S
cientific linked the health of indi-studies which viduals with their social relationships have shown that active social support can at least in part explain the long life expectancy that some people enjoy. Those who tended to isolate themselves from social contact, on the other hand, were more likely to suffer from mental health problems such as depression.Loneliness is hard to define because it is a subjective thing. A simple and acceptable definition is: a feeling of malaise or distress that the person concerned attributes to a lack of rela- tionships with other people with whom to exchange feelings and ideas and to do things. Lone- liness is due more to the quality of contacts people have than to the number of them. So it depends less upon the contacts that an individual actually has than on how he or she feels about them. A person can feel lonely even when his or her social life is objectively seen as rather active.
Three types of loneliness can be distinguished: the temporary kind, loneliness caused by significant life events such as divorce or bereavement, and chronic loneliness. Temporary loneliness is normal, for we all feel lonely every now and then, maybe for an evening, a day, a few days or even several weeks. Loneliness resulting from bereavement or other loss is also temporary but can evolve into
30
Keep in
touch
by Rene Diekstra
the chronic form, notably when the person cannot adapt to the new situation that has been created. Chronic loneliness is the kind that has the most serious consequences.
Communal life is not always without tensions, certainly, but these are generally less danger- ous than those caused by chronic loneliness and isolation. An indi- vidual who lives as part of a couple or a family tends to live longer. And after the death of a partner, the risk of illness and premature death increases mark- edly in the surviving partner.
This relationship between social relations and mortality is clearly demonstrated by research. The death rate among isolated per- sons proves to be three times that of others who enjoy active social lives. Apparently social support or social relationships have a buffering effect, which results in what some scientists call ''social immunity.''
It may well be that the variations in life expectancy among different nations can at least partly be explained by differences in social support systems. For example, the Japanese live in a rather polluted and highly industrialised country. As a nation they smoke and drink substantially and their work life is often very stressful.
Yet their life expectancy exceeds that of practically all other nations in the world.
This is not a question of race - a theory advanced by certain scientists -because the mortality rate of those Japanese who emi- grate to the United States falls into line with that of the other Americans within the time-frame of one generation. There are, however, Americans of Japanese origin who do settle in the United States yet whose life expectancy remains at the level of their home country. There are far fewer cases of cardiovascular disease and other illnesses common to
"western" civilisation among them. The question arises, what is their secret? A probable expla- nation is that they remain attached to their cultural roots and above all to the tradition that requires Japanese individuals to consider themselves as members
There is evidence that those who refuse social contact as they grow older may well be shortening their life
expectancy. Photo WHOjZafar
WORLD HEALTH ll/88
of a community or family group.
This sense of belonging defines their identity and ensures that they remain community members throughout their lives.
In most other industrialised countries, by contrast, culture is much more based on the individ- ual, on the "I", and on declared social and emotional indepen- dence from others. Some scientists suggest that the modern American and Western European way of life suffers because it neglects the bearing that social relationships have on health, even though this may be even more important than eating habits or physical exercise. The mechan- isms of social immunity are not yet completely understood, but a number of studies suggest that the psychological processes that are activated by social ties have an almost direct influence on the body's immune system.
What is clear is that social relationships can have three important positive effects. First of all, they can serve as a buffer or a
security net in the case of serious events. They enable us to cope with our grief and distress through support and also pro- vide material help. Then, rela- tionships can also form a buffer against depression. When we can at any moment find a relative or a close friend or somebody else to talk to about our troubles and fears, we are less likely to wrap ourselves in a cloak of despair and impotence that may lead to depression. And it is well-established that the state of depression undermines our resistance to illness. Thirdly, it seems that an active social life favours the secretion of certain substances in the brain known as endorphines, opiate-like substances which have a benefi- cial effect on mood and beha- viour. These same substances are secreted, for example, through regular physical exer- cise. The bottom line? An outing with family or friends can have as salutary an effect on our health as an exhausting exercise session.
STRESS MANAGEMENT Relaxation exercise
STEP 1: Sit or lie down in a quiet and dimly lit room. Make yourself as comfortable as possible.
STEP 2: Allow your eyes to close as you slowly take a deep breath.
Hold it for ten seconds. Exhale slowly and relax. Imagine the tension leaving your body as you exhale, and say to yourself "My breath flows in and out like the tides." Repeat this five or six times, then pause for twenty seconds.
STEP 3: Now tense every muscle in your body for ten seconds, then let go and allow relaxation to occur. This is called the tension-release method. As you repeat this three times, keep your mind completely free. just let thoughts come and go freely as they will. Don't focus on anything.
STEP 4: Imagine as vividly as you can a warm, soothing feeling entering your toes, penetrating deep into your feet, then passing through your ankles into the calves of your legs, and so on to· the top of your head. Keep repeating to yourself, "Calm, relax, let go."
STEP 5: Imagine the feeling moving upwards through every part of your body. Try to get the image of yourself lying there, relaxing, letting go. Feel the tension leaving your body. Your heart and lungs are working smoothly. You are calm and serene.
The feeling continues up into your neck and shoulders. Your tongue and mouth relax. Let your mouth hang open. Tell yourself, "let go."
Finally, the feeling penetrates deep into your brain. There is a soothing, relaxing peace, with nothing to think about. Your brain is calm, your entire body loose and tension-free as if you were a rag doll.
Pause for about twenty seconds.
STEP 6: Now count to yourself from one to ten and suggest that your muscles will let go even further as you approach ten. Remember, whatever it is that you seem to be doing to relax, continue it far past the point where your body feels relaxed.
STEP 7: Before you get up, you must bring yourself to an alert state of mind. Count slowly to twenty and tell yourself that when you reach twenty your eyes will open, you will be alert and refreshed. All parts of your body will be relaxed and normal.
This relaxation process should take about fifteen minutes. Don't rush it. Do it at least twice each day. It can even be practised in a sitting position while travelling on a bus or train. In time, you may speed up the process until you achieve complete relaxation in three or four minutes.
WORLD HEALTH ll/88
Authors of the month
Dr Mohamed ABDELMOUMENE is Deputy Director-General of the World Health Organization.
Dr Aulikki NISSINEN is Professor of Community Medicine at the University of Kuopio, Finland.
Dr Fritz K. KAFERSTEIN is the manager of WHO's Food Safety unit.
Dr David NABARRO is with the Department of International Community Medicine at the Liverpool School of Tropical Medicine in the UK.
Mr Valery ABRAMOV is an Information Officer with WHO's Division of Public Information and Public Relations.
Dr BIAN Jin You is a Dental Health Officer with WHO's Oral Health unit.
Dr Stoian TODOROV is a Geneva-based dentist.
Dr M. E. M. PAALMAN is Director of the Nether- lands Foundation for STD ControL She is also a member of the National AIDS Committee in the Netherlands.
Mr Philippe STROOT and Mr Andrew MOYSE are with WHO's Division of Public Information and Public Relations.
Dr Waiter LEAL FILHO is a Brazilian Biologist, specialist in Environmental Education, currently attending a PhD programme at Bradford University in the U.K.
Dr Maximilienne LEVET-GAUTRAT is a psycho- logist-gerontologist and lecturer at the University of Paris X at Nanterre. She is co-author, together with Chantal Pelletier, of Papy-Boom
Dr Michel JANCLOES is Chief of the Office of International Cooperation at WHO Headquarters in Geneva.
Dr Ken STANLEY is a scientist with WHO's Cancer unit.
Mr John MADELEY, a freelance journalist specialis- ing in development and health, is based in the U.K.
Dr Re ne Dl EKSTRA is a senior scientist in bio- behavioural sciences with WHO's Mental Health Division.
WORLD HEALTH
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IN THE NEXT ISSUE
A concerted international effort will be made very soon to "map" the human genome - that is, to locate every one of the 3,000 million pairs of nucleotides which constitute our genetic structure. An article in the December issue of World Health exam- ines some of the medical and ethical consequences. This issue. which has no single theme, looks at primary health care approaches in different countries, and reviews a new book on a strange aspect of the history of quinine.
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