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

Tell friends that you take "fitness" seriously, and they will probably conclude that you exercise regularly, avoid saturated fats, LDL cholesterol, and tobacco, and go easy on salt and alcohol. And staying fit, they'll assume, helps to ward off cardiovascular problems.

True enough, but if all your workouts are solitary and your jogs solo, you may be overlooking something. It's not just physical fitness that's important for heart health, says medical researcher James J. Lynch, but something he calls "communicative fitness."

Defined broadly, this is a state in which personal relationships are loved-based and stable, conversation is plentiful, and verbal exchanges with friends, family members, and coworkers 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 sprinters have become commonplace -- evidence mounts that we are running the other way when it comes to 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 10 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 2009, spending for health care was estimated at 17.6 percent of the gross domestic product, or about $8,160 per person, according to the Kaiser Family Foundation.

Few have examined these realities as deeply or as soundly as Lynch has. 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 in Pikesville, Maryland.

To a larger audience -- the alert reading public -- Lynch is known, even 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 the part that borders 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 -- of medical, sociological, and spiritual realities -- that demands attention.

Both the shallow end and the deep end of U.S. think tanks are filled with culture critics ever bemoaning the nation's "loss of community." Lynch's findings place him far from simplistic 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, one from the early 1960s and the other from the mid-1990s. At the same time, Nevada's median income level was the nation's second highest, and the state had an average 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, Utah has 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 and one of the lowest per capita health care expenditures.

The mortality data gathered about Nevada and Utah in the 1960s remained unchanged through 1998. But 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, and uprootedness 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 many patients who were faithful exercisers and ate soundly, yet had premature coronary disease. Although James Fixx, the marathoner and author of the 1977 bestseller, 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 1984 while running alone on a country road in Vermont. An autopsy on Fixx, whose father died of heart attack at age 43, revealed that two of his coronary arteries had significant blockage.

Lynch thinks other factors may have been involved. Fixx was once an overweight smoker, had been divorced twice, and was living alone in Vermont the summer of his death. Lynch definitely stops short of ascribing Fixx's death to those factors. 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, Connecticut. Was he a lonely man at the end, and was that a cause of his death? 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 his own patients. He tells of Joe W., 70, a successful corporate 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 had been forced to go on welfare, and he had to leave school in the ninth 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 painful memory negatively affected the patient's blood pressure, revealing an emotional linkage that no cardiologist had previously observed directly. It was a communicative, not a physical, problem. Lynch writes that Joe W. "mentioned that he was very concerned about what others thought 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 an intriguing 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 to be found 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 great and lasting.

-- Colman McCarthy is a former Washington Post columnist and book reviewer who directs the Center for Teaching Peace in Washington, D.C. He is the winner of a 2001 Excellence in Journalism award for an opinion series from the Northern California Chapter of the Society of Professional Journalists.

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Last updated August 26, 2009
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