Friends Are Medicine

"Tension is who we think we are. Relaxed is who we really are.” Lao Tsu

In 2015, the U.S. Surgeon General issued a health alert stating that being socially isolated carried the same health risks as smoking up to 15 cigarettes a day. The warning was issued after several years of research confirmed that having at least one close, supportive relationship was related to significantly lower levels of stress. Decades of research on the link between social connections and health conducted by Dr. Julianne Holt-Lunstand consistently showed that people who had at least one intimate relationship tended to live longer and being socially isolated placed more stress on the body than smoking, poor diet, or a lack of exercise. Although the link between social connections and health has always been recognized as important, its impact on our health was widely underappreciated in the medical community. Dr. Holt-Lunstand’s studies showed that, much like exercise, sleep, and diet, our relationships had a direct impact on our physiology, and could act much like medicine in improving the quality—and length--of our life.

If having close friends keeps us healthy and helps us live longer, how many friends do we need to get the most benefit? Research shows that what seems to blunt the harmful effects of social isolation is having at least one intimate person in your life. Although most people would say that having two to three close friends is ideal, the medicinal effect of social connection can be achieved with a low dose—going from none to one significantly reduces the stress associated with social isolation. Having more friends can produce additional health benefits, primarily due to the novelty and sense of connection a broader network of friends can offer. However, one is all we need.

Not all friendships are created equal when it comes to health benefits. We know that some relationships, even close friends, can cause rather than cure stress in our lives. Regardless of how important a relationship may be, it is the type of bond we hold that determines its health benefits. We can love someone deeply, but strife and conflict in the relationship can trigger high levels of stress that undermine our well-being and longevity. Rather, it is a healing, intimate bond--one characterized by mutual affection, trust, and support--that confers the greatest health benefits. These are the bonds we have with a partner, friend, or family member that foster a deep sense of ease, a feeling of trust and safety in which we know that person will be there to support us, no matter what happens.

As humans, we are hardwired to be social creatures, but we are also programmed with a need for safety in our social relationships. Safety is a primal need, deeply embedded within our physiology, which evolved in response to changes in our social structures. As humans evolved from living in small groups to wider complex communities, we developed neurophysiological capacities that enabled us to recognize and communicate the moods and feelings of other people. As human societies expanded and we encountered more unfamiliar people, we needed ways to determine who was safe to approach, and who should be avoided to escape potential injury. Several neurophysiological structures, primarily cranial nerves, evolved to help us assess risk by regulating our facial expressions, listening acuity, and vocalizing that not only communicated safety to others, but helped us decipher who in our increasingly complex world was a potential threat.

Whereas our ancestors navigated their social interactions on a visceral level, our relationships today are much more complicated and require more resources to navigate. We tend to approach relationships using cognitive skills, overriding our gut reactions with thoughts based on cognitive evaluations. We make judgments related to a person’s motivation, how a person is dressed, one’s interests and background, or other data we deem important. But our visceral reactions will always bubble up, which causes us to struggle when our gut feelings don’t match our narratives. We’ve all experienced this dissonance, feeling uncomfortable around someone who, cognitively, matches our internal criteria of a “nice” person. We ignore our gut reactions at our peril; when it comes to close relationships, our thoughts can easily misinterpret danger cues for attraction. Visceral warning signals of danger include an increased heart rate, constriction of the throat, muscle tension, and sweating, but are easily overrun by our desires and confused with love at first sight. Divorce attorneys make a good living off our preference for narratives.

When we are in the presence of others, these evolutionarily based neurophysiological structures are continuously scanning our social environment for cues related to safety. Working just under our conscious radar, these structures scan a person’s facial features, searching for cues of safety or danger. Facial features that signal safety include slight creases at the corners of the eyes, a soft gaze, relaxed facial muscles, and a slight upturn in the corners of the mouth. These cues make someone seem approachable and friendly, calming our nervous system. Conversely, a hard stare, or a constricted face with a furrowed brow and clenched jaw, as well as a face devoid of emotion is interpreted as threatening. I know a college professor who consistently received student reviews that described her as being “aloof and cold”. Most of her friends knew her to be a vibrant and warm person, so these evaluations were perplexing. That changed one day when a coworker told her to stop wearing her glasses at the end of her nose: her glasses tended to slip down her nose which caused her to lift her chin so she could see through her glasses. But the tilt of her chin made it look like she was peering down in judgment at her students, creating an air of superiority that was not representative of her nature.

Sounds also influence our sense of safety; the speed and cadence of a person’s voice can be relaxing, or it can trigger a need for fight or flight. Folk music characteristic of the turbulent protests during the Vietnam war era used melodic, soft tunes as a platform to deliver strong anti-war messages. The musicians understood that people were more likely to listen to the lyrics if the melodies were relaxing. People who are tense are not receptive to new information and demonstrate decreased listening acuity. We don’t listen as well when we are tense, stressed, or anxious, so we are more likely to tune out people who lack modulation or intonation in their voice. Talking rapidly without a breath or a pause, or using short, succinct sentences, being monotone or very loud tends to make others defensive and uncomfortable. We also respond negatively to high pitched or shrill voices; interestingly, we tend to pull away or avoid people who speak very softly or mumble, sometimes even viewing them as a threat.

Whereas facial expressions and vocalizations are important, it is the way we listen and are listened to that causes the biggest shifts in our social connections. People feel safe when they sense they are understood; defensiveness and stress prevail when we believe others are judging us. If we want to cultivate deeper connections with others, the best starting point is to turn our attention away from our own thoughts, take a deep breath, get grounded, and strive to truly listen and understand others with respect, compassion, and empathy. And our deep, visceral safety cues are designed to be reciprocal—as we communicate safety and support to others, they relax and send safety cues to us as well. It is here where we build the bonds of mutual trust that enhance and support our well-being.

Maya Angelou famously said that people will not always remember what we say, but they will remember how we make them feel. Rather than search for that one intimate, nurturing relationship that will improve our health and help us live a long life, we will reap more benefits by focusing on the signals we are sending others. Are your facial features, tone of voice, and listening skills signaling safety or are you, at a very subtle level, creating tension that makes others feel defensive? Keep in mind that not every relationship needs to be a haven of mutual acceptance, and even our most supportive relationships will go through times of turmoil. But when it comes to relationships, as a rule, we are wise to listen to our gut to hear what it has to say about the people around us and, in doing so, we may hear the messages we are communicating to them. This is how we forge healthy connections.