need something done in critical thinking and reading 115
Reborn909
readingportfolio-WELL-pages.docx“Hell,” wrote Jean-Paul Sartre, “is other people.” The line comes from the play No Exit, a drama about the afterlife of three damned souls as they begin their punishments in the underworld.1 Expecting to face torture for their earthly transgressions, the characters are surprised to find that hell is merely a small room that they must share for eternity. This fate proves more than sufficient as the play unfolds, as the three characters are unable, or unwilling, to provide each other with the mutual support that could help them transcend their situation. The relationships among the characters turn increasingly toxic until they realize, at last, that they are doomed to make each other miserable forever.
Sartre’s play captures a key truth: humans are fundamentally social, and our social networks—our often-overlapping groups of friends, family, colleagues, and acquaintances—shape our well-being in profound ways.2No Exit takes a pessimistic view of this influence, but it is equally true that our relationships can provide the pleasure, satisfaction, and joy that give life meaning and foster health. Where human relationships are nurturing, cooperative, and centered around healthy behaviors, they can be a bulwark against disease. Where they are destructive, or encourage harmful behavior, they can lock us into a cycle of poor health, just as Sartre’s characters are locked in their room, sabotaging each other’s chances to improve their collective condition. What I take most from Sartre’s play is that human existence is inevitably shaped by others, and this extends to all aspects of our life, including our health.
No Exit also captures our shared circumstances as human beings. While we may like to think of ourselves as islands, our biological evolution does not support a life without social networks; in other words, loneliness poses challenges for health.3 We cannot escape the fact that our well-being will never be a matter of pure self-sufficiency; it is deeply dependent on our interactions with the people around us, the people with whom we share a “room”—our world. To make sure that our world is healthier than the one in Sartre’s play, it’s essential to talk about people and our place among them.
Human interactions shape health at each stage of life. The first bonds we form are typically with family members who influence our health by taking care of our immediate needs and by modeling the behaviors and values we will carry with us into the world. The next phase of social development is outside our immediate family, cultivating relationships at school, work, and elsewhere. As with family relationships, these friendships influence our values and behavior. If friends engage in risky activities like smoking and drinking, it increases the likelihood that we will do the same. If friends model healthy habits, we are likelier to make these behaviors our own, too. As life progresses, one may choose to have children or to live with a significant other. This represents a further level of social integration, as we become more deeply invested in the networks we have formed over the years. All these stages of social development have a cumulative effect on our health, creating a network of love and friendship that, if properly nurtured, can enrich our lives from youth through old age.4 Social networks can also improve our odds of reaching old age: the more integrated we are into our web of friends, family, and acquaintances, the longer and healthier our lives tend to be.5
Who we interact with can also influence the pattern of health and disease among our social networks. This influence is most obvious and simplistic when we talk about contagious diseases. If the people around us are vulnerable to disease—if they are unvaccinated, for example—it increases our own chance of becoming sick. This is so basic that it is easy to overlook—another example of the “water in the goldfish bowl” that we do not notice. Vaccines are a wildly effective tool for mitigating these diseases, but, even then, the effectiveness of vaccines depends on the choices made by the people around us: the more people who choose to be vaccinated, the stronger our collective defense will be; this is known as herd immunity.6 But when the people around us reject vaccination, it undermines herd immunity, and our health can suffer. For example, in the years since measles was declared eliminated from the United States in 2000, a high percentage of measles cases have occurred among intentionally unvaccinated people.7
Disease can also spread through our observation and behavior. A 2007 study demonstrated how interactions with other people can be a conduit for spreading behaviors and lifestyles, which in the case of the study was manifested in obesity.8,9 The scientists evaluated more than 12,000 people over the course of 32 years and found that an individual is 57% likelier to become obese if someone she considers a friend is obese. This link was strengthened if the friendship was considered mutual, in which case an individual’s obesity risk rose by 171%. Strikingly, physical distance does not seem to affect the relationship between our friends’ weight and our own: the link was found to persist even between friends who were many miles away from each other. This phenomenon is known as social contagion,10 which the Oxford Dictionary of Psychology defines as “The spread of ideas, attitudes, or behavior patterns in a group through imitation and conformity.”11 It stems from our tendency to learn by observing and mimicking other people’s behavior.12 Other areas where social contagion may play a role include the spread of smoking, depression, and sleep loss.13–15
Social contagion is still a fairly new area of study, but emerging research suggests that it has a profound influence on human health. One study looked at military service members who had been deployed to bases around the United States and found that families of service members deployed in counties with higher obesity rates were likelier to become obese.16 The risk of obesity was even higher among families who lived longer in a particular location and resided off-base. This study suggests that patterns of health do not just spread through infection; they can also spread through imitation, via our social networks.
While social relationships can aid the spread of bad habits and disease, the lack of relationships can be even worse. We need only look at what happens when individuals are denied access to social networks to see how dependent humans are on the company of others for health, happiness, and survival. Consider the example of long-term solitary confinement, a punishment still in use in U.S. prisons.17 This practice, in which prisoners are isolated from the prison’s general population, can lead to depression, paranoia, hallucinations, and increased suicide risk. But isolation doesn’t have to be this extreme in order to undermine well-being; simply being lonely can harm health, too. The mortality risk posed by loneliness is statistically comparable to the hazard posed by drinking and smoking and is greater than the health hazard of obesity.18,19 In other words, loneliness is a public health issue. In 2018, the English Prime Minister Theresa May acknowledged the scale of this problem by appointing a Minister of Loneliness to help the country tackle the issue of widespread social isolation.20
Long before the United Kingdom chose to address loneliness through the creation of a government office, The Beatles released a song, “Eleanor Rigby,” that captured the essence of social isolation—and hinted at its risks.21 The song’s central character, the lonely Eleanor Rigby, is picking up rice in an empty church where a wedding has just taken place. The church is overseen by the equally lonely Father McKenzie, whose job includes writing the words “of a sermon that no one will hear.” Both characters inhabit a world that feels indifferent to their isolation. Eventually, Eleanor Rigby dies, and her funeral is tended to Father McKenzie, with no one else in attendance. At the end of the song, Paul McCartney wonders where all the lonely people come from.
The answer to McCartney’s question lies with the conditions in society that enforce isolation and disrupt social networks, conditions that include stigma, age, disability, and economic disadvantage. The ongoing U.S. opioid epidemic has shown how stigma can alienate people from one other, isolating those most in need of human connection and exacerbating an arduous affliction. Addiction is a chronic disease that society treats as a crime.22 We marginalize people with addiction, making it harder for them to reach out to others for assistance. Stigma of similar pervasiveness has contributed to the loneliness faced by individuals in other populations, including LGBT, immigrants, and anyone denied inclusion in their communities.23
It is important to note, too, the self-reinforcing stigma of loneliness itself.24 Because society, particularly American society, places such emphasis on the capacity of the individual to overcome any adversity, it is easy to feel as if acknowledging loneliness is a kind of weakness, a sign that we are somehow not up to the job of navigating modern life. The irony, of course, is that if more people spoke about their loneliness, we could see how common it truly is, reduce the stigma around discussing it, and improve health for all.
Loneliness can also be a product of age and disability, conditions that exacerbate isolation and prevent individuals from engaging with the full life of a community.25 The problem of loneliness among older people is pervasive: 42.6 million older U.S. adults are estimated to suffer from chronic loneliness.26 Given that a huge swath of the world’s population is about to enter old age, this problem will only get worse if we do not pay attention to it. Already, in countries like Japan, where an aging population has grown ahead of that population in the United States, the country faces the challenge of millions of lonely elderly who experience the health consequences of their loneliness.27 But loneliness is not just a product of age and disability; it can also make these conditions worse. Lonely adults are likelier to experience mobility declines, difficulty with upper extremities tasks, and difficulty climbing.28 High levels of loneliness have also been linked with greater risk of physical frailty.29
Economic disadvantage is a common source of isolation, confining people to low-income areas and excluding them from the schools, clubs, recreational activities, and jobs enjoyed by people with greater financial resources.30 This isolation is driven by the globalization that has left many communities behind in the U.S. industrial heartland, even as the other parts of the country reap the benefits of these trends. The people who live in these economically disadvantaged regions face epidemics of addiction, depression, and suicide; these are called “deaths of despair,” and they reflect their deepening isolation.31,32
In cities, economic disadvantage and the isolation that comes with it is frequently tied with race and residential segregation. In the 1930s, the federally funded Home Owners’ Loan Corporation encouraged banks and insurers to approve or deny home loans based on racial criteria, keeping black residents in one part of a city and whites in another.33,34 Over the years, government agencies also used the construction of public housing units and major roadways to segregate cities, further isolating black communities.35 As is consistent with U.S. history, this separation was far from equal. Blacks were placed in poor neighborhoods, while whites were housed in more desirable areas, their surroundings less noisy, less polluted, and more conducive to health than the sections designated for people of color. The legacy of this segregation persists. Not only are black Americans likelier to live in economically disadvantaged areas, but even affluent black families are likelier to live in poorer communities.36 In the United States, 37% of black families earning $100,000 or more per year live in poor areas, compared to just 9% of white families.37 This combination of place, race, and economic vulnerability fuels isolation, excluding many black Americans from the full range of privileges enjoyed by their white counterparts.
All these factors compound contemporary isolation in an era when cultural and technological currents have made it all too easy to slip into loneliness. In many ways it has never been easier to imagine that we can exist without face-to-face human interaction: digital devices let us consume vast quantities of entertainment whenever and wherever we want, social media is reshaping our communications, and powerful drugs appear to offer an escape hatch from life’s challenges—though, as the opioid crisis makes painfully clear, this seeming escape hatch is actually a deadly trap door.38 These conditions have the potential to keep individuals more isolated and unhealthy and prevent them from seeing the conditions that underlie their loneliness. It’s the core tragedy of “Eleanor Rigby”—not that its two characters are lonely, but that they are lonely so near one another without ever connecting. Vexingly, and like Sartre’s characters in No Exit, Eleanor and Father McKenzie have the potential to provide each other with the compassion and support that could dramatically improve their circumstances. But, for whatever reason, they do not. It reflects the challenge of building healthy social networks in the twenty-first century. Our technology keeps us intimately linked while also pulling us apart. Like Eleanor and Father McKenzie, we are alone, together.
As much as we may like to think otherwise, we are not islands. And until we address the conditions that undermine our social networks, health will remain poor. To build this world, we must invest in common spaces where communities can come together and strengthen social ties—from public schools, to community centers, to safe injection facilities where people with addiction can go without fear of stigma. It also means making cultural, religious, and civic institutions as inclusive as possible. Consider the social and health victories that have followed the U.S. Supreme Court ruling in favor of same-sex marriage: it struck a blow against isolation, allowing gay Americans to access the social stability, legal protections, and health benefits that come with marriage.
Finally, we must acknowledge, out loud, the widespread existence of loneliness and its effects on health, helping to destigmatize this very common condition. It means creating structures that support people at times in their life when they are likeliest to be lonely, and it means creating communities that are more inclusive of older adults and people with disabilities. Home visits, mentoring partnerships, and exercise programs can all help to keep older adults socially integrated. Providing physical accommodations and the universal health coverage necessary to meet the needs of the disabled can go far toward ensuring that they can remain engaged members of society.
At the end of the day, talking about health means talking about people—and making sure that people are talking to each other. Human contact within social networks can be an incubator for social movements; social movements can build a healthier world. For example, the HIV/AIDS movement, which has saved countless lives by advancing better ways of preventing and treating the disease, emerged from the networks of marginalized, largely LGBT people who, at the start of the epidemic, had few people willing to advocate for them in the broader society. By banding together and finding allies in the United States and around the world, these activists managed to overcome the loneliness imposed by stigma and disease and make remarkable progress against HIV/AIDS in just a few decades. Similar community-based movements have made progress in gender equity, environmental justice, and civil rights.
