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Jacqueline Olds - A Cry Unheard: New Insights into the Medical Consequences of Loneliness (review) - Perspectives in Biology and Medicine 45:3 Perspectives in Biology and Medicine 45.3 (2002) 460-463

Book Review

A Cry Unheard:
New Insights into the Medical Consequences of Loneliness

A Cry Unheard: New Insights into the Medical Consequences of Loneliness. By James J. Lynch. Baltimore, MD: Bancroft Press, 2000. Pp. 345. $26.95.

James Lynch is a psychologist and scientist on a mission: he wants to make sure that in our obsession with medical data such as cholesterol level, blood pressure and heart rate, we don't "miss the forest for the trees." He intends that we understand the crucial and possibly causal role that social isolation, sadness, and shame play in people who show signs of early cardiac disease. He describes his theories and findings in a fascinating new book titled A Cry Unheard: The Medical Consequences of Loneliness. This is a 25-year follow-up book, bringing [End Page 460] together data further affirming the theory and data in Lynch's first work, The Broken Heart (1977). In the 1977 book, Lynch proved to be a pioneer in recognizing the link between loneliness, recent bereavement, and heart attacks. Even after his first book was published with its compelling findings, the medical literature of early cardiac disease continued to ignore the findings about the dangers of social isolation. Instead, study after study was done looking at the details of cardiac risk factors without attending to marital status or social isolation as key risk factors. Now that Lynch has written a second book—and much more data has accumulated proving that he was correct back in 1977—we must ask ourselves why we as a society are so resistant to admitting that loneliness could be a serious medical problem.

I think our resistance to acknowledging the dangers of loneliness has deep cultural roots. The United States is a country of "tie breakers" who left the old country to achieve liberty and economic freedom. Our constitution's emphasis on freedom has slid into an emphasis on self-sufficiency and individualism with some disdain for the mutual dependency of the Old World. When we find that we have had an overdose of self-sufficiency causing loneliness, most Americans are embarrassed to admit it, feeling they are losers almost to the point of being un-American.

And this brings us to another of Lynch's surprising revelations in his new book. He gives us compelling information indicating that early school failure, with its concomitant shame, correlates with early cardiac death. This, Lynch feels, is because people with early school failure (flunking, being held back, or dropping out before graduating high school) are more anxious and uncomfortable with dialogue (in fact, it causes larger increases in their blood pressure when they speak than for the rest of us), so they isolate themselves socially and have heart disease earlier. Lynch's theory explaining these people's early school failure is that many have experienced what he calls "toxic talk" from their parents in their preschool years, leaving them nervous and pessimistic about the usefulness or pleasure of dialogue. Thus, he thinks they are less likely to do well in school settings, where the ability to be verbal is essential. He also thinks that many of these people go on to become blue-collar workers, and that these workers are, in fact, the real Type A personalities to whom we should give early cardiac preventive medical care, rather than targeting the business executives who are less likely to have early cardiac disease. All of these theories are propounded in clear prose with proper discussion of the counter-arguments.

Lynch rarely comes across as a dogmatic polemicist, although he is very passionate about his theories. One of the author's professors in graduate school, W. Horsley Gantt, helped shape his interest in cardiology and the behavioral interactions around blood pressure and heart rate back in 1962. Gantt showed that petting a laboratory dog could cause immediate reductions in the dog's blood pressure and heart rate of 50 percent. Gantt also found that dogs who were artificially stressed through painful electric shocks would usually double [End Page 461] their heart rates, but that this increase in heart rate could turn into a decrease in heart rate from the base line if the dog was petted during the painful shocks. Another researcher, Dr. Aaron Katcher, found that children stressed in the dentist's office had similar increases in heart rate and blood pressure when they moved around and struggled, but there was another group of children who neither moved around nor had increases in blood pressure and heart rate. Gantt noticed that adults lose the tendency to wiggle and move around when stressed, but adults still may have huge changes in their blood pressure and heart rate in relations to stress. He coined the term "schizokinesis" for the split between internal stress reactions reflected in changes in blood pressure and heart rate, and the lack of external signs of discomfort. He also found that people having these large changes in their autonomic functioning had little clue that these were taking place. But both Gantt and Lynch felt these changes in blood pressure and heart rate made people feel uncomfortable in a deeper sense (like experiencing an attenuated fight/flight response), and thus people who have major blood pressure increases during dialogue try to avoid it when possible leading to socially isolated lives.

Lynch's discovery of some people's internal discomfort with dialogue was not observed through external signs, but rather by using a machine that non-invasively measured blood pressure continuously through therapy sessions. This group of people whose blood pressure increased considerably during dialogue didn't show discomfort or admit feeling it, but they tended to talk more quickly and breathlessly while their blood pressure increased. In various experiments, Lynch was able to help them decrease their blood pressure while talking by counseling them to talk more slowly and helping them remember to take breaths. Lynch speculates that these blood pressure increases are the equivalent of blushing or a baby's crying—something which is a reflex not under the person's conscious control but symptomatic of the stress. He feels that occasionally therapists miss these signs of stress (not surprising, since they're almost invisible) and may even overload the patient with stress by trying to uncover too much too fast. He thinks that if therapists titrate the dialogue, so that patients can move slowly at their own pace without being overwhelmed with emotion, they are less likely to actually do the patient harm.

A Cry Unheard left me with some pressing questions that I hope Lynch will treat in his next book. First, what about people with a "shy" temperament in the Jerome Kagan sense, whose blood pressure increases during dialogue, but not because they experienced "toxic talk" early in life? Lynch made me curious about how temperamental factors in general fit in with his theories. Second, does the group of patients Lynch has noticed whose blood pressure rises precipitously during dialogue fall into the category of "office or white coat" hypertension, used in medical circles to describe patients whose blood pressure is higher when talking to their doctors? I wondered whether shame in general had the effect Lynch found in his group of patients who had early [End Page 462] school failure—that is, would each person have as a marker for topics that make them ashamed, major increases in blood pressure during discussion. Finally, I would have wanted a few more details about the Ramsay "blue machine" which non-invasively measured blood pressure during therapy and made many of Lynch's findings possible.

In general, though, Lynch has written an intriguing and provocative book. He feels that early hypertension and heart disease is by-and-large a communicative disease in people who have a variant of the fight/flight response when they converse. He hypothesizes that this puts extra strain on the heart, and that these people often feel lonely and anxious and start to avoid others because of their extreme internal autonomic responses. He speculates that this communicative disease (as he calls it) will become as important as the communicable diseases in this century. Clearly this is a radical approach to early cardiac disease and one that we cannot afford to continue to ignore.


Jacqueline Olds
Harvard Medical School

Permission to reprint a book review printed in this section may be obtained only from the reviewer.

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