Articles written by me on Self-care and Palliative Medicine
On Self-Care & Palliative Medicine

“What’s Love Got to Do With It?”

“To love and be loved is to feel the sun from both sides.” David Viscott

Valentine’s Day is here again. . . stimulating thoughts of love. Love of family, love of friends, romantic love. . .the forms of love vary widely. . .but the effects on psyche and overall health are remarkably consistent. In pondering this week’s titular question which has become a hallmark song for Tina Turner, we understand that LOVE and relationships have a great deal to do with our health. This week’s Insight addresses this reality.

In 1996, ABC producers conducted a large scale, cross sectional survey of the American public to see what factors people felt were most important in generating happiness. The results were aired in an hour long special in April of that year. Close relationships topped the list by a large margin–followed in order by control over one’s life,challenging and fulfilling work, a sense of optimism, faith in God, anda sense of purpose. Interestingly, money wasn’t in the top 6 except in cases of poverty or extreme financial hardship. Dorothy Parker had an amusing observation on the value of money, quipping “If you want to know what God thinks of money, just look at the people he gave it to.” Clearly, we value relationships, and we understand their importance in our happiness.

So, what’s this “second hand emotion. . .(this) sweet old-fashioned notion” got to do with health? Thanks to large-scale studies, the evidence demonstrating a link between social support and physical well-being has grown in recent years. Research shows that having a good number of close social relationships is associated with a lower risk of dying at any given age. The least socially connected individuals in a nine year California-based study were twice as likely to die as those with the strongest social ties, even when health habits such as smoking, alcohol use, obesity, and use of preventive health services were taken into account. Similar studies in Georgia, Michigan, Sweden and Finland have corroborated these findings. Consistently, people with excellent social support systems seem to outlive hermits and recluses twofold.

In the Velveteen Rabbit, a young, furry toy rabbit is educated on what it means to be loved, to be REAL by the veteran well-loved toy Skin Horse. “Real isn’t how you are made. . .it’s a thing that happens to you. When a child loves you for a long, long time. . .then you become REAL. . .It doesn’t happen all at once. You become. It takes a long time. That’s why it doesn’t often happen to people who break easily, or have sharp edges, or who have to be carefully kept. Generally, by the time you are Real, most of your hair has been loved off, and your eyes drop out and you get loose in the joints and very shabby, But these things don’t matter at all, because once you are Real you can’t be ugly, except to people who don’t understand.”

We accept the vulnerability in intimate love relationships because in doing so, we allow ourselves to be known, to be nurtured by another. In our wonderfully fragile hearts we have the capacity for great joy and great sorrow. To share with another is a kind of therapy. . .and this therapy increases our longevity. We love from a sense of who we are. . .what feels comfortable. . .what is “right.” Disappointment and disillusionment can occur as we open ourselves to the honesty of intimacy. But, the rewards of sharing your heart with someone far outweigh the educational ‘hurts’ along the way. We search for soulmates, struggle to be good parents, and are occasionally disappointed by friends. Some efforts to find love and meaningful relationships are unsuccessful, but they nevertheless connect us to the emotional energy of other human beings; and we grow from the experiences of connecting. Friedrich Nietzsche even went so far as to say, “Love your enemies because they bring out the best in you.”

Additionally, some studies have examined the benefit of caring relationships specifically to sick individuals. Cancer patients can survive up to twice as long when they are optimally connected socially. Interestingly, in one study, the strongest link between social support and cancer was for smoking-related cancers in men, and hormone-related cancers (e.g. breast cancer) in women.

So, why does social support make such a difference? Obviously, social support aids us emotionally by making us feel less isolated and less frightened as we deal with illness. When we know someone loves us, this knowledge influences our behavior to take better care of ourselves. . . because we know we’re important to someone else. We tend to avoid bad habits and to maintain good ones (to “take care of ourselves”) when friends and partners, and children tell us they are fearful because we smoke, or eat too much, or drink too much alcohol. Feeling supported by family and friends causes a decrease in our production of stress-induced hormones that trigger such harmful effects as elevated heart rate and blood pressure, suppression of our immune systems (making us more susceptible to illnesses of all kinds), and depression. Our general sense of security is enhanced by fellowship and friendship with other human beings. Case-control studies of people in cancer support groups have demonstrated significant increases in survival–presumably because of the power of support from caring people on our bodies as a whole. And, our sense of being loved doesn’t have to come just from other humans! Multiple studies prove that Pets (in self-proclaimed ‘pet lovers’) soothe owners’ reactions to stress and actually increase longevity as well. So snuggle up to fuzzy Fido, or lumbering Spencer, or sleek Juanita more often!

In the big picture, one must never dismiss the importance of self-love. If intimacies have soured, if divorce or separation (including death) have isolated you from nurturing relationships, remember to celebrate your self-worth in self-love. Though sharing with other human beings enhances the joy in life, be aware of your own lovable qualities and your individual contribution to the world. Derek Walcott expresses these sentiments eloquently:

Love after LoveThe time will come
when, with elation,
you will greet yourself arriving
at your own door, in your own mirror,
and each will smile at the other’s welcome,

and say, sit here. Eat.
You will love again the stranger who was your self.
Give wine. Give bread. Give back your heart
to itself, to the stranger who has loved you

all your life, whom you ignored
for another, who knows you by heart.
Take down the love letters from the bookshelf,

the photographs, the desperate notes,
peel your own image from the mirror.
Sit. Feast on your life.

My patients, my family, and my friends, Happy Valentine’s Day to you! May you be surrounded by love and all its healthful benefits during the coming year. And, above all, I hope that you can love yourselves for the unique gifts you bring to the world.

Stephen L. Hines, M.D.
February 2001

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