by Wayne Jonas
“Doctor Jonas,” the head nurse said to me one morning, “I think you might want to talk to Mabel’s family—especially Jason, her grandson. He and the pastor think she wants to die.”
Jason, as it turned out, had gone to college and earned a degree in psychology. “My love child,” Mabel had once told me about him. “He just sits and listen to me and gives me no grief. Always was that way.”
I scheduled a meeting with Jason and the pastor. Indeed, they confirmed that ever since I had prescribed the home nurse and the family came in to care for her, she had complained about being a “burden” and “useless” to her family. “I’m better for you-all dead,” she would sometimes blurt out. The family members tried to counter that attitude, imploring her not to say that and insisting that she was still loved. That seemed to make things worse. Jason told me that ever since this hospitalization, she had confessed to him that she was trying to decide whether she should go back home or die right then and there. As family members came and went, she would feel better for a while, but then fall back into her “I’m a burden” attitude. Back and forth this went. I suggested she was depressed, and I prescribed a mood-elevating drug, but it would not become effective for several weeks. Besides, that would not address the core issue that she was struggling with now—the meaning of her life with advanced CHF.
Then the pastor made a suggestion. If we could get the family to agree not to try and “take care of” Mabel on their visits, but to seek out learnings and wisdom from her—let her take care of them—maybe that would help Mabel feel useful again. Jason agreed. Although he had suggested to individual family members that they not counter Mabel’s comments, they had never discussed a coordinated plan for how to receive her love and wisdom. If the doctor and the pastor recommended and helped organize such a plan, he was sure that most of the family would go along.
So, working with the family, we set up a plan to let Mabel love again. Jason and the pastor gathered most of the family together, and they agreed when visiting Mabel to ask her questions related to struggles they were having in life and to seek her wisdom. The basic question they would seek from her was—“What has love got to do with it?”—a question they knew she could answer. The gathering was arranged. I had to transfer the other patient in her room out just to fit in all the family and friends who came—more than thirty in all. The pastor said a prayer, and then the family asked her if she would do this.
“Well,” she said between labored breaths, tears in her eyes, “I guess I can try that for a while.” The pastor, to my surprise, suggested they sing the old African American spiritual “Ain’t Got Time to Die.” They all knew the words.
Within three days, Mabel’s numbers stabilized—basically back to where they were on the medical regimen I had put her on when she was first admitted to the hospital. She went home with oxygen and hospice. She lived six more months, and she died with her family around her at home. She never entered the hospital again. She had found her healing power through to the end.
THE SCIENCE OF LOVE AND LOSS
From the time we are born to the time we die, life is punctuated by loves—people, places, pets, and passions—that we get deeply attached to. Life is also punctuated by the loss of those same people and passions. Our mind and body are constantly alert to find such loves and on guard against their losses. We instinctively seek the former and avoid the latter. Survival may sometimes depend on it. Yet the world is both ugly and beautiful, inflicting on us trauma and cruelty, and also inducing in us healing and compassion—sometimes all at the same time. How do we find peace in the face of pain and grief? How can we feel whole when we are broken and battered? Why do we try so hard to avoid pain, suffering, and death, even at the risk of not fully living?
It is not an easy task to face suffering, and almost impossible if we are alone. When illness and injury come, when our life is threatened by disease, and our body and soul buried in pain or sadness, it is the presence of a caring person that can often carry us through that suffering into healing. Facing loss is especially difficult if our early experiences with others were not caring, if our first ventures into love were met with rejection or loss or, worse, with anger or violence. If experiences in our childhood involved too much pain or trauma, we may be too afraid to open to the love of others, even when it is offered. Yet it is by sharing our suffering with others—and by its presence as we explore our fears—that healing and wholeness come, because some of the most meaningful experiences humans can have is when we are cared for and care for others. We are social beings; we are not whole without love.
Sociologist Dr. Ian Coulter, chair of integrative health research at the RAND Corporation and a professor at UCLA, described the scientific aspect of this to me in detail. Sociologists define a person as an individual embedded into a social network of mental, physical, and personal interactions. That network not only defines us as a person but also influences what happens to us on all levels of our being—including in our body.
Harvard physician and social scientist Professor Nicholas Christakis and his colleague James Fowler summarized many of these influences in their book Connected: The Surprising Power of Our Social Networks and How They Shape our Lives. They say, “As we studied social networks more deeply, we began to think of them as a kind of human superorganism. They grow and evolve. All sorts of things flow and move within them….Seeing ourselves as part of a superorganism allows us to understand our actions, choices, and experiences in a new light.” I agree. Who you are connected to—not only your family, but even your “friends’ friends’ friends”—impacts large swaths of your health and happiness, whether you know it or not. Everything from obesity to smoking to infection to alcohol use and depression are mitigated and influenced by your social network—often in ways you cannot see. Not only does this help us understand and explain how we change along with others, but it also applies to individual healing. If we look at a person as if he has a literal social and emotional body—and treat any injury to this body with the same importance as we treat a cancer or heart attack—we can unleash that aspect of our healing potential. When we do that, this social and emotional dimension of healing provides us with powerful tools for resilience, recovery, and repair.
Extensive evidence shows that social support protects us from disease and death and enhances recovery from illness. In studies with subjects who had similar conditions, strong ties to family and friends reduced the risk of dying by 50% compared to those who were alone. Isolation and loneliness are strong contributors to chronic diseases—both mental and physical—and work primarily through the body’s stress and fear responses, inducing inflammation in the walls of blood vessels and in the brain and impairing the immune response. Dr. John Cacioppo, professor of cardiology at the University of Chicago, summarizes much of this research in his book Loneliness: Human Nature and the Need for Social Connection. Lonely people have a 45% increased risk of dying from all causes and a 64% increased chance of dementia in later life. The magnitude of increased health risks for people who are socially and emotionally disconnected from others and the comparative protection for people who are well connected are comparable to well-established risk factors such as smoking, obesity, injury, substance abuse, and environmental quality. Here’s a specific example: Two studies compared men who had experienced heart attacks. The men who reported being in loving relationships had lower death rates than the men who were not in such relationships. The increased odds of dying after that for those not in loving relationships was as great as if they smoked a pack of cigarettes a day. Research has also shown a significant relationship between a patient’s recovery after a heart attack and the extent of the spouse’s social support, family stress, marital satisfaction, and sexual comfort. Other studies have found that patients are statistically less likely to die after a serious illness if a nurse simply calls them weekly to check on how they are doing. Several researchers have tested the mental, physical, clinical, and economic impact of making even short
but deep emotional connections. Like the rabbits in the study mentioned earlier, connecting to someone who cares for you—even a little—reduces the odds of illness and premature death and helps you heal.
Loneliness is not the same as simply being alone, which for many can be a welcome and enjoyable state. Loneliness refers to the quality and depth of relationships—or lack thereof. It is not about the number of connections, either; rather, it is about how deep those connections are and how happy they make us. When people feel love and safety with others, their stress reactions in the brain and body are diminished and reparative functions improve. Professor Cacioppo points out that in the absence of social safety, stress hormones surge, triggering the release of cardiovascular and inflammatory chemicals and activating genes that lead to damage to mind and body. Socially disconnected people are more prone to arterial stiffening, leading to increased blood pressure—a risk factor for heart disease and stroke. Their bodies are also less efficient at repair and maintenance functions: their wounds heal more slowly, and their sleep—a vital restorative function—is less effective. Connections associated with love and safety increase heart rate variability—a moment-to-moment marker of relaxation and health risk. Increased heart rate variability—that is, a rate that quickens and slows with the cycles of inhalation and exhalation—correlates with resilience, good health, and increased lifespan. Heart rate variability can be tracked minute by minute, making it a good marker of the quality of one’s relaxation state, emotional connection, and physical health. Mabel’s heart rate variability decreased as her CHF progressed. When she felt love, however, it improved. I smiled as I thought of the science behind social and emotional connection. I could just imagine Mabel saying, “What did I tell you? Love heals with every heartbeat!” It does.
A HEALING PRESENCE
The first time my wife, Susan, went through chemotherapy, she did it largely alone. I was so busy with my job in the military that I often could not be present for her. Like many doctors, I hated feeling helpless, so I was compelled to take action, even when there was no good evidence that any action would help. I didn’t know how to feel comfortable just being with Susan. It felt like I lost my power and control. So I worked. She found a supportive network to help her through, seeking strength in her spiritual life and the need to care for our young children. She did well.
When she started chemotherapy for cancer the second time around, I told her that this time I would be there—that we were in this together. She believed me and appreciated it, but realized how difficult it would be for me. She also knew that my periodic presence was not enough support for what she was about to go through. After all, she pointed out, I was running a large research organization, had to continue doing my job for our income, and had many demands on my time. Because of that, Susan reached out and gathered helpers around her: our daughters, our son and daughter-in-law, my sister, her sister, her mother, her sisters-in-law, other family members, and friends. Her goal was to take care of herself and help take care of our new grandchild. I didn’t realize that she needed more than psychological support from me; she needed my physical presence—with my emotional body.
I should have known this. I had done research showing that the physical presence of a loving person does more than provide psychological support. The physical presence of another person has a direct impact on a person’s body and mind. For example, the electromagnetic waves from the beating heart of one person can be detected in the brain of a person standing next to them. The beat of your heart is picked up and produces a sort of reflection in another person’s brain. This might partly explain why when you are near a very calm person, you also start to feel calmer. That calming feeling also increases heart rate variability and the activity of the parasympathetic (relaxation response) part of the nervous system and stimulates the vagus nerve. Increased activity in the vagus nerve creates a biochemical and physiological cascade of effects that reduce inflammation and increase resilience to stress at the organ, cellular, and genetic level. Thus a person’s physical presence—without her doing anything at all—can influence another person’s brain and their other organs, immune system, cells, and genes, as well as bring a feeling of peace. This is probably the underlying reason that some people are said to have a “healing presence.” People are probably picking up on the physical emanations from the person’s relaxed and calm heart.
There are additional ways in which physical presence influences healing. We know, for example, that electromagnetic waves in the form of heat and infrared radiation emanate from the body, especially the hands. Through meditation, biofeedback, and breathing techniques, people can increase or decrease the amount of this heat and infrared radiation. Infrared radiation, especially in the frequencies of 400 to 800 nanometers, is absorbed by a chemical in our cells called cytochrome c. Stimulation of cytochrome c increases the amount of adenosine triphosphate (ATP)—the energy-producing molecule found in all cells. In dozens of experiments done at Walter Reed Army Institute of Research, investigators found that individuals who put their hands around test tubes containing immune cells while meditating increased the amount of infrared radiation emanating from their hands, which stimulated the immune cells to produce more ATP and energy. After this exposure those cells were more resilient—that is, they survived better when hit with stresses such as heat and chemical shocks. Remarkably, the kind of meditation and visualization that was the most effective for increasing the amount of ATP and resilience of these cells looked like love. Cultivating a feeling of love—such as gratitude, affection, and appreciation—produced the greatest effect. Mental activity such as counting backward or thinking about the weather did not increase ATP or improve cellular resilience.
I knew all this research—had even done some of it—but for some reason I didn’t think it was relevant for helping Susan heal. Scientists (including me) are generally skeptical of any research purporting to objectively measure and explain emotional and social interaction or the energy it creates. The area is considered too intangible and subjective to be reliable, so it is dismissed without looking at whether the research is rigorous or relevant. My skeptical doctor side had also dismissed it as an interesting laboratory findings but not relevant for patient care. I wanted something more doable—a medication, supplement, or behavior. I wasn’t going to simply wave my hands over her head or take naps with her. What good would that do, I thought? So even as Susan began to lose energy and feel poorly from the chemo infusions, week after week, I didn’t think my presence could really make a difference in how she did.
Then one week, I went away on a boating trip through the Grand Canyon with our daughter. We were off the grid for a while, and I was not with Susan for more than a week. When we got back within cell phone range, I received a call from her. While I was away, her white counts had dropped precipitously and she had developed a fever. The oncologist had given her a shot to boost her white blood counts and put her on antibiotics. If it persisted, she would be hospitalized and isolated.
I came home, fearful that this drop in white blood count was likely to recur the following week, because the effects of chemotherapy tend to be cumulative. But something about just being together started to make her feel better. Then I remembered the research at Walter Reed. Still skeptical, I decided to try a little of this laying on of hands—this healing presence process—myself. I recalled from the research that the technique that affected the immune cells most powerfully involved breathing, imagining a soft white light filled with love being transmitted through the top of my head, down through my arms and hands, and out into her body. After a few minutes of trying this, I could feel warmth coming into my hands from increased blood flow and heat. Susan also said that she could feel something—and then she fell asleep. The session lasted about fifteen minutes.
The next day, her energy was much improved—she was up early and out pulling weeds in the garden, something she had not done for months. Was it from more ATP, I wondered? At her next chemotherapy
session two days later, her white blood count had recovered practically back to normal—so she did not need the immune-boosting shot. Were her white blood cells more resistant to the chemo? She was clearly less fatigued, slept less, and was more active during the day. I was stunned. Had the simple physical presence of another loving person produced this response? I decided not to go on any more trips for a while. From then on, my job was to just make sure my body—in all its physical, social, and emotional dimensions—was around.
OPENING UP
Although little research has been done on the therapeutic effect of the physical presence of another person, there is extensive research on the impact of making emotional connections. When our encounter with another person results in connecting to our emotional self—especially to a part we have avoided dealing with because of fear or grief—the healing can be profound. In his book Opening Up, social psychologist Dr. James Pennebaker summarizes much of this research. A single sharing of a deep trauma or loss with another can improve health. Some of the most remarkable studies in this area are with Holocaust survivors. Even decades after the war, most Holocaust survivors have never discussed their experiences in concentration camps or the trauma, fear, and losses they endured. In the research, these survivors were asked to write or speak about those experiences to another person who simply listened in a safe and confidential environment. The investigators then measured the impact of this sharing on the survivors’ biology (inflammatory response or blood pressure, for example) and health. Compared to those who wrote or spoke about something superficial—the weather or what they had to eat that day—this single deep sharing resulted in significant health improvements. The improvements were wide ranging and lasting—better immune function, less pain, improved mood, and less need for medical care, even a year later.