How Supportive Ties Affect Cardiovascular Health and Resistance to the Effects of Trauma: A Review of the Evidence
by
Mitch Hall
This paper reviews the evidence for how supportive ties affect both cardiovascular health and resistance to the effects of trauma. Supportive ties are those interpersonal bonds also referred to as social support, a term which “…connotes all we mean by caring relationships among people” (Pilisuk & Parks, 1986, p. 40). Some authors have differentiated among the functions served by supportive ties (Berkman & Glass, 2000; Wills & Shinar, 2000) and have discussed the benefits, both theoretical and observed, of different types of support, identified as emotional, instrumental, informational, companionship, and validation (Wills & Shinar, pp. 88-89). Underlying these variations among supportive ties, Pilisuk and Parks observe that their “…most powerful effect seems to be in the capacity for viewing ourselves as cared for, needed, and worthy of the love of others” (p. 40).
In succeeding sections, this paper discusses (1) the effects of supportive ties, or their lack, on a person’s overall health and longevity; (2) the findings of recent research about the multifaceted functions and dimensions—electromagnetic, neural, hormonal, healing, and social-emotional--of the human heart, (3) the influence of supportive ties, or their absence, on the cardiovascular system, with particular reference to myocardial infarction, angina pectoris, and hypertension, and (4) the effects of supportive ties on people’s ability to cope with and heal from trauma. Before proceeding to a review of the influence of supportive ties on cardiovascular health and resistance to the effects of trauma, it is worthwhile to consider the broader context of what research has found to be the general effects of social support on health.
The Effects of Supportive Ties on Human Health and Longevity
Empirical research over the past two or more decades has persuasively demonstrated that supportive ties between and among human beings significantly enhance health and longevity. Achterberg states, “The research is overwhelming; human bonds are medicine” (1998, pp. 7-8). The opposite is also true, as Berkman and Glass (2000) conclude from their review of 13 large prospective studies conducted during the preceding 20 years:
“Virtually all of these studies find that people who are socially isolated or disconnected to others have between two and five times the risk of dying prematurely from all causes compared to those who maintain strong ties to friends, family, and community” (p. 160).
In addition to mortality, morbidity is also directly correlated with a lack of social support:
“As early as 1976, Cassell examined populations for a wide range of diseases and found that those individuals with the greatest incidence of pathology were persons who had either been low on social support or recently lost their customary supports” (DiCowden, p. 5)
The research reveals that the presence of even one supportive relationship can make a crucial contribution to a person’s health and survival:
“In multivariate models that control for sociodemographic factors, psychosocial factors, including living arrangements, depressive symptoms, and clinical prognostic indicators, men and women who reported no emotional support had almost three times the mortality risk compared with subjects who reported at least one source of support” (Berkman & Glass, p. 161).
The Heart
The human heart is the first organ to begin forming as we develop in utero, followed by the brain, and then the rest of the body (Pearce, 2002, p. 67). When the heart ceases beating, without any possibility of being revived, we die. From the beginning to the end of life, the heart is central. When we speak idiomatically about the heart of the matter, we mean the essence of an issue. In traditional Chinese medicine, the inner spiritual core of the self—shen-- is deemed to reside, not in the head, but in the heart (Teeguarden, 1984, 1987, pp. 64-65). Likewise, in many indigenous cultures, the heart is held to be the organ of thought (Eden, 1998, p. 156).
Recent scientific research may lend credence to these multicultural perspectives on the heart because it has demonstrated that the heart is more than just a marvelous pump for the circulation of blood through the approximately 15 miles of vessels and thousands of miles of minuscule capillaries in the body (Pearce, 2002, pp. 56-57). Pearce refers to the “triune heart” (p. 55) because of its interrelated electromagnetic, neural, and hormonal functions. The beating heart generates two and a half watts of electricity. The resulting electromagnetic wave is “…at an amplitude from 40 to 60 times greater than that of brain waves…” (Pearce, p.56), and the currents radiate from 12 to 15 feet beyond the body, while being strongest within a three-foot radius (Pearce, 2002). The strength of these cardiac waves is approximately a thousand times that of brain waves (Eden, 1998, p. 156). Because of its predominant power, “…the heart tends to pull the brain and other organs into synchronization or ‘entrainment’ with its rhythm…” (Eden, 1998). The heart’s electromagnetic field is configured like a torus that arcs out from and back to its source in the protective thoracic cavity. This torus is organized around a roughly vertical axis that extends through the torso from the perineum to the crown of the cranium (Pearce, p. 57).
Furthermore, in fascinating research that is relevant to subsequent discussion in this paper about the effects of supportive ties on heart function, it has been found that the electromagnetic field generated by the heart of one person can even entrain the brain waves of another (Pearce, 2002, pp. 245-246). Linda Russek, a scientist at the University of Arizona, interviewed--as part of a study conducted with her colleague Gary Schwartz--individual men who had previously rated themselves as having been either well nurtured or not in childhood. Within a brief time, the brain waves, as measured by EEG, of the men who perceived their childhoods as positive became synchronized with Russek’s heart frequencies, as measured by ECG. “The EEG patterns of the subjects with negative childhoods showed a much slower-forming and weaker correspondence to the interviewer, if any at all” (Pearce, p. 246). These results may indicate, as has much other research (Bowlby, 1969; Lewis, Amini, & Lannon, 2000), that weak attachments in early childhood make it difficult to form supportive ties or establish interpersonal rapport in adulthood. As we shall see, the heart itself is in turn affected by the quality of our ties with others.
In connection with the preceding discussion of the heart’s scientifically measurable electromagnetic field, it is significant that many healers have spoken of the energy of healing as radiating from the heart chakra (Motoyama, 1981, 1984; Green & Shellenberger, 1993, p. 51). The Polish-born healer Mietek Wirkus stated, “Heart center vibrations relate to unconditional love, and to treating other beings with love, understanding, and respect.” (Green & Shellenberger, 1993). He affirmed that healers “…must feel and be the heart chakra…” through “…the real sensation of pure love which brings warmth, delicate vibrations in your heart area” (Green & Shellenberger, 1993). In these statements, Wirkus is giving phenomenological descriptions of his felt experience, which indicates that the heart can be a subtly tuned amplifier and transmitter of altruistic intentions.
Far from being made up only of smooth muscle cells, the heart is also composed of neurons grouped in ganglia with the same sort of axon-dendrite connections found in the brain (Pearce, 2002, p. 64). These neural cells are estimated to comprise from 50 to 65 percent of all cardiac cells (Pearce, 2002). “Researchers at the University of Melbourne have shown that the heart has a nervous system and that it makes decisions independent of the brain, such as how fast to beat” (Eden, 1998, p. 156). The heart’s highly organized neural structures connect to nerves throughout the body and also have “…unmediated neural connections with the emotional-cognitive, or limbic, brain” (Pearce, p. 64). There are receptors in the heart’s ganglia for “the same neurotransmitters that function in the brain” (Pearce, 2002). Additionally, the atrium of the heart produces a hormone called ANF that influences the limbic brain, the balance between the sympathetic and parasympathetic nervous systems, the immune system, and virtually every other hormonal action of the body (Pearce, pp. 68-69).
In light of the foregoing discussion of recent scientific discoveries about the complexity, power, and roles of the heart, we can perhaps better appreciate the fact that ancient cultures saw the heart as the seat of the soul. Metaphorically speaking, “A human being has dual hearts—the first a pulsating fist of muscle in the chest; the second, a precious cabal of communicating neurons that create feeling, longing, and love” (Lewis, Amini, & Lannon, 2000, p. 122). In English, as in other languages, many idioms attest to this “second” heart, the social-emotional heart. We speak of holding those we love in our hearts or close to our hearts. Anguish is referred to as heartache, whereas overwhelming sorrow or grief is called heartbreak. Sincere intentions and actions are heartfelt. To be generous and compassionate is to be openhearted or warmhearted, whereas being devoid of compassion is to be heartless. Open and possibly naive self-disclosure in romantic matters is called wearing one’s heart on one’s sleeve. Rejection involves closing one’s heart to another person. A heart-to-heart conversation is intimate and candid. To follow one’s heart means to act on the basis of an intuitive sense of one’s own most fulfilling option. Finally--and this listing of metaphorical heart expressions does not exhaust the possibilities--to hearten is to encourage, and our English word courage is itself derived from the French word, coeur, meaning heart. Having looked at some major aspects of what is known about the heart--literally and figuratively--we are now ready to review the evidence for how supportive ties affect the health of the heart and of the overall cardiovascular system.
The Effects of Supportive Ties on Cardiovascular Health
Numerous studies have demonstrated that cardiovascular health is robustly associated with the presence of supportive social ties in a person’s life and that the lack of such ties is one of the variables that are likely to lead to cardiovascular disorders. In a review of 81 studies regarding the effects of social support on physiological processes, Uchino, Cacciopo, and Kiecolt-Glaser (1996) found that 57 of these studies (70%) focused on aspects of cardiovascular function. The authors noted that, “This emphasis is understandable considering that cardiovascular disorders are still the leading cause of death in the United States and that social support has been linked to lower coronary heart disease (CHD) rates” (Uchino, Cacciopo, & Kiecolt-Glaser, p. 489). In fact, beyond the United States, “Heart disease remains the major cause of death and disability in the Western world” (Kaplan & Toshima, 1990, p. 439).
The heart and vascular system are subject to various diseases and dysfunctions. These include myocardial infarction, angina pectoris, hypertension, arrhythmias, mitral valve prolapse, atherosclerosis, and hypercholesterolemia (Achterberg, Dosses, & Kolkmeier, 1994, pp. 177-210). Some studies have looked at the effects of social ties on cardiovascular health in general, while others have focused on one of the aforementioned conditions. An example of research about cardiovascular health in general is the Framingham Heart Study of 142 female subjects. Those women who worked in “clerk or clerical roles and had unsupportive spouses” had significantly higher levels of cardiovascular disease (Kaplan & Toshima, 1990, p. 428). Let’s look at research findings regarding three specific types of coronary heart disease: myocardial infarction, angina pectoris, and hypertension.
Myocardial infarction (MI)
Myocardial infarction (MI) is the medical terminology for a heart attack. More than 1.5 million people have heart attacks every year, and one-third of them were unaware they had heart disease prior to the heart attack. You suffer an MI when the blood supply to a portion of your heart muscle is cut off for a period of time. This may be due to a spasm in the wall of the coronary artery, a blood clot lodging in the artery, or a cholesterol plaque occluding the blood flow. (Achterberg, Dossey, & Kolkmeier, 1994, p. 198).
Clearly MI is a serious concern because it can occur unannounced, can be extremely painful and terrifying, and can be disabling or fatal. Among the questions that have been investigated concerning the effects of social ties on MI are the following. Who is at higher risk for MI in the first place? In the event of MI, who is more likely to survive and who more likely to die? Following MI, how do social ties affect subsequent longevity? Who is more likely to suffer a recurrence of MI?
An epidemiological study in the 1960s of the Italian-American community of Roseto, Pennsylvania attracted much interest among public health professionals because “…the death rate from myocardial infarction in this town was half that of neighboring communities and the United States as a whole” (Green & Shellenberger, 1996, p. 49). Researchers were surprised that the cardiovascular status of these subjects was so relatively healthy in spite of the presence of many high risk factors. In general, these people “…were overweight, consumed more total fat than the average American, had a high rate of cigarette smoking, were sedentary, and had serum cholesterol levels comparable to the average American” (Green & Shellenberger, 1996). The low death rates from MI were found to be due to high levels of social cohesion and mutually supportive social ties. When younger generations became “…more materialistic, individualistic, and mobile…” (Green & Shellenberger, 1996), MI rates rose to levels comparable with those in the rest of the United States.
In the Recurrent Coronary Prevention Project (RCPP), Friedman et al. studied 862 men who had previously suffered one MI. The men were randomly assigned to three different outpatient protocols. The cardiac counseling cohort (N=270) met for about 25 sessions in small groups to discuss their anxieties about heart disease and to receive information about “…diet, exercise, and the physiology of the cardiovascular system” (Green & Shellenberger, 1996, p. 51). The cardiac and behavioral counseling subjects (N=441) met in groups of 10, facilitated by caring leaders, for an average of 38 sessions. In addition to providing cardiac counseling, the facilitators of these groups helped the men to recognize their own type A behaviors and to develop skills for healthier behaviors. “A control group of 151 subjects received no treatment” (Green & Shellenberger, 1996). After 4.5 years in the study, researchers found, “…that men who participated in a caring, supportive group in addition to traditional care had a 45% lower recurrence of myocardial infarction than those treated with traditional medical care only” (Green & Shellenberger, p. 53).
The RCPP involved interventions that expressly provided opportunities for social ties as part of outpatient treatment. Without making such interventions, Ruberman et al. studied “2320 male survivors of acute MI” and found that “patients who were socially isolated were more than twice as likely to die over a 3-year period than those who were less socially isolated” (Berkman & Glass, 2000, p. 160). Another study of MI patients “…classified the survivors according to social isolation and stress and then followed them prospectively. Those who experienced low stress and were socially connected had one-fourth the rate of mortality of those who were under high stress and were isolated” (Kaplan & Toshima, 1990, p. 430). These research projects are a few from among “…a host of studies suggesting that social ties, especially intimate ties and emotional support provided by those ties, influence survival among people post-MI or with serious cardiovascular disease” (Berkman & Glass, 2000). Berkman and Glass also observed that, “…evidence to date suggests that measures of social integration are related to mortality and perhaps to the development of atherosclerosis whereas emotional support is most highly related to survival in post-MI (myocardial infarction) patients” (Berkman & Glass, p. 156). In many studies, support groups have been associated with “decrease in number of myocardial infarcts” and “reversing the effects of heart disease” (Achterberg, 1998, p. 6).
Angina pectoris
“Angina is the name of the chest pain you feel when your heart muscle is not getting enough oxygen” (Achterberg, Dossey, & Kolkmeier, 1994, p. 197). The cause of this often frightening condition is “a temporary decrease in blood flow,” which usually lasts fewer than 10 minutes and does not permanently damage cardiac muscle (Achterberg, Dossey, & Kolkmeier, p. 198). People who suffer from angina pectoris describe sensations of “tightness, pressure, burning, or a squeezing pain or discomfort” (Achterberg, Dossey, & Kolkmeier, 1994), and they can get relief by resting and relaxing. While physical exertion can precipitate an angina episode, so can intensely distressing emotions such as fear, anger, and grief (Achterberg, Dossey, & Kolkmeier, p. 197).
A 5-year prospective study of 10,000 married Israeli men who were 40 years and older found that from among the highly anxious men in the sample “…those who perceived their wives to be loving and supportive had half the rate of angina of those who felt unloved and unsupported” (Achterberg, Dossey, & Kolkmeier, 1994, p. 181). In the general population, “…the average incidence of angina pectoris is 5.7 per 1000 adult males” (Green & Shellenberger, 1996, p. 48). For highly anxious men who lack a loving, supportive wife, the angina rate rises dramatically to 93 per 1000, whereas for highly anxious men whose wives show them love and support, the rate drops to 52 per 1000 (Green & Shellenberger, 1996). The key question in the Israeli study about angina risk was simply stated: “Does your wife show you her love?” (Green & Shellenberger, 1996).
Hypertension
High blood pressure, also known as hypertension, puts a person at greater risk for MI. A device called a sphygmomanometer can be used to measure the pressure in the arteries during both the pumping and resting phases of the heart’s action. Systolic blood pressure (SBP) refers to the pressure in the arteries when the heart is contracting to pump blood, and diastolic blood pressure (DBP) is the pressure when the heart is at rest between beats. Either or both of these measures can be elevated beyond safe limits (Achterberg, Dossey, & Kolkmeier, 1994, p. 185). Hypertension can be situational or chronic. Time of day, levels of exertion, and body position are among the factors that affect blood pressure. A temporary and minor rise in blood pressure is usual under stressful circumstances, and some people, called “hot reactors,” show disproportionate elevations of blood pressure when they perceive a situation as stressful (Achterberg, Dossey, & Kolkmeier, p. 186).
Research has shown direct effects of social ties on heart rate and blood pressure regulation. Because most people find public speaking stressful, researchers have looked into how the presence or absence of social support affects a person asked to speak in public. In one experiment conducted by Kamarck and associates, “People without support had higher systolic and diastolic pressure both before the actual challenge as well as during the challenge. Thus, support availability protects against increased blood pressure response associated with stressful situations (Berkman & Glass, 2000, p. 154). In another study using the public speaking context,
“Lepore et al. (1993) had participants perform a speech, while in one condition a confederate made comments designed to reflect emotional support. In contrast, the confederate in the low emotional support condition was reserved and inattentive. Results indicated that the social support speech condition was associated with lower SBP and DBP reactivity than the no support speech condition” (Uchino, Cacciopo, & Kiecolt-Glaser, 1996, p. 511)
In a review of 28 studies, Uchino, Cacciopo, and Kiecolt-Glaser (1996) found that in 23 of them, “…the results of the correlational studies are consistent with the notion that higher social support is associated with better cardiovascular regulation (e.g., lower blood pressure)” (p. 490). An apparent gender difference emerged from the studies regarding the kind of social support that helps regulate blood pressure: “…social resources were a stronger predictor of blood pressure in men, whereas instrumental support was a stronger predictor of blood pressure in women” (Uchino, Cacciopo, & Kiecolt-Glaser, p. 491). A few studies compared the differential effects on blood pressure of the presence of a family member, a friend, or a stranger. Spitzer et al. found that “…being around a family member was associated with lower ambulatory SBP and DBP compared with being around a friend or stranger” (Uchino, Cacciopo, & Kiecolt-Glaser, p. 505). For many people, siblings are among the closest and longest lasting of supportive ties. In view of this fact it is not surprising that, “Individuals high in number of siblings and low in life stress were characterized by the lowest blood pressure” (Uchino, Cacciopo, & Kiecolt-Glaser, p. 505).
In one experiment, Gerin et al. contrived a conflict situation. They engaged participants in discussions either with or without social support. In both conditions, two confederates attacked the participant’s views. In the support condition, a third confederate defended the participant, whereas in the condition without any social support, the third confederate sat in silence. “Results of the study revealed that social support during the conflict discussion was uniformly associated with lower increases in heart rate, SBP and DBP” (Uchino, Cacciopo, & Kiecolt-Glaser, 1996, p. 510)
Achterberg (1998, p. 6) reports on a review in Science by James House et al. of over 60 studies that showed those who felt included in supportive social networks are at less risk for, among other things, blood pressure disorders and cardiovascular disease. On the other hand, the effects of a lack of supportive ties appear to be cumulative: “The laboratory studies suggest that the higher cardiovascular reactivity seen in situations involving low social support may translate to gradual elevations in tonic blood pressure across the lifespan” (Uchino, Cacciopo, & Kiecolt-Glaser, 1996, p. 510). As has been repeatedly demonstrated, isolation and lack of reliable social ties are highly stressful and harmful to cardiovascular health. Graphic representations of the heart’s electrical activity show that, “In response to a negative signal, the frequency realm of the heart drops from coherent to incoherent” (Pearce, 2002, p. 71), and such incoherent patterns can likely be observed in people who chronically lack supportive ties. Schore (2002) reports on studies that demonstrate that, “…strategies of the right hemisphere are underutilized by coronary heart disease patients…” (Schore, 2002, p. 228). Since the right hemisphere is strongly connected with the limbic brain, and since these are the primary regions of the brain involved in social-emotional functioning, the correlation noted by Schore is consonant with what we know about the effects of supportive ties on the health of the heart.
In closing this section about cardiovascular health, it is heartening to note that at any age and in virtually any condition, we respond positively to others who reach out to us in a heartfelt manner: “In a remarkable series of studies of people in coma by James Lynch, when a compassionate nurse or doctor stopped at the bedside and spoke to the patient or touched with a comforting hand, their electrocardiograms showed a slower rate” (Achterberg, 1998, p. 4).
The Effects of Supportive Ties on Resistance to the Effects of Trauma
Having reviewed the evidence for how supportive ties affect the health of the heart, I would like to consider how such ties affect our ability to deal with and heal from the effects of trauma. Whereas stress is a physiological reaction to any level of perceived threat to physical or psychological wellbeing (Chaitow, 1990, p. 20), trauma refers to the most severe stresses. These are the shocks, frights, abuses, violations, and losses—whether to ourselves, to those who are dear to us, or to other people for whom we feel compassion--that are so extreme they cause our heart rates to accelerate, among other somatic reactions, to the point that we could, as we say idiomatically, be scared to death, or that break our hearts to an extent that we may not know how we can survive the anguish. In a similar vein in 1914, Freud had defined trauma as “…a breach in the protective barrier against stimuli leading to feelings of overwhelming helplessness” (Levine, 1997, p. 197).
Levine (1997) distinguishes between two kinds of trauma. Shock trauma refers to “…potentially life-threatening events that overwhelm our capacities to respond effectively” (Levine, p. 10). Developmental trauma—also called relational, ambient, or cumulative trauma (Schore, 2003, pp. 68, 74)—occurs in infancy and childhood when one or more of the people who are supposed to be our caregivers are instead abusive and neglectful (Levine, pp. 10-11). In both kinds of trauma, the physiological reactions are the same and occur in two stages. “In the initial stage, hyperarousal, an alarm reaction is initiated by the sympathetic nervous system…” (Schore, p. 67). This involves such physiological reactions as increased heart rate and blood pressure, faster and more shallow breathing, dilation of the pupils, and increased muscular tension, all aspects of the instinctual “fight or flight” strategies orchestrated at the level of the reptilian brain (Levine, p. 95). The second stage of reaction to trauma is a “…later-forming and longer-lasting reaction…a parasympathetic response…” (Schore, p. 67). It involves dissociation, which is the physiological, emotional, and psychological shutting down and withdrawal from the threatening external world (Schore, p. 67).“ When fight and flight responses are thwarted, the organism instinctively constricts as it moves toward its last option, the freezing response” (Levine, pp. 16, 99). This response is seen in all animals, as for example, when they cannot evade a predator. They freeze as if already dead. If an animal has gone into the freezing phase, but for some reason senses it has a new opportunity to escape from a predator, its body begins to vibrate, twitch, and tremble, which is “…the organism’s way of regulating extremely different states of nervous system activation” (Levine, pp. 97-98). Human reactions to trauma follow similar patterns.
Levine summarizes the four key components of the traumatic reaction as “hyperarousal, constriction, dissociation, and freezing (immobility) associated with helplessness” (Levine, 1997, p. 132). He has observed that, “When we are unable to flow through trauma and complete instinctive responses, these uncompleted actions often undermine our lives” (Levine, p. 32). Traumatized people’s lives can be undermined in varied ways. Their physical health may suffer. They may reenact the helpless victim role. They may become perpetrators who inflict trauma on others. deMause sees warfare as the collective restaging of early, widespread, developmental trauma (deMause, 2002).
To help people heal from the effects of trauma, we need to understand the physiological and energetic, as well as psychological dimensions of these effects.
“Traumatic symptoms are not caused by the ‘triggering’ event itself. They stem from the frozen residue of energy that has not been resolved and discharged; this residue remains trapped in the nervous system where it can wreak havoc on our bodies and spirits. The long-term, alarming, debilitating, and often bizarre symptoms of PTSD develop when we cannot complete the process of moving in, through, and out of the ‘immobility’ or ‘freezing’ state” (Levine,1997, p. 19).
“The roots of trauma lie in our instinctual physiologies. As a result, it is through our bodies, as well as our minds, that we discover the key to its healing. …My observations of scores of traumatized people have led me to conclude that post-traumatic symptoms are, fundamentally, incomplete physiological responses suspended in fear. Reactions to life-threatening situations remain symptomatic until they are completed. Post-traumatic stress is one example” (Levine, p. 34).
It is important to recognize that for traumatized people, “…the intense, frozen energy, instead of discharging, gets bound up with the overwhelming, highly activated, emotional states of terror, rage, and helplessness” (Levine, 1997, p. 100). By flowing through trauma, Levine means the release, in a supportive context, of energy that has become mobilized to maintain chronic neuromuscular and emotional constriction. The role of this constriction is to defend us from being overwhelmed by feelings of helplessness, by the anger and rage that were repressed when we were not able to fight back, and by the fear and terror that could not be released by fleeing the threat.
Here we return to our theme of supportive ties because they, above all else, are needed to help people heal from trauma. “To move through trauma we need quietness, safety … We need support from friends and relatives, as well as from nature” (Levine, 1997, p. 36). Unfortunately, however, “In our culture, there is a lack of tolerance for the emotional vulnerability that traumatized people experience. Little time is allotted for the working through of emotional events” (Levine, p. 48). However, we need to make a cultural priority of allotting as much time as needed for such emotional processing, whether for survivors of childhood abuse, of rape and assault, of warfare, of hate crimes, or of any other traumatic events. With a modicum of understanding of the psychology and physiology of trauma--and with love, trust, respect, and patience--supportive ties can help a traumatized person recover from trauma. While Levine offers a three-year training program for professional therapists who work with traumatized people, he affirms, “When shock trauma is the result of an isolated event or series of events and there is no consistent history of previous trauma, I believe that people, in community with family and friends, have a remarkable ability to bring about their own healing” (Levine, p. 11). For developmental trauma, Levine believes additional social support from a psychotherapist is usually needed.
The efficacy of supportive ties has, in fact, been observed to make a big difference in how people cope with the loss of a spouse, which is known to be highly traumatic: “Separation via divorce or death of a spouse is a common precursor to a wide spectrum of mental and physical pathologies” (Pilisuk & Minkler, 1980, p. 98). Nonetheless, supportive ties notably reduce the traumatic effects of such a loss: “…such age-linked trauma as widowhood…need not result in a decline in morale or in increased susceptibility to mental disorder, provided that the older person maintains a link with an intimate social acquaintance or confidant” (Pilisuk & Minkler, 1980, p. 99). Even the memory of a supportive tie can sometimes sustain a person in the most traumatic of circumstances, as was the case for the psychiatrist Viktor Frankl, who, while imprisoned in a Nazi death camp, maintained hope and the will to live by envisioning his beloved wife (Frankl, 1939, 1963; Achterberg, 1998, p. 7).
Anngwyn St. Just, Director of the Arizona Center for Social Trauma, cites clinical evidence that empathic and respectful support is essential for helping people heal from trauma (personal communication, March 29, 2003). She encourages therapists, relatives, and friends to be attentively present to trauma survivors in a non-judgmental way, to “show up, shut up, and tune in.” Because trauma leads to feelings of powerlessness, she seeks to empower the traumatized and to help them become aware of and to feel confidence in their own inner resources, which have already served their survival.
What is true of stress is equally valid for its most extreme form, trauma: “…social support, especially perceived social support, has been shown to buffer the deleterious influences of stressful life events on the risk of depression and depressive symptoms” (Berkman & Glass, p. 151). Among the benefits of the emotional support provided by supportive ties is that it “…alters threat appraisal of life events, enhances self-esteem, reduces anxiety/depression, and motivates coping” (Wills & Shinar, 2000,p. 89). Because survivors of trauma tend to confuse past, present, and future (A. St.Just, personal communication, March 29, 2003), supportive ties help them to reappraise past threats by recognizing that they are indeed in the past and do not need to recur in the future. The supportive ties make this possible by providing physical and emotional safety in the present, so that the psychological and physiological residues of trauma can be released, thanks to the presence of this support.
Conclusions
This paper began by reviewing what is known about the salutary effects of supportive ties on human health and longevity. This was followed by a look at some of the myriad wonders of the human heart, as understood through recent scientific findings, as expressed in the folk wisdom of idioms, and as posited by indigenous cultures. Then the paper cited numerous scientific studies about the beneficial effects of supportive ties on cardiovascular health, with special reference to three conditions—myocardial infarction, angina pectoris, and hypertension. In the last section, we considered the nature of heartbreaking trauma and how supportive ties can help a person to heal from trauma’s physiological and psychological effects.
Blaise Pascal, the 17th century French philosopher and mathematician is often quoted to the effect that, “The heart has its reasons about which reason knows nothing.” In light of the evidence we have reviewed concerning the effects of supportive ties on the heart and on healing from trauma, we now know something central about the heart’s reasons, and this is that we thrive in the depths of our hearts and the fullness of our lives to the extent the we share the supportive ties of friendship, caring, and love with one another.
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