Relationships & Immunity
by
Mitch Hall
How Interpersonal Relationships Affect Immune System Functioning
Introduction
Throughout the human life cycle, the quality of our interpersonal relationships is one of the primary factors that influence how well we thrive physically--as well as emotionally and cognitively--and how well our immune systems function to keep us healthy. Numerous research studies since the1970s have investigated and attempted to understand how human relationships affect different aspects of immune system functioning (Berkman & Glass, 2000, p. 142). This paper will describe and reflect on the evidence this area of research provides for the proposition that caring, supportive relationships between and among people can—similarly to such factors as good nutrition, hygiene, adequate sleep, and an environment free of toxins—strengthen and balance our immune systems. It will also discuss how the lack of supportive relationships can cause a deterioration of immune functioning.
Following this introduction, the paper is organized into four sections. The first defines and describes major aspects of the immune system. The second shows how the immune system is connected to the nervous and endocrine systems. The third discusses how interpersonal relationships affect immune system functioning in the earliest stages of life and in adulthood. A developmental perspective on the adult capacity for relationships with others is proposed, and the basic findings of several empirical studies are presented. In the concluding section, some models of the psychosocial mechanisms that link social support to health are reviewed, and the importance of taking the wider socioeconomic context into account is affirmed.
The Immune System
Before looking at how relationships affect the immune system, it will be helpful to define what the term immune system means and to review what is known about some of its salient features. The immune system is defined as “the integrated body system of organs, tissues, cells, and cell products such as antibodies that differentiates self from non-self and neutralizes potentially pathogenic organisms or substances (Soukhanov et al, 1996, 1992, p. 903). In other words, the immune system refers to those aspects of the body whose direct task is to defend and protect us from the harmful effects of a host of invasive microorganisms and substances, collectively known as antigens, and including viruses, bacteria, fungi, parasites, yeasts, toxic chemicals, cancer cells, and organic or inorganic waste products.
Pilisuk and Parks (1986) identify three principal aspects of immune system functioning.
First, it can create or induce an immunity so that, even if we are exposed to a particular pathogenic agent, it will not affect us. Second, the immune system may elaborate or strengthen a particular defense so that our tolerance limits are greater… Third, the immune system may go to work by activating particular cells or substances that devour or otherwise remove the disease-causing agent (p. 42).
When we look at the immune system in greater detail, we recognize it is dauntingly complex and can inspire awe when it is contemplated. “It consists of more than a trillion cells, hundreds, perhaps thousands of chemical messengers, and an estimated 107 different activities (Achterberg, Dossey, & Kolkmeier, 1994. p. 317). As advanced as modern medical science has become, it is clear that it cannot possibly have fathomed the intricacies of more than a relatively small number of the 10 million varied activities attributed to the immune system. While some immune system components have been discovered recently, “…these newly identified cells represent still a fraction of the total population of the defense network, much of which has not yet been discovered or named (Achterberg et al., p. 327).
The immune system involves many organs, tissues and bodily fluids. According to Uchino, Cacioppo, and Kiecolt-Glaser (1996), “The major organs of the immune system are the thymus, bone marrow, lymph nodes, spleen, tonsils, appendix, and Peyer’s patches” (p. 513). Scientists have analyzed in detail the biochemical properties and functioning of a number of specific, known immune cells that are found in the blood, lymph, and tissues. Some examples follow in order to provide a glimpse of the immune system’s marvelous intricacy, and in order to define technical terms that will be referred to later in the paper in connection with studies that explore how interpersonal relationships affect immune system functioning.
The neutrophils, of which the body produces about 100 billion daily (Achterberg et al., 1994, p. 321), are among several types of immune cells called leukocytes, a synonym for white blood cells (WBC’s). They are also categorized among the cells called phagocytes, that is, cells that fight infections by engulfing and digesting antigens.
The macrophages are large, complex phagocytes that can live for years. They produce some, and have receptors for all, of the known neuropeptides, the emotion-related messenger molecules, such as the beta-endorphins. After attacking an antigen, “the macrophage saves a strip of the invader’s protein, and wears it…” to prepare other immune components for recognizing and opposing this particular adversary (Achterberg et al., 1994, pp. 325-326). Interestingly, the glial cells, which comprise 80% the brain mass and about which “very little is yet known” (Pearce, 2002, p. 67), are “macrophage-like” (Achterberg et al., p. 325).
Lymphocytes are immune cells that circulate in the lymph. These include the T-cells and the B-Cells. The T-cells are first produced in the bone marrow but then move to the thymus gland in the chest, where they mature and become differentiated into three types with different functions. These types are the Helper T’s, Killer T’s, and Suppressor T’s.
Helper T-cells coordinate other immune functions. Macrophages find them in the lymph and insert into their receptors information about a particular antigen that is a current danger. “Then the macrophage…excretes a chemical called interleukin-1 that causes this T-cell to begin replicating. The Helper T’s send out their own chemicals—lymphokines such as interferon and the interleukins, which stimulate immune activity and cellular proliferation” (Achterberg et al., 1994, p. 325). The lymphokines comprise a dozen known proteins that are considered “chemical ‘words’ with which immune cells communicate during battle” (Jaret & Nilsson, 1986, p. 728). Killer T’s target specific viruses, bacteria, and cancer cells. They “shoot their lethal proteins into the infected cells” and destroy even viral DNA (Achterberg et al., pp. 325-326). Suppressor T-cells signal that the antigens have been adequately destroyed and that the immune response can calm down so that the body’s own healthy cells and tissues are not destroyed (Achterberg et al., p. 326). The role of the suppressor T-cells is one illustration of the fact that “we are dealing with a system that has many checks and balances, many self-regulating or feedback mechanisms” (Pilisuk & Parks, 1986, p. 43).
The B-cell lymphocytes “migrate after their birth in the bone marrow” directly into the lymph nodes and vessels (Jaret & Nilsson, 1986, p. 720). When Helper T’s alert B-cells, the latter mature into plasma cells that produce specific “antibodies or immunoglobulins … that “are shaped to fit into a crevice in the invader, freezing it in its tracks,” and then the B-cells signal neutrophils and macrophages to come to destroy the immobilized antigen (Achterberg et al., 1994, p. 326).
Natural Killer (NK) cells fight against cancer cells and viruses; their Golgi apparatus fires into the antigens like a cannon. Eosinophils (about 2.3 percent of the WBC’s) and basophils and mast cells (.5 percent of WBC’s) are phagocytes with delineated functions, the former related to allergens, the latter to the beginning stages of wound healing. Memory cells, recruited from some T- and B-cells, carry information about specific antigens and “circulate for many years after the invasion is over” (Achterberg et al., 1994, p. 327). They are ready to mount a rapid and vigorous defense if the same antigen invades the body again. Still other immune cells are known as killer cells and cytotoxic T-cells, which are T-lymphocytes that attack cancer.
In view of the preceding, admittedly simplified and cursory, review of some of the known components of immune system functioning, we now need to turn our attention to the connections between the immune system and both the endocrine and nervous systems. These connections are essential to understand as they provide information about the physiological pathways through which interpersonal relationships could, as asserted above, be one of the major regulators, for good or ill, of different aspects of the immune system.
The Immune System’s Connections with the Endocrine and Nervous Systems
All systems of the human body are interrelated, interactive, and interdependent. We need to keep this holistic perspective in mind when considering how human relationships—mediated by the senses and occurring between persons who are outside the bodily borders of one another’s skin--could affect the immune system, which functions, as we have seen, in such intra- and intercellular depths as the bone marrow, thymus, blood stream, and lymph. After Pilisuk and Parks (1986) show evidence that “Social support presumably works its preventive effects through the person’s immune system” (p. 42), they affirm that they are “…obliged to recognize that the chain of physiological occurrences relevant to an individual’s disease resistance is affected by the most central activating and integrating systems of the body: the hypothalamus, the autonomic nervous system, the reticular formation, and the pituitary and adrenal glands” (p. 46). The following paragraphs of this section discuss some facets of these connections between body’s nervous, endocrine, and immune systems.
The fact that macrophages and the glial cells of the brain are remarkably similar, as noted above, suggests intriguing, as yet not understood, connections between the immune system and the brain, as does the related fact that the macrophages produce and contain receptors for the neuropeptides, whose role is to transmit emotional messages throughout the body. “Moreover, there are both anatomical and chemical connections between the immune and nervous systems that may serve to integrate their activities” (Marx, 1985, p. 43). The empirical verification of these connections refutes the earlier scientific consensus, based partially on test-tube studies and partially on lack of data, that the immune system functioned in a “largely autonomous” fashion (Marx, p. 43).
For years now scientists have recognized that stress could lead to immune suppression through the well-studied hypothalamic-pituitary-adrenal (HPA) pathway (Marx, 1985, p. 44). The sequence involved in this mechanism can be seen in the following example. Let’s say a person perceives an external threat, such as imminent job loss, and becomes aroused and worried in a generalized stress response. Consequently,
…the hypothalamic region of the brain produces corticotropin-releasing factor, which in turn triggers the secretion of adrenocorticotropic hormone (ACTH) by the pituitary. The ACTH then acts to stimulate secretion by the adrenal gland of corticosteroid hormones, which include immune suppression among their effects (Marx, pp. 44-45).
Another writer’s account of the last stage of this process expresses it this way: “During stress…the body releases large amounts of a steroid called cortisol. We know now that macrophages recognize cortisol. And when they encounter it, they can no longer respond normally to infection” (Jaret & Nilsson, 1986, p. 733). In the preceding scenario, we see the close interaction of the nervous, adrenal, and immune systems when stimulated in the stressful interpersonal context of a vulnerable employee without job security. If a person in such circumstances does not manage and moderate the stress response effectively, he or she may be at increased likelihood of succumbing to illness due to impaired immune function.
In addition to the HPA pathway, subsequent research discovered that autonomic nervous system (ANS) fibers directly innervate such key immune system organs as the thymus, spleen, lymph nodes, and bone marrow ((Marx, 1985, p. 45), which is further evidence of the interdependence of the nervous and immune systems. Additionally, Roszman of the University of Kentucky College of Medicine “found that lesions in the anterior region of the hypothalamus produce decreases in a variety of immune functions, whereas lesions in the amygdala or hippocampus lead to increases” (Marx, p. 45). Other researchers have shown how “immune effects on the nervous system might be mediated by the more typical neurotransmitters, neuromodulators, or hormones” (Marx, 1985). On the basis of all of the above evidence and more, the case has been persuasively made for the intrinsic and inseparable connections among the immune, nervous, and endocrine systems. Such research gave rise to the integrating perspective of psychoneuroimmunology (Pilisuk & Parks, 1986, p. 44). Pilisuk and Parks observed that,
The immune system has something in common with the nervous system. Both relate the individual organism to the world outside. Both systems are affected by experience and have mechanisms of memory. Both the nervous system and the immune system defend and adapt (Pilisuk & Parks, p. 42).
In view of the preceding, we are now ready to examine how our social relations with “the world outside” of other humans may affect the intricate workings of the world inside that includes our immune systems.
The Effects of Interpersonal Relationships on Immune System Functioning
From the beginnings of life, our immune systems depend literally on social support. In the first dyadic relationship, that between mother and infant, nature provides the newborn child with the wonderful immune enhancement of the colostrum that flows from the mother’s breasts for from one to five days after birth. The colostrum is so important because
…the human newborn has an undeveloped immunological capacity at birth; that is, it has no antibodies and little ability to make its own defenses against foreign invaders. The anti-body rich colostrum from its mother’s breast, which is some 15 to 20 times richer in gamma globulin than maternal serum, provides the newborn with such antibodies, and confers a passive immunity upon him for the next six months, by which time he will gradually have acquired his own antibodies (Montagu, 1978, pp. 64-65).
The colostrum “is thought to pass on to the newborn the entire set of immunities gained by the mother in her lifetime” (Pearce, 1992, p. 117). This simple, biological fact presages, I believe, the ongoing, if increasingly subtle and less immediately obvious, connections between supportive relationships and robust immune functioning. An infant who is breastfed according to nature’s optimal design at this stage of life is, I believe, neurologically imprinted with the implicit association between nurturance and interpersonal relationship.
Even in the absence of breastfeeding, babies can survive, and possibly thrive, provided they are nurtured adequately. Lacking nurturance in the first months of life, however, we wither, succumb more easily to infections, and may die. For example, in the United States, in the 19th century and into the beginning of the 20th century, more than 50 percent of all infants in their first year of life and nearly 100 percent of those in foundling institutions died from a condition variously called marasmus (Greek for “wasting away”), infantile atrophy, or infantile debility (Montagu, 1978, pp. 72-79). Babies died from marasmus even in well-off circumstances in homes or institutions that were hygienic and where they received adequate nutrition. Eventually, a few doctors, such as Fritz Talbot of Boston and J. Brennemann of New York, intervened clinically to demonstrate that what the dying infants had been missing was nurturance, as behaviorally expressed by being regularly held, hugged, caressed, rocked, sung to, and fondly gazed at by a loving caregiver (Montagu), 1978. Establishing such nurturing behaviors in orphanages, for example, led to sharp decreases in infant mortality.
It was the British psychoanalyst, John Bowlby (1969) who first postulated--in a brilliant, original synthesis of clinical, psychoanalytic, ethological, and evolutionary evidence and theory-- that attachment to a loving caregiver is a primary inborn need of human infants, that this need is not secondary to that for food or other material factors, and that the need for supportive attachment figures persists, with variations, throughout our lives. Attachment theory, as the cohesive perspective pioneered by Bowlby and Mary Ainsworth and colleagues (1978) came to be known, provides a framework within which many disparate observations about the effects of relationships on varied aspects of immune system function make sense. Bowlby was not alone in positing the primacy of relationships to our humanity. Pilisuk and Parks, (1986, p. 59) point out that Maslow in 1943 and Muray in 1938 had already expressed recognition of “a sense of affiliation or belonging…as a basic human need.
Ainsworth found empirically that empathic, nurturing mothers who are attuned to and appropriately responsive to their babies’ needs produce securely attached children. Longitudinal data have shown, for example, that “attachment security continues to be a powerful predictor of life success,” providing children with “a considerable edge in self-esteem and popularity as high school students” (Lewis, Amini, & Lannon, 2000, pp. 74-75). A prospective study begun in the mid-twentieth century on the basis of interviews of about 200 male, Harvard medical students suggests that the life success that stems from secure attachment includes healthy immune system functioning. The original interviews determined the extent to which the men perceived themselves to have benefited in infancy and childhood from nurturing parental behavior. Based on the interview results, the men were divided into two groups, those who believed they had been well nurtured and those who believed that had not been well nurtured. Forty years later, the survivors of the original study were given physical exams. “Of those who rated their parents supportive and nurturing, 25 percent had illnesses related to age. Of those rating their parents unsupportive, 89 percent had age-related illnesses” (Pearce, 2002, p. 245). The results of this study are highly suggestive that receiving nurturance in early childhood, or at least the perception one has received such nurturance, gives significant health-enhancing benefits into the later years of life. Pearce’s account of this study does not provide information about other, key intervening variables in the subjects’ lives, such as the strength and security of attachment relations in the their lives at the time of the physical exams. However, attachment theory would predict that those who had been well nurtured in their early years also had much higher probabilities of entering into and maintaining stable, satisfying, mutually nurturing relationships in later life. Berkman and Glass note (2000, p. 153) that, “The impact of social attachments made in early years on health outcomes remains an intriguing and understudied area; however, the vast body of epidemiological evidence produced to date indicates that it is adult social circumstances that are linked to poor health outcomes.” Nonetheless, according to research conducted within the theoretical perspective of attachment theory, adult social circumstances are strongly influenced by the implicit (unconscious) memory pathways of social expectation and capacity for relatedness established in the neuronal circuits of the limbic brain and the right hemisphere during the earliest dyadic relationship with the primary caregiver (Lewis, Amini, and Lannon, 2000; Schore, 2003). Therefore, as Berkman and Glass acknowledge (p. 153), both early developmental influences and current relationship circumstances are likely to have health outcomes. The impact on health in later life of the earliest attachment relationships, which we know strongly affect one’s sense of self-worth and capacity for interpersonal relationships throughout life, appears to be a promising area that merits more research.
Recent neurobiological research sheds more light on the neurological pathways through which relationships may affect immune system functioning. Schore (2003) has demonstrated how the right cerebral cortex, especially the orbitofrontal area, for the entire lifespan “plays a superior role in the regulation of fundamental physiological and endocrinological functions whose primary control centers are located in subcortical regions of the brain,” and how the right hemisphere “is centrally involved in the vital functions that support survival and enable the organism to cope actively and passively with stress” (Schore, p. 44). The research he cites and integrates also demonstrates that it is primarily through the right hemisphere and limbic brain that human beings relate to one another affectively. This is especially relevant to immune system functioning because “the early development of right-limbic interconnections into the immune system influences the etiology of a vulnerability to psychosomatic disorders…” and because “…an underactivation of the right brain is associated with a high degree of physical health complaints…” (Schore, p. 228). In other words, individuals who have not benefited from secure attachment in the beginning of their life and who do not enjoy viable, supportive relationships in the present are more likely to show deficient immune system functioning because the parts of the brain directly involved with the immune system are not functioning optimally due to social deprivation. This is an area calling for further research. Berkman and Glass (2000) state, “The literature on biological pathways is not as well developed as are other areas of social network research. We believe this is an excellent area in which to do research” (p.164).
In their extensive literature review on “social integration, social networks, and health,” which we have already cited, Berkman and Glass (2000) develop a sophisticated, multivariate, conceptual model that causally links social-structural conditions, social networks, psychosocial mechanisms, and individual pathways-- behavioral, psychological, and physiological--to interpret how interpersonal relationships may affect immune system functioning (Berkman & Glass, p. 143). Within the framework of this model, they interpret the significance of many separate studies that reveal the profound effects of relationships on health. They state, “We envision a cascading causal process beginning with the macrosocial to psychobiological processes that are dynamically linked together to form the processes by which social integration affects health” (Berkman & Glass, p. 144). At the level of what they call psychosocial mechanisms, they identify five factors: social support, social influence, social engagement, person-to-person contact, and access to material goods and resources (Berkman & Glass, p. 148). From among these factors, they acknowledge that social support--“typically divided into subtypes, which include emotional, instrumental, appraisal, and informational support” (Berkman & Glass, p. 145)--is most frequently considered to be the key to immune system vitality. If the premise of attachment theory is, as I believe, accurate, that is, if a primary need at all stages of life from the beginning to the end is close relationships involving both attachment and caregiving with other people, then the central importance of emotional support to health cannot be underestimated.
Pilisuk and Parks highlight the psychological dimension of social support as, “…going beyond the particular social, emotional, and material exchanges between people” (Pilisuk & Parks, 1986, p. 40). They affirm that social support “means we see ourselves as objects of continued caring and concern by others, for whom we also care” and that social support’s “most powerful effect seems to be in the capacity for viewing ourselves as cared for, needed, and worthy of the love of others” (Pilisuk & Parks, p. 40). When we do not view ourselves in this way because our relationships with others do not nurture us or sustain our sense of self-worth, and possibly did not do so from the beginnings of our lives, we experience stress, which, as we have discussed, ultimately depresses our immune system functioning, especially if the stress is prolonged or severe.
At this juncture of the essay, I would like to cite basic findings from some of the numerous epidemiological, public health, medical, and sociological studies that demonstrate the effects of social support and social integration, or lack thereof, on specific aspects of immune system functioning. The authors upon whose work I am drawing were themselves making secondary reviews and interpretations of the primary research of other scientists, whose studies they cite. My purpose in assembling these accounts is to demonstrate the empirical grounds for the assertion that social support enhances immune system functioning. In considering this material, we need to be mindful that, “There is no single measure of immune function, and researchers in the field of psychoneuroimmunology (PNI) have used various measures to index aspects of immune function” (Uchino, Cacioppo, and Kiecolt-Glaser, 1996, p. 513). When a particular study measures levels of a specific immune cell, such as natural killer cells or helper T-cells, for example, this does not imply that other aspects of the immune system are not also involved among the effects of certain conditions. It simply means that other aspects were not analyzed by the testing protocols in use for that study.
Marvin Stein and colleagues studied men whose wives suffered from advanced breast cancer. They found that “the ability of the men’s lymphocytes to respond to an activating agent declined significantly within a month or two of the deaths of their wives. In some of the men, the responses remained low for a year” (Marx, 1985, p. 44). We can conjecture that the men whose immune responses remained low for longer periods were those who were less connected in a social support network than was the case for the men whose recovery was faster. Another study of bereaved spouses, conducted by Bartrop and associates in Australia, “found a significant drop in one of the important T cell functions…six weeks after the death of a spouse” (Pilisuk & Parks, 1986, p. 44).
Sandra Levy found reduced natural killer cell activity and increased spread of cancer to the lymph nodes among women with breast cancer who “who suppressed their anger, lacked good social support, and were apathetic…” (Marx, 1985, p. 44). This study noted three variables associated with decreased immune system functioning. I believe that it can be reasonably argued that the lack of social support made it unsafe for the women to express their anger and also led to their apathy. If others had shown care for them, and had encouraged them to express themselves, they would have been more likely to process their feelings and to mobilize their energies for living as well as possible under the circumstances, and possibly for healing. If others had shown acceptance and love for them, they would have felt valued and better able to affirm themselves.
Glaser and Kiecolt-Glaser found reduced levels of helper T-cells and natural killer cells in medical students on the day of examinations. “Moreover, these indicators of cellular immunity were depressed even before the exams in those students shown by psychological testing to be experiencing generally higher life stresses or loneliness” (Marx, 1985, p. 44). The lonely students also had “significantly high Epstein-Barr virus (EBV) antibody titers” (Berkman & Glass, 2000, p. 155), which indicated suppressed functioning of the relevant aspects of the immune system that would destroy that virus.
Glaser and Kiecolt-Glaser “studied marital relationship and immune function in 473 women and found that the stronger and more supportive the relationship was perceived, the higher the NK cell activity” (Achterberg, 1998, p. 3).
A 17-year, longitudinal study of 7,000 Alameda County, California residents and a similar study in Tecumseh, Michigan found that “the quality and extent of the social network (how many people they felt close to and could ask for help) had the highest correlation with health and longevity out of all the variables studied…A deficient social network was associated with death from all diagnoses, including heart disease, cancer, suicide, and accidental death” (Achterberg, 1998, p. 5).
In a five-year study of 10,000 married, Israeli men, over 40 years of age, the best predictor of those who would develop angina pectoris and related anxiety was their answer to the question, “Does your wife show you her love?” Those who answered “no” were much more at risk (Achterberg, p. 7; Green & Shellenberger, 1993, p. 48).
In the mid-1960’s, epidemiologists found that, despite sedentarism, high dietary fat consumption, high rates of cigarette smoking, and high frequency of being overweight, the Italian-American residents of Roseto, Pennsylvania had half the death rate from myocardial infarction found in neighboring communities. “The researchers hypothesized that the protective factor was mutual social support” (Green & Shellenberger, 1993, p. 49). As Bruhn and Wolf predicted, when community cohesion broke down due to wider social changes, myocardial infarction rates rose.
Even the observation of social support in a documentary film appears to confer immune function benefits. McClelland showed experimental subjects films about the work of Mother Teresa and her associates who were caring for the destitute sick and dying in Calcutta. Regardless of their subjective attitudes toward Mother Teresa, viewing the film “…produced an immediate and significant increase in secretory immunoglobulin A levels in all subjects” (Green & Shellenberger, 1993, p. 49). Control groups who viewed action movies, for example, did not experience such a boost to their immune systems.
The psychiatrist David Spiegel and associates did a 10-year prospective study involving 86 women who had received traditional medical treatment for breast cancer. The experimental subjects were 50 women who participated in support groups of peers with whom they developed close friendships and could express their feelings about their illness. The control group of 36 women did not have such peer support.
At the 1-year follow-up, the women in support groups were less anxious and less depressed than the control women, and at the 10-year follow-up Spiegel and colleagues found that women in the support groups lived an average of 18 months longer than women without a support group (Green & Shellenberger, 1993, p. 50).
We can infer from this study that the longer-lived women who participated in peer support groups had better functioning immune systems, with higher levels of natural killer cell and other cancer-fighting activity.
Berkman and Glass (2000) summarize the results of 13 prospective studies with large sample populations conducted in several countries from the 1980s to 2000. In every case, the data revealed that individuals “…who are isolated or disconnected from others are at increased risk of dying prematurely” (Berkman & Glass, pp. 158-159). In an earlier study, Berkman had hypothesized that the chronic stress of social isolation leads to physiological changes that cause the body to age faster, to succumb more easily to diseases, and to decline in functions more rapidly (Berkman & Glass, p. 151). The longitudinal studies appear to support that hypothesis.
In a study of 1368 male and female patients who had undergone cardiac catherization from 1974 through 1980, those who lacked a spouse or confidant were “…over three times as likely to die within 5 years compared with those who had a close confidant or were married” (Berkman & Glass, 2000, p. 160). Other relevant indicators, such as socioeconomic class, did not influence this association.
Cohen and associates conducted a study to “…test the hypothesis that the diversity of network ties is related to susceptibility to the common cold” (Berkman & Glass, 2000, p. 164). Such susceptibility is a good indicator of the level of immune system functioning. After subjects reported on the their involvement in 12 types of social relations, they were given “…nasal drops containing one of two rhinoviruses…” The more diverse the social network of a subject, the less susceptibility to colds was shown “in a dose-response manner” (Berkman & Glass, p. 164).
Fleming and associates studied the effects of perceived social support on the stress levels of people living in the vicinity of the Three-Mile Island nuclear reactor at the time of the accident there that released higher than usual levels of radioactivity into the environment. People who rated themselves low in social support showed significantly higher urinary levels of the catecholamine norepinephrine (Uchino, Cacioppo, & Kiecolt-Glaser, 1996, p. 512), and this hormone has been shown to have effects on immune functioning. Such findings notwithstanding, “…there is a surprising dearth of research on social support and neuroendocrine processes in humans,” despite the fact that “the neuroendocrine system almost certainly serves as an important gateway between personal relationships and health” (Uchino et al., p. 524).
Conclusions
The studies cited above show strong effects of social support on immune system functioning. Different researchers have postulated varied mechanisms that link social support to health. S. Cohen, for example, suggested three possible mechanisms: (1) the social mechanism of stress buffering; (2) the psychological mechanism of inducing positive affective states; and (3) the behavioral mechanism of reinforcing health-promoting actions and habits (Uchino et al., p. 502). Berkman and Glass (2000), as discussed above, elaborate five psychosocial mechanisms—social support, social influence, social engagement, person-to-person contact, and access to material goods and resources (Berkman & Glass, p. 143). Each of these mechanisms, in their model, has several sub-mechanisms. Some researchers have observed that perceived social support, based on subjective evaluations, is actually more significant in predicting health outcomes than received support, as measured objectively by an outside observer of events (Pilisuk & Parks, 1986, p. 47; Wills & Shinar, 2000). Individuals who have a sense of options, the freedom to choose, self-efficacy, and control in their lives also have been shown to benefit from better health (Syme, 1989). Significantly, having such a sense of control of oneself and the ability to influence one’s circumstances is highly correlated with being socially integrated and supported. Another of the studied psychological mechanisms whereby social support influences immune function relates to a positive sense of self-worth, which is socially supported:
…being valued by a community of others contributes to being valued by oneself. The secure, positive, and cared for self helps restore equilibrium after destabilizing threats. Such restoration is the neural signal that helps preclude a failure in the immune system (Pilisuk & Parks, p. 54).
The evidence reviewed in this paper establishes compelling support for the view that human beings’ immune competence to resist disease and to heal from illness is greatly enhanced by social support, emotional intimacy, and mutually meaningful connections with other humans. The lack of such support, intimacy, and connection has repeatedly been empirically demonstrated to be strongly associated with poorer immune functioning, higher morbidity rates, and earlier mortality.
The research on which this paper is based reports on the presence or absence of supportive interpersonal relationships, but did not explore the impact on the immune system of a person’s involvement in relationships characterized by such negative features as abuse, neglect, shaming, violence, domination, injustice, exploitation, and oppression. However, we can hypothesize that because of the highly stressful effects of such negative features in relationships, the immune system probably suffers serious impairment. This is an important area worthy of research.
I have taken the position that healthy social support and networks later in life are developments likely rooted in secure attachment early in life. As Berkman and Glass (2000) have stated, “Research on humans and animals (both primates and nonprimates) indicates that early experiences, especially social experiences, between primary caregivers and infants, are powerful determinants of social, behavioral, and physiological development across the life span” (pp. 151-152). I believe this development necessarily involves the functioning of the immune system and have discussed some of the neurobiological grounds for this belief. The conclusion is inescapable that optimal health is, partially and to a significant degree, a gift bestowed by all the people who have genuinely cared for a person throughout his or her life. Despite cultural myths and biases idealizing rugged individualism, we are not self-enclosed monads. In fact, it has been argued, on the basis of strong evidence, that,
… because human physiology is (at least in part) an open-loop arrangement, an individual does not direct all his own functions. A second person transmits regulatory information that can alter hormone levels, cardiovascular function, sleep rhythms, immune function, and more—inside the body of the first. The reciprocal process occurs simultaneously: the first person regulates the physiology of the second, even as he himself is regulated (Lewis, Amini, & Lannon, 2000, p. 85).
Realizing this can inspire a strong sense of responsibility for how we relate to one another because our health literally depends on it.
Before closing, I wish to note that caring friendships, couples, families, and personal networks—with all their demonstrated, health-supporting benefits--are themselves embedded in and affected by wider social contexts. Some of the authors whose work has provided information for this paper have explicitly treated these wider contexts (Pilisuk & Parks, 1986; Berkman & Glass, 2000). Syme (1989) has observed, “the lower the socio-economic status position, the higher the rate of virtually every disease and condition known to researchers” (p. 4). Taking account of such variables as caste or class status in a highly stratified society leads to another level of analysis about the effects of social support on immune system functioning. It is an important and needed level, but one that is beyond the scope of this paper to treat in detail. As Pilisuk and Parks soberly state,
Yet, in a larger sense, local love is not enough. The priorities of modern industry, by cutting the funds available for local services, produce more casualties, more illness, more broken homes, more people in need than all our mutual help groups can assist. Massive involvement in warfare in poor countries creates more homeless, more refugees, more hungry, more bereaved people than support groups can help (p. 199).
While the important issues they address above are usually thought of as being economic and political, they are, at the same time, deeply matters of public health. Pilisuk and Parks recognize “…how much we need one another in the continuous fight for a more caring social order” (p. 199). Partaking in such a struggle for a culture organized around caring involves joining with others who share similar values in efforts to extend social support to those who are endangered and disadvantaged by uncaring policies and practices, which, in the final analysis, means all of us. As it turns out, participating in such activities for peace, justice and the environment is itself health-enhancing. The social psychologist John Drury and associates at the University of Sussex in the United Kingdom found (Reuters Health, 2002) that those who engage in altruistic endeavors “report their activism helps them overcome ‘stress, pain, anxiety, and depression,’ and that the results are long-lasting and provide feelings of deep happiness” (Hall, 2002, p. 41). In keeping with the theme of this paper, we see once again that being connected in supportive ways with others, both in our own social networks and reaching beyond them, is a tonic to our immune systems. Extending the circle of social support, it appears, brings health benefits to those who care and commit themselves to act altruistically on behalf of the lives of all. Our immune systems thrive in the interpersonal ambience of the caring connections, the compassion, and the love we share with one another.
References
Achterberg, J., Dossey, B., & Kolkmeier, L. (1994). Rituals of healing: Using imagery for health and wellness. New York: Bantam Books.
Achterberg, J. (1998). The healing web of human relationships. Presented at the Creating Integrated Care Seminar, San Diego, CA.
Berkman, L. F. & Glass, T. (2000). Social integration, social networks and health. In L.F. Berkman & I. Kawachi (eds.): Social Epidemiology. New York:Oxford University Press. 137-173.
Bowlby, J. (1969). Attachment and loss (volume 1): Attachment. New York: Basic Books.
Green, J. & Shellenberger, R. (1996). The healing energy of love. Alternative Therapies 2 (3), 46-56.
Hall, M. (2003). Peace quest: Cultivating peace in a violent culture. Sausalito, CA: Peacequest
Jaret, P. & Nilsson, L. (1986). Our immune system: The wars within. National Geographic. June, 1986, 708-734.
Lewis, T., Amini, F., & Lannon, R. (2000). A general theory of love. New York: Vintage Books.
Marx, J.L. (1985). The immune system “belongs in the body.” Science, 227, 43-45.
Montagu, A. (1978). Touching: The human significance of the skin. New York: Harper & Row, Publishers.
Pearce, J. C. (1992). Evolution’s end: Claiming the potential of our intelligence. San Francisco: Harper Collins Publishers.
Pearce, J. C. (2002). The biology of transcendence: A blueprint of the human spirit. Rochester, VT: Park Street Press.
Reuters Health. (2002). Protesting may be good for your health. Health eLine 2002-12-23. Retrieved December 30, 2002 from http://www.reutershealth.com/en/index.html.
Pilisuk, M. & Parks, S. H. ((1986). The healing web: Social networks and human survival. Hanover and London: University Press of New England.
Schore, A. N. (2003). Affect regulation and the repair of the self. New York: W. W. Norton & Company.
Sukhanov, A. H. et al. (1996). The American heritage dictionary of the English language. Third edition. Boston and New York. Houghton Mifflin Company.
Syme, S. L. (1989). Control and health: A personal perspective. In A. Steptoe, A. & A. Appels, (eds.). Stress, personal control and health. New York: Wiley & sons, 3-18.
Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996). The relationship between social support and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychology Bulletin,119, 488-531.
Wills, T. A. & Shinar, O. (2000). Measuring perceived and received social support. In S. Cohen, L.G. Underwood, & B.H. Gottlieb, (eds.), Social support measurement and intervention: A Guide for health and social scientists. New York: Oxford University Press, 86-137.