Person To Person: The Extended Benefits Of Social Relationships
Person To Person: The Extended Benefits Of Social Relationships
Sam Goldstein, Ph.D.
February, 2006
Copyright © 2006
We are social beings. Our culture has evolved with a strong foundation of people living, working and playing together. Researchers have demonstrated the importance of friendships and social contacts for children's mental health and as powerful predictors of normal adjustment in adulthood. In this month's article, I extend the importance of social relationships beyond mental health to include physical health as well. As you will read, researchers continue to generate a wider expanding foundation of data reflecting the importance of social relationships.
In his acceptance award from the American Psychological Association for distinguished scientific contributions in 2004, psychologist Sheldon Cohen argued that social variables related to support, connection and integration with others as well as negative interactions are significantly associated with health outcomes. Dr. Cohen opined that these variables each influenced health through different mechanisms and that associations between these variables and health are not random findings, attributable simply to personality differences.
Mother Theresa once wrote that she was convinced "that the greatest of all sorrows is to feel alone, to feel unwanted, deprived of all affection." In our workshops and books, Dr. Robert Brooks and I have advocated that a basic ingredient in nurturing hope and resilience in ourselves, our children and extended relationships is the connection to at least one other person who through their words and actions conveyed unconditional support. The late Dr. Julius Segal, a Harvard faculty member, referred to such a person as a charismatic adult. In this case an adult from whom a child gathers strength. The power of one individual to change the life of another, we believe, should not be underestimated. Studies of adults with childhood histories of risk, including abuse, neglect, school failure or being raised in significantly adverse environments such as war torn areas find that at risk individuals are capable of rising above their hardships. Some individuals are able to overcome significant challenges and lead successful and satisfying, personal and professional lives. Time and time again these individuals cite another person who cared for and supported them as a significant component of their survival.
In our 2003 book, The Power of Resilience, we describe connectedness as a life force. We associate connectedness with resilience and suggest being connected involves a mutual give and take, a high level of trust, caring and openness. This connection provides a sense of security and safety. Our friend and colleague, Dr. Ned Hallowell, has written extensively about the theme of connections in his book, Connect: Twelve Vital Ties that Open Your Heart, Lengthen Your Life and Deepen Your Soul. Dr. Hallowell eloquently expands the definition of connections beyond interpersonal relationships noting that being connected involves being a part of something larger than yourself. Such connections can come from family members, community organizations and colleagues in the work place. In our book we offer a set of guidelines to nurture connectedness, including making connections a top priority, recognizing that connections come in many forms, being compassionate and assertive in relationships with others.
Dr. Cohen's work and that of his colleagues provides exciting new data extending our understanding and appreciation of connections and social contacts to good health. Social relationships within a structure of social networks, support received from others and the quality and quantity of social interactions, have all been described as contributing to physical health. Further, the extent of feelings of isolation and loneliness have been identified as predictors of ill health and poor well being. Dr. Cohen notes that there is increasing evidence that different social variables influence health through entirely different and independent mechanisms.
Characteristics of the Social Environment
Three key characteristics are examined when considering the role of the social environment and its relationship to health. The first involves social support. Social support refers to the assistance provided by others in the form of friendship, nurturing, even material resources intended to benefit an individual's ability to cope with stress. The second, emotional support, involves the expression of empathy, caring, reassurance and trust. Emotional support in relationships provides individuals with opportunities for emotional expression and the venting of emotions. Finally, social integration reflects participation in a broad range of social relationships. In particular, stable social structures are protective and serve to assist individuals in regulating their behavior. It is of interest to note that in her fifty year study of children born on the island of Kauai, Dr. Emmy Werner reported that the maintenance of a long-term marital relationship served as a powerful protective factor, leading those individuals to feel better about themselves and function better in every day life.
How Do These Characteristics of the Social Environment Improve Health?
Social connections benefit health by providing psychological and material resources needed to cope with stress. Stress influences health both by promoting behavioral coping responses detrimental to health (e.g., smoking, substance use, etc.) and by activating physiological systems of the sympathetic nervous system, particularly the hypothalamic-pituitary-adrenal cortex. Prolonged or repeated activation of these systems place people at risk for the development of a range of physical and psychiatric conditions. Further, perceived availability of social support has been found to predict good adjustment during adolescence as well as a buffer for the effects of stress on psychological distress, depression and anxiety. The most striking evidence for stress buffering in physical health, was reported in a study in 1993 in Swedish men over the age of fifty. Those with high numbers of stressful life events in the year before the baseline exam were at substantially greater risk for mortality over a seven year follow-up period. This effect was moderated among those who perceived that high levels of emotional support were available to them. In contrast, perceived emotional support made no difference for those with few stressful events. Social integration did not act as a stress buffer. However, Cohen and his colleagues argue that social connectedness is beneficial irrespective of whether one is under stress. It has even been hypothesized that social integration assists in the body's ability to fight off infectious disease. Cohen and his colleagues found that greater social integration, as assessed by the number of social roles (e.g., mother, friend, neighbor, etc.) was associated with less susceptibility to clinical illness. This association was confirmed across two viruses and was independent of demographic factors and of the immunity to the experimental virus at baseline.
Can Our Social Environment Be Destructive To Our Health?
Social networks provide emotional, intellectual and material support. They guide and offer boundaries for behavior. They provide opportunities for social engagement. They also provide a context for potential stress, conflict and feelings of loss or loneliness. Thus, it is not surprising that a lack of a functional social network is associated with adverse health. Cohen and colleagues examined the influence of social conflicts on susceptibility to the common cold. He and his colleagues assessed whether subjects were involved in serious, enduring social conflicts using an intensive interviewing technique. Each subject was then exposed to a virus that caused the common cold. Those with enduring conflicts were more than twice as likely to develop a cold as persons without any chronic stressors in their lives. The conflicts contributing to this relationship included enduring problems with spouses, close family members and friends. These associations were independent of pre-exposure immunity to the virus, demographics as well as many other controls. Social environments and one's response to them can have powerful, detrimental effects. These effects are likely mediated through changes in endocrine, immune and cardiovascular responses as well as health related behaviors.
Is it the Social Environment or Our Personalities that Really Matter?
At times it is argued that personality traits that impact social connections such as attachment, extroversion, agreeableness or hostility may be the primary determinants in shaping social connectedness. But are social traits responsible for the associations that have been attributed to the social environment? Hostile individuals have been found to have a greater risk for coronary artery disease and other physical health problems. Sociability has been found to lead to greater resistance to developing colds when persons were exposed experimentally to a cold virus. It is likely that personality traits implicated in social relations do play a role in health. However, as I have written and argued elsewhere, biology while affecting probability does not determine destiny. As has been demonstrated time and time again in the resilience literature, experience is a better predictor of outcome, likely even for many health issues, than genetics.
Can the Social Environment be Changed to Improve Health?
In summarizing the existing intervention literature, Dr. Cohen was somewhat pessimistic. He noted that investigators have approached this complex problem with good intentions but often without deep theoretical analysis or a strong base of prior research. Dr. Cohen noted that to truly demonstrate what he believes to be the case that social connections serve as protective health factors, researchers need to make use of natural social networks in their studies, increase the availability of social support within existing social networks by improving social skills and building stronger ties to existing networks, reduce negative interactions and work to create close, nurturing and peripheral ties between an individual and his or her community. Finally, researchers need to identify the characteristics of those who benefit most and least from social integration and support interventions.
So What Does This Mean for Each of Us?
These data provide a strong basis for the argument that to be happy, healthy and resilient requires genuine connections to others. In The Power of Resilience, Dr. Brooks and I suggest readers ponder the following questions in their quest to find and maintain nurturing connections. How would you answer these questions?
- Where are your current connections located? How well balanced are they?
- Who are the five people in your life with whom you feel most connected? In what ways do you feel connected to each?
- What do you do to express this feeling of connectedness and keep them vibrant and alive?
- In addition to your relationship with people, what are three other things in your life to which you feel connected? Through participating in these activities you maintain and create social networks as well.
I urge you to consider your responses to these questions. If you are unhappy with your answers, feeling disconnected, isolated or alienated from others, make a plan to change. If change seems difficult or insurmountable, seek help from a professional counselor to address these issues. As Dr. Brooks and I write, the centrality of connectedness and compassion in our lives is reflected in the number of people who have spoken and written so eloquently of these themes. It is little wonder that these themes have attracted such attention. They are the roots of emotional and physical health and of hope. They should not be neglected if we are to lead resilient, healthy lives. Perhaps the physicians' guidelines for good health should read: Get enough sleep, eat well, take your vitamins and stay connected.
