A Cry Unheard - The Medical Consequences of Loneliness (Review)

A Cry Unheard: New Insights into the Medical Consequences of Loneliness by James J. Lynch. Bancroft Press. 345 pp. $26.95

Reviewed by Colman McCarthy

Tell friends that you take “fitness” seriously and it’s likely they will conclude that you exercise regularly, avoid saturated fats, LDL cholesterol and tobacco, and go easy on salt and alcohol. They’ll probably think, as you do, that the greater your fitness the greater your immunity from cardiovascular problems.

Not so fast. In addition to physical fitness, there is what James J. Lynch calls “communicative fitness.” Defined broadly, it is a state where personal relationships are loved-based and stable, conversation is plentiful, and verbal exchanges with friends, family members and co-workers are more supportive and stress-free than not. While record numbers of Americans continue to pursue physical fitness—marathons with 20,000 and 30,000 runners are common—evidence mounts that we are going the other way regarding communicative fitness.

“It is a striking fact,” writes Lynch, “that mortality rates in the United States for all causes of death, and not just heart disease, are consistently higher for divorced, single and widowed individuals of both sexes and all races. Some of the increased death rates in unmarried individuals rise as high as ten times the rates for married individuals of comparable ages….Apart from the health toll exacted by the rising tide of human loneliness, its economic costs should give us all pause. For I am convinced that if we were to attack loneliness and its attendant symptoms of social isolation, and familial and communal disintegration, with the same dedication we have applied to the elimination of the physical aspects of AIDS, cancer, and heart disease, we could cut our national health expenditures by at least 50 percent.” In 1996, health costs were 14 percent of the gross domestic product, up from five percent in 1969.

Few have examined these realities as deeply or as soundly as Lynch. He is a veteran medical researcher who taught for 30 years at the medical schools of Johns Hopkins, the University of Maryland and the University of Pennsylvania. In addition to directing the Life Care Center in Baltimore, he is on the staff of the Cardiovascular Rehabilitation Program at Lifebridge Health, Pikesville Md.

To a larger audience—the alert reading public—Lynch is known, and perhaps revered, as the author of two earlier works: “The Broken Heart: the Medical Consequences of Loneliness” (Basic Books 1977) and “The Language of the Heart: the Human Body in Dialogue” (Basic Books 1985).

That might have covered the waterfront, or at least that part which splashes into the nation’s coronary wards. But in the quarter-century between his first explorations into loneliness and this one, Lynch’s research, along with others’, has produced new evidence—medical, sociological, spiritual—that demands attention.

Both the shallow end and deep end of America’s think tanks are filled with culture critics ever bemoaning the nation’s “loss of community.” Lynch’s findings place him far apart from the master generalizers. Among the specifics he offers to support his argument that a link exists between loneliness and heart disease is a comparison of cardiovascular death rates in Nevada and Utah.

Nevada, a state with high rates of divorce, single parent households and uprooted citizens born somewhere else, ranked No. 1 for heart disease among both white males and females in two studies from the early 1960s and the mid-1990s. At the same time, it had the nation’s second highest median income level, and was average in the number of physicians and hospitals. Neighboring Utah had the lowest incidence of heart disease. With the Mormon religion a major influence in both civic and personal life, the result has been high rates of stable and long-lasting marriages, strong family bonds and enduring ties to place. Utah had the nation’s lowest rate of heart disease in 1995. It had one of the lowest per capita health care expenditures.

The mortality data gathered about Nevada and Utah in the 1960s remained unchanged through 1998. For Lynch, the Nevada way of life as first examined in the 1960s was “a foretaste of what would eventually occur across the United States. Divorce, mobility, living alone, uprootedness, and births to unmarried women—have now become acceptable middle-class norms throughout the United States.”

In places, Lynch takes his theories too far afield. In a section called “the paradox of physical fitness and communicative stress,” he mentions the many patients he has seen who have been faithful exercisers and ate soundly yet had premature coronary disease. Although James Fixx, the marathoner and author of the 1977 best-seller “The Complete Book of Running,” was not a patient, Lynch drifts into speculation about why he died at age 52 of a heart attack in 1884 while running alone on a country road in Vermont. Once an overweight smoker whose father died of heart attack at age 43, an autopsy on Fixx revealed that two of his coronary arteries had significant blockage.

Lynch thinks other factors may have been involved. Fixx was twice divorced, he was living alone in Vermont the summer of his death and had suffered the early loss of a father. For sure, Lynch stays short of ascribing those factors to Fixx’s death. But he does say that “it is not unreasonable to speculate that these problems might have had something to do” with it. Dealing in speculations--imprecise might haves and could have beens-- is risky.

I knew Jim Fixx, had run the last six miles of the 1977 New York Marathon with him, and attended his funeral at a church in Greenwich, Conn. Was he a lonely man at the end, and was that a cause of his death? Maybe yes, maybe no. I don’t know. I don’t think Lynch or anyone else knows with anything close to certainty. Speculation remains just that.

Lynch is on surer footing when analyzing events in the lives of patients he sees himself. He tells of Joe W, 70, a successful corporation executive who had had quadruple bypass surgery. During a rehabilitation session in which his blood pressure and heart rate were automatically recorded by a computer, he told Lynch of his childhood poverty. His mother was forced to go on welfare and he had to leave school in the 9th grade.

While recalling this, his blood pressure suddenly surged from 130/60 to 230/137. Lynch, the seasoned specialist, quickly grasped the medical dynamic. The pain of the remembered childhood poverty negatively affected the patient’s blood pressure, in ways that no cardiologist had previously understood. It was a communicative, not a physical, problem. Lynch writes that Joe W ‘s “early struggles had help sensitize him to the suffering of others, and that all his life he had cared deeply about others. He then mentioned that he was very concerned about what others thoughts of him—that he was, in fact, ‘way too concerned’ about that. He recalled how ironic it was that he had never told anyone, except his wife, that he lacked a high school diploma. He was just too uncomfortable and too ashamed.”

Lynch reaches the obvious conclusion: “This painful memory of personal shame seemed to be etched in [the patient’s ] heart and blood vessels, hidden from everyone’s view, only bursting into vascular reality when he tried to share that emotional pain and shame with another in dialogue.”

Much more of lasting value is in these pages. Lynch’s message is that we must move away from the language of exile and loneliness and get back to the language of communion.

If we begin to speak to each other heart to heart, regardless of whether or not we see eye to eye, the cardiovascular benefits can be large and lasting. They are only a heartbeat away.