contribute to a host of disorders, including heart attacks, asthma, some types of cancer, diabetes, herpes, headaches, even the common cold.
"[Social support] is a protective mental-health behavior that reduces the risk and frequency of stress associated with a number of conditions," says Gene Cohen, M.D., director of the Center on Aging at George Washington University. "In most cases, social support has a very positive and protective effect."
Social support can take a variety of forms — not only friends but also family, church or club membership, work colleagues, support groups, and neighbors. Traditionally, family has been the most important of these. But the role of friendship is gaining in significance in modern society, where family ties often are frayed, divorce is epidemic, and job mobility pulls even close-knit families geographically far apart. "If you have superficial relationships, that doesn't do you good," says Joan Klagsbrun, a Boston-based clinical psychologist who cofounded the Wellspring Center for people with illness. "What helps is real intimacy."
Intimacy and companionship help keep our immune, nervous, and endocrine systems functioning well, while isolation and loneliness tend to trigger harmful changes. "There's a lot of human evidence that tends to support the notion of social buffering — that is, the ability of the social group to essentially modify the way we respond to stressful events," says Levine. "The secretion of stress hormones and changes in immune responses are markedly altered in relation to social support systems."
In addition to this buffering action, friendships — through the expression of emotion that they afford — have direct health benefits. "If you're holding in your true feelings," Klagsbrun explains, "that has a negative effect on your immune system.
"Good support also can make us feel cared for and worthy of love," she adds. "Having a secure place has a profound effect on how we think and feel about our surroundings and ourselves."
Some of the research offers insights into what kinds of social support are the most helpful. Nancy Waxler-Morrison and colleagues at the University of British Columbia followed a group of 133 women with breast cancer for four years to see the relationship between patients' social networks and their survival rates. The researchers found that several measures were significantly associated with survival, including support from friends, contact with friends, and total support (friends, relatives, neighbors). There was no significant benefit, however, from such measures as responsibility for others, support from relatives, and educational level. (It should be noted that other studies do show benefits from being responsible for others.)
Just as Ann Norman found, the breast-cancer survivors surveyed in this study said that practical help from friends — cooking, child care, driving to the hospital and waiting during treatment — was especially meaningful to them. "The practical help is a manifestation of their concern," says Norman. "So you see it on two levels."
Serious illness can also put friendship to a test, however. Waxler-Morrison reports that "some women lost friends — either temporarily or permanently — apparently because of the friends' inability to tolerate life-threatening illness."
For psychotherapists, social workers, and health professionals, these findings offer new avenues to help clients. "In meeting with individuals, help them re-examine their social and personal opportunities and encourage them to stretch in different ways, to explore new relationships with the possibilities that they will have health-promotion value," says Cohen.
Klagsbrun agrees. For example, one of her clients was both a single mother and a high-powered executive who had become socially isolated and plagued with constant colds and minor illness. Klagsbrun helped her take stock and find ways to build her social network. The client re-established ties with some cousins, joined a temple, and become part of a single mothers' group. "The difference in her health was astounding," says Klagsbrun.
Too often, she adds, the role of social support goes unrecognized. "Many clinicians get so involved with the individual and family that they neglect the social network. It's important to make people aware of the powerful impact that it can have."
Contributing editor Beth Baker is a writer in Takoma Park, Maryland.
How to Help a Seriously Ill Friend
Learn about the disease. Ask your friend if he wants to talk about the illness and treatment, and be prepared to listen.
Help out. Mundane tasks, from walking the dog to doing the laundry to grocery shopping, can be overwhelming if you're ill. A network of friends who can share daily burdens can be an enormous help.
Give emotional support. A hug and a few tears can go a long way toward helping someone who is ill. If your friend starts to cry when talking about her problems or fears, don't try to stop her. If you start to cry, let yourself. Empathy and intimacy are powerful aids to healing.
Adapted from "Social Support: How Friends, Family, and Groups Can Help," by David Spiegel, M.D., in Mind/Body Medicine, How to Use Your Mind for Better Health, edited by Daniel Goleman and Joel Gurin, Consumer Reports Books, 1993.
Copyright © 1998 Common Boundary, Inc. All rights reserved.