Them

Why We Hate Each Other — and How to Heal

St. Martin's Press

Contents

OUR LONELINESS EPIDEMIC

Why the Chicago Heat Wave Isn't Capitalized • Loneliness Kills • Not All Depression Is Depression • The Prophet of Social Capital • The Scissors Graph Society • Haves and Have-Nots • Fathers and Margins for Error • Can We Admit the Goodnight Moon Gap Yet? • The Parent Lottery • How to Be Happy

In the summer of 1995, Chicago experienced the deadliest heat wave in U.S. history. For seven days in July, the upper Midwest sweltered under three-digit temperatures, and the Windy City had no wind. The Chicago Tribune compared the humidity to "roasting under a wet wool blanket." On Thursday the 13th, the mercury sat at 106 degrees, but the heat index cracked 120 at Midway Airport. Temperatures fell at night, but only to the high 80s. I've been in Middle Eastern cities on 115-degree days, but this was worse.

Chicago wasn't built for this kind of heat. Many residents didn't have air conditioning, and those who did ran their units so relentlessly that parts of the power grid collapsed. Electricity went out around the city, leaving people to bake in brick apartments.

Heat exhaustion takes a terrible toll on the body. An elevated heart rate, muscle cramps, and nausea can be accompanied by fainting, seizures, and hallucinations. Most people can manage 48 hours of intense heat, but after that the weakened body begins to fail. Without medical attention, the kidneys and other vital organs shut down.

Chicago's hospitals and morgues filled, and the Cook County medical examiner was forced to store human remains in rented freezer trucks. Coroners initially counted 465 dead, but many of the dead weren't discovered until weeks later, when the stench of decomposition oozed from homes and apartments. Researchers would eventually tie 739 deaths to the week's weather.

Chances are, you've never heard of this extraordinary episode, and I likely wouldn't have either except that Melissa and I were living in Chicago at the time. We'd just gotten married and moved into a tiny apartment in Evanston, across the street from Northwestern University's football stadium. We were fortunate: Our window air-conditioner managed to alleviate the scorching heat. The only ill effect we experienced was when the dashboard of Melissa's eighteen-year-old clunker cracked from daily baking in the sun.

Why the Chicago heat wave Isn't Capitalized

Researchers from the Centers for Disease Control, descending on Chicago, hoped to prepare for future heat waves by identifying which populations were most vulnerable and why. Many of their findings were unsurprising: those who lacked air conditioning died at higher rates; the elderly and the sick were at greatest risk; and among the elderly and the sick, those without caretaker relationships, or without ready and reliable access to transportation, fared worst.

But sociologist Eric Klinenberg found himself puzzled by one part of the story: How was it that so many people could die unnoticed in a city of 2.8 million citizens? Klinenberg began an investigation that lasted more than five years. His initial findings simply echoed those of the CDC. But then he struck on something surprising: At a glance, three of the ten neighborhoods with the lowest number of heat-related deaths, Klinenberg found, looked demographically just like the neighborhoods with the highest number — predominantly poor, violent, and African-American. Race and poverty could not fully account for who died and who survived.

The crucial variable, Klinenberg discovered, was social relationships. In neighborhoods that fared well during the heat wave, residents "knew who was alone, who was old, and who was sick," and took it upon themselves to do "wellness checks." They "encouraged neighbors to knock on each other's doors — not because the heat wave was so exceptional, but because that's what they always do." By contrast, areas with high death tolls were areas that previously had been "abandon[ed] ... by businesses, service providers, and most residents"; only "the unconnected" remained. They died alone because they lived alone. In the final analysis, the difference between life and death, Klinenberg's Heat Wave: A Social Autopsy of Disaster in Chicago concluded, was connections — or what he labeled "social infrastructure." Isolation turned something dangerous into something deadly.

More than two decades later, schoolchildren across the country still know the tale of how in 1871 Mrs. O'Leary's cow kicked over a lantern, igniting a blaze that devoured Chicago, but few will ever learn about the (never capitalized) heat wave of 1995 — even though it killed twice as many people as the (always capitalized) Great Chicago Fire. Why?

Part of the answer is that Currier and Ives's images of the Chicago conflagration were impressed onto the imagination of nineteenth-century America. But that's only another way of saying that the heat wave victims died out of the nation's eye, just as they lived out of their community's eye. Their deaths have gone unremembered because their lives went unnoticed.

Loneliness Kills

In classic works of literature, people often die from extraordinary rejection or loss. Shakespeare's King Lear, Ophelia, and Lady Montague die from grief; Hugo's Jean Valjean dies after losing Cosette; Tolstoy's Anna Karenina is so convinced she's unloved that she throws herself under a train.

Though it might be tempting to chalk these deaths up to literary melodrama, the American Heart Association says that death-by-heartbreak is in fact quite real. In "broken heart syndrome" (technical name: Takotsubo cardiomyopathy), rejection or loss causes stress hormones to flood the body, mimicking the effects of a heart attack. "Tests show dramatic changes in rhythm and blood substances that are typical of a heart attack," the AHA reports. And, though rare, it is possible for otherwise healthy people to die from this condition. Everyone has heard of elderly couples who die within weeks or months of each other.

But is loneliness an out-of-the-ordinary event? Must its consequences take the form of sudden death? What happens when loneliness builds over time? It turns out that this is precisely what is happening in the United States today, in epidemic proportions.

Eric Klinenberg's research inaugurated the "loneliness literature" — sociological and medical research into the effects of community on well-being. Scientists are now showing that loneliness affects the brains and bodies of millions of people, in measurable and alarming ways.

Breakthroughs in imaging technology are producing an explosion in what we know about the human brain. For example, neurological scans using functional magnetic resonance imaging (fMRI) show that our response to emotional rejection lights up the same brain region that registers emotional response to physical stress, giving rise to the same health effects: increased stress hormones, decreased immune function, and heart problems. So it comes as no surprise that lonely people get sick more often, take longer to recover from illness, and are at higher risk of heart attacks. According to researchers at Ohio State University and the University of Chicago, emotional stress causes us to age faster — and it turns out that chronically lonely individuals are more prone to Alzheimer's disease and dementia. Studies suggest that one lonely day exacts roughly the same toll on the body as smoking an entire pack of cigarettes.

Among epidemiologists, psychiatrists, public-health officials, and social scientists, there is a growing consensus that the number one health crisis in America right now is not cancer, not obesity, and not heart disease — it's loneliness. And with our nation's aging population, it's only going to get worse.

Shakespeare and Tolstoy, it seems, were on to something. Loneliness is killing us. According to a seminal report from the Dahlem Workshop on Attachment and Bonding, "Positive social relationships are second only to genetics in predicting health and longevity in humans." Brigham Young University's Julianne Holt-Lunstad has been studying data from 3.5 million Americans over nearly four decades. According to her findings, lonely, isolated people are somewhere around 25 percent more likely to die prematurely — not just from suicide (which has been spiking across multiple demographic categories in the United States in the last two decades), but from any of an array of health problems. Similarly, University of California–Irvine social ecologist Sarah Pressman has been comparing the mortality effects of loneliness to various better-understood causes, such as obesity, heavy drinking, and smoking. Persistent loneliness reduces average longevity by more than twice as much as heavy drinking and more than three times as much as obesity (in fact, loneliness drives obesity, not vice versa, as previously thought). The research of loneliness experts John T. Cacioppo and William Patrick confirms that loneliness alters behavior and physiological response in ways that are "hastening millions of people to an early grave."

Men are especially at risk. One comprehensive study of 67,000 American men found that bachelors under the age of 45 were far more likely to die in a given year than their married male peers. It turns out that men, unlike women, tend to stop forming friendships once they begin careers or marry — for most men, by their early thirties — which makes them particularly susceptible to disruptions in their social networks later in life. For most men, marriage and children constitute their chief points-of-entry in adult life into any broad community, and their sources of social support atrophy quickly when those vanish. Elderly men are the loneliest demographic group in the United States. Of the lonely dead discovered in the wake of the Chicago heat wave, there were a stunning four times moremen than women.

Doctors are sounding the alarm about what public-health experts now call our "loneliness epidemic." Former U.S. surgeon general Vivek Murthy speaks widely about the physical toll of persistent loneliness. As he told the Boston Globe, the conclusion is clear: "The data is telling us ... that loneliness kills."

Not All Depression Is Depression

How widespread is our problem? A fifth of Americans volunteer that loneliness is "a major source of unhappiness" in their lives, and a full third of those over the age of 45 confess that "chronic loneliness" is a fundamental challenge with which they are struggling.

These numbers are huge, but they actually understate the problem. Part of the difficulty of capturing the gravity of the crisis is that our terminology is fuzzy — for example, we don't consistently differentiate between "social isolation" and "loneliness." "Social isolation" is when a person objectively lacks relationships. Klinenberg and other researchers found that it's entirely possible, as in Chicago in the summer of 1995, to be socially isolated even while surrounded by millions of people. But loneliness is a more expansive category than isolation. According to psychologists, loneliness is not merely isolation or an individual's "perception of being alone and isolated," but rather the "inability to find meaning in one's life." Sociologists sometimes describe the concept as "a subjective, negative feeling related to deficient social relations," or the "feeling of disconnectedness" from a community of meaning. It's hard to measure, and perhaps even harder to talk about clearly.

Jacqueline Olds and Richard S. Schwartz, clinical psychiatrists who also happen to be married to each other, argue in their important book, The Lonely American, that much of what is called "depression" might actually be chronic loneliness. They observed in their practices that many of their patients' descriptions of depression were tied to accounts of isolation. "We began to notice how hard it was for our patients to talk about their isolation, which seemed to fill them with deep shame," they write. "Most of our patients were more comfortable saying they were depressed than saying they were lonely" (their emphasis). After reading Olds and Schwartz, I began to ask psychiatrists and psychologists whether they had noticed anything like this in their own work. A flood of agreement followed.

One therapist exclaimed: "Oh, heavens, yes! The number one reason people think they're coming into my office is self-diagnosed depression. But most of the time, my conclusion is that their challenge is lack of community and healthy relationships. My fear is that my profession is just prescribing them a medication, because that's the easiest path out of the appointment."

Before continuing, let's be clear: Lots of Americans do, indeed, suffer from depression, and breakthroughs in psychotherapy methods and pharmacology have changed lives — and surely saved many. My purpose here is simply to relate what many mental-health professionals have observed: that sometimes what patients think is depression is actually a response to deep-seated loneliness.

Loneliness is surely part of the reason Americans consume almost all the world's hydrocodone (99%) and most of its oxycodone (81%). Recently, in New York Magazine, journalist Andrew Sullivan laid out how these drugs are often used to dull something more than physical pain — what he calls "existential pain." Explains Sullivan: "The oxytocin we experience from love or friendship or orgasm is chemically replicated by the molecules derived from the poppy plant. It's a shortcut — and an instant intensification — of the happiness we might ordinarily experience in a good and fruitful communal life." Sullivan describes a scientific experiment that compared how rats in different situations responded to the presence of an artificial stimulant (water with morphine: rodent heroin). A rat alone in his cage drank five times as much morphine water as a rat whose cage included food, colorful balls, an exercise wheel, and attractive lady-rats. "Take away the stimulus of community and all the oxytocin it naturally generates," Sullivan writes, "and an artificial variety of the substance becomes much more compelling." Every day in the United States, 116 people die from an opioid-related drug overdose. According to the CDC: "In 2016, the number of overdose deaths involving opioids (including prescription opioids and illegal opioids like heroin and illicitly manufactured fentanyl) was 5 times higher than in 1999."

The natural, healthy stimulus of community is vanishing, and the damaging health effects of persistent loneliness are being compounded — by drug overuse and abuse, which now claim more lives in a year than diabetes, liver disease, pneumonia, or the flu. This is very bad and very new.

The Prophet of Social Capital

What is causing this pervasive experience of alienation? Why are so many more Americans isolated and alone than half a century ago?

To help answer these questions, there's no one better to consult than Harvard social scientist Robert Putnam, who has been chronicling the collapse of neighborly America for a quarter century. Putnam asks the big questions: What makes life livable in a big, diverse democracy like ours? What are the ties that bind us together? What causes those ties to fray or unravel? Why are so many indicators of social collapse currently spiking?

In the early 1990s, Putnam took note of a curious phenomenon: While there were more bowlers in America as a share of the population than at any time before, fewer of them were joining bowling leagues. People were doing various things — but they weren't doing them together. Putnam was teasing out the connection between community life and personal fulfillment: "Though all the evidence is not in," he wrote, "it is hard to believe that the generational decline in social connectedness and the [associated] generational increase in suicide, depression, and malaise are unrelated."

Putnam used bowling leagues as his shorthand, but he found similar trends across many types of social and service organizations. From bridge clubs to alumni groups and veterans' associations, memberships were aging and nobody was joining. Between 1975 and 1995, membership in social clubs and community organizations such as the PTA, Kiwanis, and Rotary plummeted. Same with labor union membership and regular church attendance. (Recently, overall participation in youth sports leagues has dropped as well.) Locally organized churches declined, with more anonymous, commuter megachurches absorbing their members.