Loneliness Can Be The Death Of Us
By Judy Foreman
04/22/1996

A little over 100 years ago, a small band of Italians left Roseto Val Fortore, a village in the foothills of the Apennines, in hopes of a better life amid the slate quarries of eastern Pennsylvania.

Naming their new village Roseto, the group soon recreated the strong community ties they had nurtured in Italy. They lived in three-generation households, centered their lives on family and built their houses so close together that all it took to have in a neighborly chat was a walk to the front porch.

By the 1960s, Roseto stood out like a distinctly un-sore thumb, becoming a magnet for researchers. While Roseto shared the same water supply, doctors and hospital with nearby villages, the town had only 40 percent as many heart attack deaths.

At first, researchers thought the Rosetans might carry some special, protective genes. But this was not the case, for Rosetans who moved away -- even to the nearby village of Bangor -- lost whatever magic the town possessed against heart disease.

That magic, now known as ``the Roseto effect,'' is as simple as it is elusive in America today: Close ties to other people.

A growing body of data shows that closeness with other people has a strong protective effect against illness and death. And that the lack of such ties -- social isolation -- can kill just as surely as smoking, obesity or high blood pressure.

That is one of the conclusions of a new book, ``Overcoming Loneliness in Everyday Life,'' due out in June by a husband and wife team of McLean Hospital psychiatrists, Jacqueline Olds and Richard Schwartz, and journalist Harriet Webster.

Loneliness is no longer just a painful experience, but a ``major public health problem,'' says Schwartz, ``and most psychiatrists haven't registered the strength of the medical data on this.''

In 1950, only 10 percent of households consisted of just one person, according to census figures. By 1994, this number had soared to 24 percent. That means 12 percent of the adult population now lives alone.

And this trend is particularly strong among older people, who are more likely than ever before, and more likely than younger people, to live alone. While fewer than 10 percent of people aged 25 to 44 live alone, census data show, nearly a quarter of those 65 to 74 do, and 40 percent of people 75 and older.

While some people certainly maintain a high level of happiness -- about three in 10, in fact, according to surveys by University of Chicago researchers cited in the May issue of Scientific American -- others are clearly lonely. A 1990 Gallup poll found that more than 36 percent of Americans are lonely.

For many people, the worst part of loneliness is that it is often accompanied by shame. It is not okay in this culture to feel lonely, Olds and Schwartz write in their book, ``because American culture prizes self-sufficiency above all else.''

``Our notion of success is being able to purchase what you need and not be obligated to anyone,'' Schwartz explains in an interview.

``Yet in other cultures,'' Olds adds, ``people have always accepted leaning on each other as part of life.''

The mere fact of living alone, of course, does not mean a person is destined to be lonely, though it probably does increase the odds, notes Dr. Gene Cohen, director of the Center on Aging, Health and Humanities at George Washington University in Washington.

Nor should loneliness be confused with depression, he says, though both involve feelings of sadness. Loneliness is a state ``you can pull out of,'' says Cohen, ``and you often maintain the motivation to get involved with other people.''

With depression, ``you may lose the motivation to be involved,'' he says, and while social support can help assuage depression, some people also need professional help, including ``the talking therapies or the judicious use of medication.''

Certainly, the ability to spend time alone happily -- creative solitude, if you will -- is one of the great joys of life, and a hallmark of a mature personality.

But the evidence is now overwhelming in two directions: Social isolation -- having few, meaningful interpersonal ties -- can have severe medical consequences, and close ties with people can significantly increase health and longevity.

Consider:

- People who are isolated but healthy are twice as likely to die over a period of a decade or so as healthy people who are not isolated, according to a 1988 review of studies on 37,000 people in the United States, Finland and Sweden. Among adults of working age, the more-isolated men are one to four times more likely to die of all causes at any age than less-isolated men, and more-isolated women are one to three times more likely to die than less-isolated women, says sociologist James House, of the Survey Research Center at University of Michigan.

- Living alone after a heart attack significantly raises the risk of subsequent cardiac problems, according to a 1992 study of more than 1,000 people by Columbia University researchers published in the Journal of the American Medical Association.

- People with heart disease have a poorer chance of survival if they are unmarried and do not have a confidant than if they are married, have a confidant, or both, according to a study of 1,368 people by Duke University researchers in the same journal.

- Women with advanced breast cancer who join a support group live twice as long as those who do not, according to a study several years ago by Dr. David Spiegel, a Stanford University psychiatrist.

- Similarly, people with malignant melanoma who participate in group intervention live longer than those who do not, according to a 1993 study by Dr. Fawzy I. Fawzy, a UCLA psychiatrist.

- While chronic stress, such as taking care of a spouse with dementia, leads to marked declines in immune response, having a strong network of friends offsets this decline, according to studies by Ronald Glaser, an Ohio State University microbiologist, and his wife, Janice Kiecolt-Glaser, a psychiatrist.

``Primates, which we are, are a social species,'' says Glaser. ``We run in packs, in troops. Social interaction between individuals'' is an important ``buffer to the physiological changes that stress is inducing.''

And this may be particularly true for older people, whose immune systems decline with age.

``The research clearly shows that social isolation is a major health hazard for elderly people. Socially isolated elders have higher rates of physical and mental illness and even death. . .'' said Karl Pillemer, director of the Applied Gerontology Research Institute at Cornell University, in an e-mail interview last week.

An older person who is isolated is also at increased risk of being abused, according to Pillemer's studies, which show that older people who were abused had less contact with friends and family than those who were not, in some cases because the abuser forbad such contact.

Many Americans, young and old, turn to therapists, self-help groups and medications to combat isolation, but there may be a better way, and it's not just seeking friends for friendship's sake.

``The idea is that you need to be willing to enter into relationships of mutual obligation,'' says Olds.

``The really naive notion of our time is that the way you make friends is just by being fascinated with someone, that you are drawn by pure attraction,'' says Schwartz.

``But the fact is, people's lives are so hectic that those purely fun relationships often don't get sustained. It's the relationships where people are really useful to each other that do get sustained, that deepen and that therefore fulfill people's needs for longterm intimacy,'' Olds adds.

If that has an old-fashioned ring to it, they say, so be it. After all, old wives' tales often endure precisely because they do contain gems of hard-won wisdom.

Like this one: To have a friend is to be one

Judy Foreman’s column runs every other week. Past columns are available on www.myhealthsense.com.

 Listen to her live call-in webcast radio show every Wednesday night from 8:30 to 9:30 EST on http://www.healthtalk.com.