The Village Effect: How Face-to-Face Contact Can Make Us Healthier and Happier (6 page)
Read The Village Effect: How Face-to-Face Contact Can Make Us Healthier and Happier Online
Authors: Susan Pinker
In 1986 a Danish cancer researcher named Marianne Ewertz studied the marital histories of 1,800 women with breast cancer and compared their situations to 1,800 healthy women of the same age. She discovered that a long marriage or a short-lived one, the recent death of a husband or a long-ago loss, a separation or a divorce—none had an impact on the women’s cancer risk.
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There’s even some evidence—as counterintuitive as it sounds—that stress helps to
protect
you from breast cancer, by impairing your ability to synthesize estrogen (reduced levels of estrogen can suppress the growth of some types of tumors).
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In a study that would give anyone pause, almost seven thousand women from Copenhagen were asked about their baseline stress levels and then were followed for the next ten to twelve years. The women with the highest levels of stress had a 40 percent
lower
chance of being diagnosed with breast cancer.
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There are also many natural experiments showing that extreme stress might well kill your spirit but it does not cause cancer. People who were imprisoned and tortured in concentration camps or the Soviet gulag, for example, or parents of children who died of cancer—all acutely traumatic events—don’t have a higher incidence of cancer than people who did not live through these
harrowing experiences.
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Nor is there a higher rate of cancer among almost twenty thousand Danish parents who have had a child diagnosed with schizophrenia—one of the most stressful events to ever strike a family. In short, social contact can stall the progress of breast cancer. But the stress of losing that support doesn’t bring it on.
THE FEMALE EFFECT
When I interviewed Sylvie for this book, she was skeptical about the connection between social contact and her recovery. Her brisk guide to cancer survival? “First they cut you, then they poison you, and then they burn you. Then it’s all over and your hair grows back.”
When describing her experience, she downplayed her fears and turned up the volume on how she went about solving the concrete problems related to her diagnosis: how she chose her treatment regimen, found the right medical expertise, and engineered the environment she needed to focus on recovery. In every situation Sylvie had deployed her social networks during a period of crisis, but she seemed oblivious—as most of us are—to the way her face-to-face social connections helped her. “I was reading about it, I called my doctor friends, I got together with them, and I got all this information from people I knew,” she told me.
I asked who had helped her the most. “Friends,” she replied, without so much as a pause. “I called my good friend Mona, who lives in another city and is married to an oncologist. I then talked to her husband for three hours, even though we weren’t really friends as two couples. She was my friend when I lived in that city, so her husband helped me. And I had Celeste. Celeste helped because she’s totally organized and very businesslike, and she’s a nurse and has been in this medical world forever. And she said okay, you’re going to this doctor, because she’s the best surgeon in town, and you’re going to do this and you’re going to do that. So I got all this information from all these people. Then I went
tut-tut-tut
, like
this.” Here Sylvie pointed her index finger as if it were a gun and shot down the problems she’d faced after her diagnosis.
I asked about her husband, an affable family man who seemed close to her and to the kids. So far he hadn’t figured in her description of the battle plan. She paused, looking at me with concern over the dark frames of her glasses. “David didn’t know what to do, and my sons didn’t really know what to do either,” she said. “They were in the same boat as I was. But my friends, they really helped me, because they’re women and they’re close in that way, you know? Celeste was excellent with information, and Dominique, well, she helped me by coming to sit with me when I went to the hospital for treatment. Then she drove me to my cottage afterwards so I could rest. She especially likes the country, so we’d hop in the car, drive up to the cottage, and stay over. We’d have a meal together and the next day she’d be gone.”
Sylvie didn’t know about Marianne Ewertz’s study showing that marriage isn’t that critical to the onset or remission of breast cancer; indeed, being married is more essential to a sick man’s ability to pull through than it is to a sick woman’s.
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Powerful sex differences
emerge in people’s responses to cancer. To begin with, there is evidence that the cancers most common in women (breast and uterine cancers) are hormone related and constitute one set of diseases, while the cancers most common in men comprise a different set, with distinct triggers as well as different responses.
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And unlike most men with their guy friends, most women reach out to their female friends and relatives to share the emotional burden of the illness, as did Sylvie. The intimacy of these interactions is what counts most in warding off loneliness and fear.
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Sylvie La Fontaine’s sociogram
. (Image and Figure Credits
1.3
)
The other side of that coin, though, is that women’s negative social interactions have a more corrosive effect on their health. Studies show that compared to men, women experience bad relationships as more physiologically disruptive and show higher levels of urinary cortisol, among other neuroendocrine markers of distress, when things break down.
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It’s as if their intimate relationships—good or bad—take center stage. Men’s relationships, except with a spouse, are more likely to play bit parts.
In Sylvie’s case the lion’s share of the information and social support she received traveled along her network of female friends, a trend I’ll call the female effect. Reaching out to other women releases oxytocin, a neuropeptide that has both analgesic and euphoric effects. This hormone, secreted during orgasm, childbirth, breastfeeding, cuddling, and nurturing, not only offers pain relief and an immediate jolt of pleasure, it also reinforces your commitment to people in your inner circle. Oxytocin creates a feedback loop that rewards both the women who reach out to others at times of crisis and those who receive help.
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Shelley Taylor, the UCLA psychology researcher who pioneered some of the research in this area, calls this the “tend-and-befriend” phenomenon. You need not be aware of the role of biology in fueling the tend-and-befriend process: how oxytocin surges through your bloodstream, damping down pain and inflammation, making you feel good in the here and now, and ultimately increasing your
chance of survival. But, like Sylvie, most women intuitively know that other women in their circle offer valuable support, both the instrumental kind that comes with the exchange of information and the ineffable kind of emotional support that takes place when women share confidences.
THE POWER OF WEAK BONDS
Are we to believe, then, that friends are more important than family when facing a chronic illness? Sylvie’s experience reveals two important rules about the movement of crucial information through our social networks. First, it’s our weaker connections who are often most influential when we need something concrete—a new job, a new doctor, a new apartment. Such important bits of information usually come our way through people we’re only loosely connected to, a principle proved many times since Stanford sociologist Mark Granovetter first proposed his idea about “the strength of weak ties” in the early 1970s.
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The reason we’re most likely to find a great surgeon, our dream job, or Ms. or Mr. Right through a friend or a colleague’s spouse, or a spouse’s colleague is that we already share so much of what we know with our family and close friends. Our backgrounds, networks, and interests are similar, so our sources of gossip overlap. Weak ties offer bridges to novel information. Our acquaintances know things our family members and best friends don’t, and they are often connected to different cliques of people whose stock of contacts and information would never reach you if you didn’t have that person in common.
In
My Own Country
, his moving memoir of his clinical education working in Tennessee during the
AIDS
epidemic, the Stanford-based infectious disease specialist and novelist Abraham Verghese describes how he, along with other physicians trained in India, first made inroads into the American medical system by virtue of the power of weak bonds:
By the time I completed medical school in India and returned stateside, a few of my seniors from my medical school in India had begun internships at county hospitals across America. Through them and through their friends and their friends’ friends, an employment network extended across the country. With a few phone calls, I could establish for any city which hospital to apply to, which hospital to not bother with because they never took foreign graduates, and which hospital took foreign graduates for the first year, used them for scut work, but never promoted them to the second year—the infamous “pyramid” residencies. And the network invariably provided me with the name of someone to stay with.
A few pages later he describes how weak bonds can act as an invisible hand that brings far-flung people with similar backgrounds together in places as unlikely as a town in the Smoky Mountains of eastern Tennessee:
The effect of having so many foreign doctors in one area was at times comical. I had once tried to reach Dr. Patel, a cardiologist, to see a tough old lady in the ER whose heart failure was not yielding to my diuretics and cardiotonics. I called his house and his wife told me he was at “Urology Patel’s” house, and when I called there I learned he and “Pulmonary Patel” had gone to “Gastroenterology Patel’s” house. Gastroenterology Patel’s teenage daughter, a first generation Indian American, told me in a perfect Appalachian accent that she “reckoned they’re over at the Mehtas’ playing rummy,” which they were.
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If Verghese were white and from Boston instead of from Addis Ababa, his splendid achievements might seem diminished by the suggestion that he simply tapped into an old boys’ network. But he and the medical Patels had intuitively done what successful immigrants do: make the most of their weak bonds.
Whether it’s how to be a good doctor or how to find one, we’re more likely to discover redemptive solutions to concrete problems through people we see only occasionally or who are friends of friends of friends. This loosely linked network is what largely powered the roaring Silicon Valley engine in its early days, according to Granovetter, who has written extensively about how individual social networks alter business or cultural horizons on a grand scale. On a smaller scale, I realized that Sylvie’s life, as well as my own, had been transformed by our weak bonds.
For instance, I had long wanted to spend most of my time writing. It took a chance encounter with a health writer I knew only slightly to help me make the jump from working as a clinical psychologist who occasionally wrote for newspapers to working as a writer who occasionally practiced psychology.
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In this way I was like 84 percent of the several thousand Quebec government managers who found their positions through weak social connections. Even though the provincial government tried to formalize hiring practices in the late seventies, hoping to make access to a highly sought-after civil service job less a matter of who you know than what you know, the sociologist Simon Langlois discovered that almost half (42.7 percent) the employees had found their jobs through personal contacts. Interestingly, the more educated the employees, the more likely that weak social ties had led them to their jobs.
The opposite was true for Quebec’s blue-collar workers. Whereas 84 percent of professionals, managers, and administrative staff found their positions through acquaintances, only 19 percent of blue-collar workers had. It was their
strong
ties—to close friends and family members—had that made the difference, a finding that’s been replicated many times since, from the shanty towns of Mexico City to American families living in poverty. “Poor people rely more on strong ties than do others,” Granovetter writes.
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Though your needs may be great, having to depend on strong networks of close friends and immediate family means that you have less information about new opportunities. Granovetter believes that the poor’s exclusive dependency on strong bonds is why poverty can be self-perpetuating.
