亲密的情感是一剂良药
许多年前在印度乡下生活的时候,我惊奇地发现当地医院一般都不为病人提供饭菜。更让我吃惊的是他们这样做的原因:只要一个病人住院,他的家人都会过来,在病房里搭地铺睡觉,还在病房里生火做饭,尽可能地照顾好病人。
当时我就想,生病的时候有亲人或者爱人日夜陪伴在身边,帮助驱除由于疾病而产生的低落情绪是多么美妙的一件事情啊。这和西方社会中病人们的孤独情形形成了多么大的反差啊!
利用人际支持和关怀来提高病人生活质量的医疗体系也可以增强病人康复的能力。比如,病人躺在病床上等待第二天的一个大手术时难免会有些担心。在任何情况下,一个人的强烈情绪往往会传染给其他人,而且人们越是紧张、脆弱,他们就会越敏感,感染别人情绪的可能性就越大。[28]因此,如果一个忧心忡忡的病人的室友也即将接受手术,那么他们两个人很可能会使彼此感觉更加焦虑和害怕。但是如果他的室友刚刚成功地接受完手术,因此感觉相对放松或者平静的话,那么室友的这种情绪就会使他感到安心一些。[29]
我曾经问过谢尔登·科恩(鼻病毒感染实验的领导者)是否有好的建议可以提供给住院的病人,他的建议是人们要有意识地寻找生理同盟。比如,他告诉我“去认识更多的朋友,特别是那些可以让你敞开心扉的朋友”是很有好处的。在我的一位朋友被诊断出患上了一种可能致命的癌症后,他做出了一个明智的决定:他开始定期拜访精神治疗师,在自己和家人经历高度焦虑和痛苦的时候向他倾诉。
科恩告诉我:“关于人际关系和身体健康的最惊人发现就是:社交生活完整的人——那些已婚、与家人和朋友关系密切、有自己的社交圈子和宗教组织,并且经常参加社交活动的人,康复速度比较快,而且寿命也比较长。大约18项研究都证实了社交性和死亡率的密切联系。”
科恩说,多花些时间和精力去与那些可以使我们得到滋养的人相处,将有益于我们的健康。[30]他还鼓励病人尽可能地在生病期间减少与那些会对自己情绪产生不良影响的人交往,多与那些可以使自己感到心情愉悦的人相处。
科恩还建议,医院不应该只是教给心脏病患者如何避免疾病再次复发,而是应该考虑到病人的社交网络,培训那些最关心他们的人,使他们成为病人的生理同盟,共同改变必要的生活方式。
社交支持对于老人和病人非常重要,其他的一些因素却会妨碍他们实现对于温馨人际关系的渴望。其中一项就是家人和朋友面对病人时的手足无措和焦虑。特别是在病人的情况产生了不良的社交影响或者他们即将死亡的时候,周围原本亲近的人们可能会因为明哲保身的态度或者过于焦虑而无法为他们提供帮助,甚至不再来看望他们。
曾因慢性疲劳综合征而卧床几个月的作家劳拉·希伦布兰德回忆说:“我周围的大部分人都疏远了我。”朋友们会互相打听她的情况,但是“在我收到一两张问候贺卡后他们就再没有了消息”。当她主动给老朋友打电话的时候,他们的谈话总是会非常尴尬。挂断电话之后她感觉自己真傻,真不该打这个电话。
但是像所有遭受疾病折磨的人一样,希伦布兰德非常渴望交流,渴望与自己的生理同盟联系。就像谢尔登·科恩所说的那样,最新的科学发现“毫无疑问向病人的家人和朋友发出了一个信号,要求他们不要忽视或者孤立病人。即使你不知道如何去安慰他,至少也应该去探望他”。
这一建议向所有关心病人的人们表明,即使我们不知道如何去表达自己的情感,但是拜访本身就是送给病人最好的礼物。拜访本身就会对病人产生惊人的影响,即使对于大脑严重受损,似乎毫无意识的植物人也是如此,医学术语把他们的这种状态称为“最低意识状态”。如果亲人或朋友向他们诉说往事或者轻轻地触摸他们,病人的大脑会和正常人的大脑产生同样的活动。[31]尽管他们似乎毫无反应,无法进行一次眼神交流,也无法回答一句话。
一个朋友告诉我她偶然读到一篇关于从昏迷中苏醒的人们的文章。这些人说,虽然他们当时一动也不能动,但是他们经常可以听到并且理解别人对他们所说的话。她正好是在去看望母亲的路上读到这篇文章的,她的母亲在充血性心力衰竭康复后也陷入了植物人状态。看到这一观点之后,她就不再只是静静地陪在母亲身边,看她的生命慢慢流逝,而是尽可能地去和她说话,或者轻轻地抚摩她。
亲密的情感在病人身体最脆弱的时候发挥的作用最显著,比如在人们患慢性病,或者免疫系统受损时,再或者年纪大了之后。尽管这种关爱并不是万能药,但是最新数据表明它有时的确可以改变人们的生理状态。
从这种意义上讲,爱不仅可以改善病人的心境,而且还会在某种程度上产生同药物治疗一样的效果。
因此,内科医生马克·佩特斯极力主张我们应该学会辨认表明病人渴望人际关系的微妙信号,比如“眼泪、微笑、眼神甚至沉默”等,并且做出敏锐的回应。
佩特斯年幼的儿子在住院接受手术之前非常惊恐害怕、烦恼不已,而且因为发育迟缓,他当时还不会开口讲话,也不知道究竟发生了什么事情。[32]手术结束之后他躺在床上,身上插满了管子:胳膊上在进行静脉注射,一根管子通过鼻孔插进胃部,鼻孔中还有氧气管,还有一根管子把麻醉剂输送到椎管,另外一个管子通过阴茎到达膀胱。
佩特斯和妻子看到心爱的儿子这副模样心如刀绞,但是他们从儿子的眼神中感觉到自己可以通过爱意来帮助他,比如抚摩他、深情地望着他,或者仅仅在旁边看着他,什么都不做。
就像佩特斯所说的那样:“爱,就是我们的语言。”
- On choosing pleasant relationships, see Robert W. Levenson et al., “The Influence of Age andGender on Affect, Physiology, and Their Interrelations: A Study of Long-Term Marriages,” Journal ofPersonality and Social Psychology 67, no. 1(1994), pp. 56–68.
- On emotional support and biological stress, see Teresa Seeman et al., “Social Ties and Support andNeuroendocrine Function,” MacArthur Studies of Successful Aging, Annals of Behavioral Medicine 16(1994), pp. 95–106. Earlier studies have found the same relationship, emotional support lowering risk,with a range of other biological measures, including lower heart rate and blood pressure, lower serumcholesterol, and lower norepinephrine: Teresa Seeman, “How Do Others Get Under Our Skin?” inCarol Ryff and Burton Singer, eds., Emotion, Social Relationships, and Health (New York: OxfordUniversity Press, 2001).
- On older people and emotional complexity, see L. L. Carstensen et al., “Emotional Experience inEveryday Life Across the Lifespan,” Journal of Personality and Social Psychology 79 (2000), pp. 644–55.
- On a supportive environment and cognitive ability in the elderly, see Teresa E. Seeman et al.,“Social Relationships, Social Support, and Patterns of Cognitive Aging in Healthy, High-functioningOlder Adults,” Health Psychology 4 (2001), pp. 243–55.
- On loneliness and health, see Sarah Pressman et al., “Loneliness, Social Network Size, and ImmuneResponse to Influenza Vaccination in College Freshmen,” Health Psychology 24 (2005), pp. 297–306.
- On social engineering in homes for the elderly speeding neurogenesis, see Fred Gage,“Neuroplasticity,” paper presented at the twelfth meeting of the Mind and Life Institute, Dharamsala,India, October 18–22, 2004.
- On newlyweds disagreeing, see Janice Kiecolt-Glaser et al., “Marital Stress: Immunologic,Neuroendocrine, and Autonomic Correlates,” Annals of the New York Academy of Sciences 840(1999), pp. 656–63.
- Ibid., p. 657.
- There was little relationship between the verbal struggle and endocrine measures in the olderhusbands.
- Tor Wagner and Kevin Ochsner, “Sex Differences in the Emotional Brain,” Neuro-Report 16(2005), pp. 85–87.
- On the importance of personal relationships, see Carol Ryff et al., “Elective Affinities andUninvited Agonies: Mapping Emotion with Significant Others Onto Health,” in Ryff and Singer,Emotion, Social Relationships. From middle age onward men place increasing importance on theirrelationships, but still to a lesser extent than women.
- On women and caring, see R. C. Kessler et al., “The Costs of Caring: A Perspective on theRelationship Between Sex and Psychological Distress,” in I. G. Sarason and B. R. Sarason, eds., SocialSupport: Theory, Research and Applications (Boston: Martinus Nijhoff, 1985), pp. 491–507.
- On women being more sensitive, see M. Corriel and S. Cohen, “Concordance in the Face of aStressful Event,” Journal of Personality and Social Psychology 69 (1995), pp. 289–99.
- On memories and biological shifts, see Kiecolt-Glaser et al., “Marital Stress.”
- Numerous studies find that women show stronger immune, endocrine, and cardiovascularreactions to marital arguments than do their husbands. See, for example, Janice Kiecolt-Glaser et al.,“Marital Conflict in Older Adults: Endocrinological and Immunological Correlates,” PsychosomaticMedicine 59 (1997), pp. 339–49; T. J. Mayne et al., “The Differential Effects of Acute Marital Distresson Emotional, Physiological and Immune Functions in Maritally Distressed Men and Women,”Psychology and Health 12 (1997), pp. 277–88; T. W. Smith et al., “Agency, Communion, andCardiovascular Reactivity During Marital Interaction,” Health Psychology 17 (1998), pp. 537–45.
- On women’s deaths from heart disease, see James Coyne et al., “Prognostic Importance of MaritalQuality for Survival of Congestive Heart Failure,” American Journal of Cardiology 88 (2001), pp. 526–29.
- On broken heart syndrome, see Ilan Wittstein et al., “Neurohumoral Features of MyocardialStunning Due to Sudden Emotional Stress,” New England Journal of Medicine 352 (2005), pp. 539–48.
- On satisfaction and women’s health, see Linda Gallo et al., “Marital Status and Quality in Middle-aged Women: Associations with Levels and Trajectories of Cardiovascular Risk Factors,” HealthPsychology 22, no. 5 (2003), pp. 453–63.
- On holding hands, see J. A. Coan et al., “Spouse, But Not Stranger, Hand Holding AttenuatesActivation in Neural Systems Underlying Response to Threat,” Psychophysiology 42 (2005), p. S44,J.A. Coan et al., “Lending a Hand: Social Regulation of the Neural Response to Threat,” PsychologicalScience (2006) in press.
- The circuitry encompasses the insula, hypothalamus, right prefrontal cortex, and anteriorcingulate.
- On neuroendocrinology and oxytocin, see C. Sue Carter, “Neuroendocrine Perspectives on SocialAttachment and Love,” Psychoneuroimmunology 23 (1998), pp. 779–818. The data for the healthbenefits of oxytocin are strong, but in map-ping biological impacts of relationships, researchers willundoubtedly find that other neuroendocrine pathways are also involved in the mix.
- On the health benefits, see Kerstin Uvn-Moberg, “Oxytocin Linked Antistress Effects: TheRelaxation and Growth Responses,” Acta Physiologica Scandanavica 161 (1997), pp. 38–42. Whileoxytocin has a short half-life—a matter of minutes—it seems to trigger a cascade of secondarymechanisms that have broad health advantages.
- On blood pressure and oxytocin, see ibid.
- Carole Radziwill, What Remains: A Memoir of Fate, Friendship, and Love (New York:Scribner’s, 2005).
- On women and stress, see Shelley E. Taylor et al., “Female Responses to Stress: Tendand-Befriend, not Fight-or-Flight,” Psychological Review 107 (2000), pp. 411–29. See also Shelley E.Taylor, The Tending Instinct (New York: Times Books, 2002).
- On relationships as emotional regulators, see Lisa Diamond and Lisa Aspinwall, “EmotionRegulation Across the Life Span: An Integrative Perspective Emphasizing Self-regulation, PositiveAffect, and Dyadic Processes,” Motivation and Emotion 27, no. 2 (2003), pp. 125–56.
- Some argue that our overall pattern of cardiovascular and neuroendocrine activity varies to asignificant degree as a function of the emotional status of our most major relationships. See, forexample, John Cacioppo, “Social Neuroscience: Autonomic, Neuroendocrine, and Immune Responsesto Stress,” Psychophysiology 31 (1994), pp. 113–28.
- On stress and contagion, see Brooks Gump and James Kulik, “Stress, Affiliation, and EmotionalContagion,” Journal of Personality and Social Psychology 72, no. 2 (1997), pp. 305–19.
- On patients and surgery, see James Kulik et al., “Stress and Affiliation: Hospital RoommateEffects on Preoperative Anxiety and Social Interaction,” Health Psychology 12 (1993), pp. 118–24.
- In this sense, the network of people who deeply care about a patient’s well-being is anunderutilized health resource.
- On brain activity in minimally conscious patients, see N. D. Schiff et al., “fMRI Reveals Large-scale Network Activation in Minimally Conscious Patients,” Neurology 64 (2005), pp. 514–23.
- Mark Pettus, The Savvy Patient (Richmond, Va.: Capital Books, 2004).
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