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Love and Survival: 8 Pathways to Intimacy and Health

Overview

The Medical Basis for the Healing Power of Intimacy

We all know that intimacy improves the quality of our lives. Yet most people don't realize how much it can increase the quality of our lives — our survival.

In this New York Timesworld-renowned physician Dean Ornish, M.D., writes, "I am not aware of any other factor in medicine that has a greater impact on our survival than the healing power of love and ...

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Overview

The Medical Basis for the Healing Power of Intimacy

We all know that intimacy improves the quality of our lives. Yet most people don't realize how much it can increase the quality of our lives — our survival.

In this New York Timesworld-renowned physician Dean Ornish, M.D., writes, "I am not aware of any other factor in medicine that has a greater impact on our survival than the healing power of love and intimacy. Not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery."

He reveals that the real epidemic in modern culture is not only physical heart disease but also what he calls spiritual heart disease: loneliness, isolation, alienation, and depression. He shows how the very defenses that we think protect us from emotional pain are often the same ones that actually heighten our pain and threaten our survival. Dr. Ornish outlines eight pathways to intimacy and healing that have made a profound difference in his life and in the life of millions of others in turning sadness into happiness, suffering into joy.

Author Biography: Dean Ornish, M.D., is president and director of the Preventive Medicine Research Institute in Sausalito, CA. He is assistant clinical professor of medicine at the School of Medicine, University of California, San Francisco, and an attending physician at California Pacific Medical Center.

Provides a review of science supporting the powerful role of intimacy in health and illness, his own struggles with intimacy.

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Editorial Reviews

Marion Woodman
The Medical Basis for the Healing Power of Intimacy

We all know that intimacy improves the quality of our lives. Yet most people don't realize how much it can increase the quality of our lives — our survival. In The New York Times, world-renowned physician Dean Ornish, M.D., wrote, "I am not aware of any other factor in medicine that has a greater impact on our survival than the healing power of love and intimacy. Not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery."

He reveals that the real epidemic in modern culture is not only physical heart disease but also what he calls spiritual heart disease: loneliness, isolation, alienation, and depression. He shows how the very defenses that we think protect us from emotional pain are often the same ones that actually heighten our pain and threaten our survival. Dr. Ornish outlines eight pathways to intimacy and healing that have made a profound difference in his life and in the life of millions of others in turning sadness into happiness, suffering into joy.
Chicago Tribune

Newsweek
Revolutionary results...Dr. Ornish's work could change the lives of millions.
Newsweek
Revolutionary results...Dr. Ornish's work could change the lives of millions.
Dr. Marion Woodman
The Medical Basis for the Healing Power of Intimacy

We all know that intimacy improves the quality of our lives. Yet most people don't realize how much it can increase the quality of our lives -- our survival. In The New York Times, world-renowned physician Dean Ornish, M.D., wrote, "I am not aware of any other factor in medicine that has a greater impact on our survival than the healing power of love and intimacy. Not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery."

He reveals that the real epidemic in modern culture is not only physical heart disease but also what he calls spiritual heart disease: loneliness, isolation, alienation, and depression. He shows how the very defenses that we think protect us from emotional pain are often the same ones that actually heighten our pain and threaten our survival. Dr. Ornish outlines eight pathways to intimacy and healing that have made a profound difference in his life and in the life of millions of others in turning sadness into happiness, suffering into joy. -- Chicago Tribune

Kirkus Reviews
Ornish, the bestselling author known for using diet, exercise, and stress management to treat heart disease Dr. Dean Ornish's Program for Reversing Heart Disease now insists that the most powerful influences on health are love and intimacy. The founder of the Preventive Medicine Research Institute near San Francisco says he knows of no other factor—"not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery—that has such a major impact on our quality of life, incidence of illness, and premature death from all causes." After backing up this claim with an impressive review of the literature supporting the healing role of social support and intimacy and the health-damaging consequences of loneliness and isolation, Ornish looks inward and describes his own personal journey to greater openness. He follows these self-revelations with a discussion of intimacy-enhancing strategies. In what is the book's least cohesive chapter, he presents a standard exercise in communication skills and briefly discusses the value of human touch, the meaning of commitment, the practice of meditation, and the role of spiritual practices and psychotherapy in developing the sense of self that is a prerequisite to achieving intimacy. Ornish then inserts a lengthy illustrative anecdote: the case of a patient whose heart disease begins to reverse after he accepts Ornish's urging to open his heart and give up his anger. The second and more compelling half of the book consists of Ornish's conversations on the role of love and intimacy in health and disease with a broad spectrum of thoughtful men and women with different perspectives: a yogi, an intuitive healer, atheologian, a sociologist, a psychologist, and many scientists and physicians.
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Product Details

  • ISBN-13: 9781402832574
  • Publisher: HarperCollins Publishers
  • Publication date: 2/1/1999
  • Pages: 298

Meet the Author

Dean Ornish, M.D., is president and director of the Preventive Medicine Research Institute in Sausalito, CA. He is assistant clinical professor of medicine at the School of Medicine, University of California, San Francisco, and an attending physician at California Pacific Medical Center.

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Read an Excerpt

Love and survival.

What do they have to do with each other?
This book is based on a simple but powerful idea: Our survival depends on the healing power of love, intimacy, and relationships. Physically. Emotionally. Spiritually. As individuals. As communities. As a country. As a culture. Perhaps even as a species.

Most people tend to think of my work as being primarily about diet. It's gotten to the point where it's hard for me to go out to dinner with people without them apologizing for what they're eating or making comments about my food—even though I make it clear that I'm not the food police.

Many stories have appeared in the media about the research I have directed for the past twenty years that has demonstrated, for the first time, that comprehensive lifestyle changes may begin to reverse even severe coronary heart disease without drugs or surgery. Almost always, these articles focus on my diet: "What do people eat?" "Isn't this diet too strict for most people?" "Are they going to live longer or is it just going to seem longer?" And so on.

I have no intention of diminishing the power of diet andexercise or, for that matter, of drugs and surgery. There is morescientific evidence now than ever before demonstrating how simple changes in diet and lifestyle may cause, significant improvements in health and well-being. As important as these are, I havefound that perhaps the most powerful intervention-and themost meaningful for me and for most of the people with whom Iwork, including staff and patients—is the healing power of loveand intimacy, and the emotional and spiritual transformationthat often result from these. While I have writtenabout thesethemes in my earlier books, the emotional and spiritual aspects ofdisease tend to get overlooked—so I decided to write an entirebook on the subject.

In this book, I describe the increasing scientific evidence from my own research and from the studies of others that cause me to believe that love and intimacy are among the most powerful factors in health and illness, even though these ideas are largely ignored by the medical profession. As I review the extensive scientific literature that supports these ideas, I will describe the limitations of science to document and understand the full range of these implications—not only in our health and illness, but also in what often brings the most joy, value, and meaning to our lives. I give examples from my life and from the lives of friends, colleagues, and patients.

Medicine today tends to focus primarily on the physical and mechanistic: drugs and surgery, genes and germs, microbes and molecules. I am not aware of any other factor in medicine—not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery that has a greater impact on our quality of life, incidence of illness, and premature death from all causes.

Cholesterol, for example, is clearly related to the incidence of illness and premature death from heart disease and stroke. Those with the highest blood cholesterol levels may have a risk of heart attack several times greater than those with the lowest levels and lowering cholesterol levels will reduce the risk of heart disease and stroke. However, cholesterol levels are not related to such diseases as complications during pregnancy and childbirth, the incidence of illness and premature death from infectious diseases, arthritis, ulcers, and so on, whereas loneliness and isolation may significantly increase the risk of all these. Something else is going on.

Smoking, diet, and exercise affect a wide variety of illnesses,but no one has shown that quitting smoking, exercising, orchanging diet can double the length of survival in women withmetastatic breast cancer, whereas the enhanced love and intimacyprovided by weekly group support sessions has been shown to dojust that, as I will describe in chapter 2. While genetics plays arole in most illnesses, the number of diseases in which our genesplay a primary, causative role is relatively small. Genetic factors—even when combined with cholesterol levels and all of theknown risk factors—account for no more than one-half the riskof heart disease.

Love and intimacy are at a root of what makes us sick and what makes us well, what causes sadness and what brings happiness, what makes us suffer and what leads to healing. If a new drug had the same impact, virtually every doctor in the country would be recommending it for their patients. It would be malpractice not to prescribe it—yet, with few exceptions, we doctors do not learn much about the healing power of love, intimacy, and transformation in our medical training. Rather, these ideas are often ignored or even denigrated.

It has become increasingly clear to even the most skeptical physicians why diet is important. Why exercise is important. Why stopping smoking is important. But love and intimacy? Opening your heart? And what is emotional and spiritual transformation?

I am a scientist. I believe in the value of science as a powerful means of gaining greater understanding of the world we live in. Science can help us sort out truth from fiction, hype from reality, what works from, what doesn't work, for whom, and under what circumstances. Although I respect the ways and power of science, I also understand its limitations as well. What is most meaningful often cannot be measured. What is verifiable may not necessarily be what is most important. As the British scientist Denis Burkitt once wrote, "Not everything that counts can be counted."

We may not yet have the tools to measure what is most meaningful to people, but the value of those experiences is not diminished by our inability to quantify them. We can listen, we can learn, and we can benefit greatly from those who have had these experiences. When we gather together to tell and listen to each other's stories, the sense of community and the recognition of shared experiences can be profoundly healing.

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First Chapter


Love and Survival

Chapter 1

Love and survival.
What do they have to do with each other?
This book is based on a simple but powerful idea: Our survival depends on the healing power of love, intimacy, and relationships. Physically. Emotionally. Spiritually. As individuals. As communities. As a country. As a culture. Perhaps even as a species.
Most people tend to think of my work as being primarily about diet. It's gotten to the point where it's hard for me to go out to dinner with people without them apologizing for what they're eating or making comments about my food--even though I make it clear that I'm not the food police.
Many stories have appeared in the media about the research I have directed for the past twenty years that has demonstrated, for the first time, that comprehensive lifestyle changes may begin to reverse even severe coronary heart disease without drugs or surgery. Almost always, these articles focus on my diet: "What do people eat?" "Isn't this diet too strict for most people?" "Are they going to live longer or is it just going to seem longer?" And so on.
I have no intention of diminishing the power of diet and exercise or, for that matter, of drugs and surgery. There is more scientific evidence now than ever before demonstrating how simple changes in diet and lifestyle may cause significant improvements in health and well-being. As important as these are, I have found that perhaps the most powerful intervention--and the most meaningful for me and for most of the people with whom I work, including staff and patients--is the healing power of love and intimacy, and the emotional and spiritual transformation that often result from these. While I have written about these themes in my earlier books, the emotional and spiritual aspects of disease tend to get overlooked--so I decided to write an entire book on the subject.
In this book, I describe the increasing scientific evidence from my own research and from the studies of others that cause me to believe that love and intimacy are among the most powerful factors in health and illness, even though these ideas are largely ignored by the medical profession. As I review the extensive scientific literature that supports these ideas, I will describe the limitations of science to document and understand the full range of these implications--not only in our health and illness, but also in what often brings the most joy, value, and meaning to our lives. I give examples from my life and from the lives of friends, colleagues, and patients.
Medicine today tends to focus primarily on the physical and mechanistic: drugs and surgery, genes and germs, microbes and molecules. I am not aware of any other factor in medicine--not diet, not smoking, not exercise, not stress, not genetics, not drugs, not surgery--that has a greater impact on our quality of life, incidence of illness, and premature death from all causes.
Cholesterol, for example, is clearly related to the incidence of illness and premature death from heart disease and stroke. Those with the highest blood cholesterol levels may have a risk of heart attack several times greater than those with the lowest levels, and lowering cholesterol levels will reduce the risk of heart disease and stroke. However, cholesterol levels are not related to such diseases as complications during pregnancy and childbirth, the incidence of illness and premature death from infectious diseases, arthritis, ulcers, and so on, whereas loneliness and isolation may significantly increase the risk of all these. Something else is going on.
Smoking, diet, and exercise affect a wide variety of illnesses, but no one has shown that quitting smoking, exercising, or changing diet can double the length of survival in women with metastatic breast cancer, whereas the enhanced love and intimacy provided by weekly group support sessions has been shown to do just that, as I will describe in chapter 2.1 While genetics plays a role in most illnesses, the number of diseases in which our genes play a primary, causative role is relatively small. Genetic factors--even when combined with cholesterol levels and all of the known risk factors--account for no more than one-half the risk of heart disease.
Love and intimacy are at a root of what makes us sick and what makes us well, what causes sadness and what brings happiness, what makes us suffer and what leads to healing. If a new drug had the same impact, virtually every doctor in the country would be recommending it for their patients. It would be malpractice not to prescribe it--yet, with few exceptions, we doctors do not learn much about the healing power of love, intimacy, and transformation in our medical training. Rather, these ideas are often ignored or even denigrated.
It has become increasingly clear to even the most skeptical physicians why diet is important. Why exercise is important. Why stopping smoking is important. But love and intimacy? Opening your heart? And what is emotional and spiritual transformation?
I am a scientist. I believe in the value of science as a powerful means of gaining greater understanding of the world we live in. Science can help us sort out truth from fiction, hype from reality, what works from what doesn't work, for whom, and under what circumstances. Although I respect the ways and power of science, I also understand its limitations as well. What is most meaningful often cannot be measured. What is verifiable may not necessarily be what is most important. As the British scientist Denis Burkitt once wrote, "Not everything that counts can be counted."
We may not yet have the tools to measure what is most meaningful to people, but the value of those experiences is not diminished by our inability to quantify them. We can listen, we can learn, and we can benefit greatly from those who have had these experiences. When we gather together to tell and listen to each other's stories, the sense of community and the recognition of shared experiences can be profoundly healing.
I am fascinated by the increasing interest in alternative medicine yet concerned that many of these remedies have little scientific evidence to support their use. I am continually amazed by the success of books making the most astonishing claims--for example, that bacon and eggs are good for you if you have a particular blood type--by authors who have never conducted or even cited a single scientific research study to support their unfounded claims even when they may be misleading and even harmful.
There is intense interest at all levels in controlling health care costs. Managed-care organizations are trying to control costs by shortening hospital stays, limiting reimbursement, shifting from inpatient to outpatient surgery, and forcing doctors to see more and more patients in less and less time--none of which addresses the more fundamental lifestyle factors that are such powerful determinants of why people get sick and why they often have a hard time changing their lifestyles. Both doctors and patients are increasingly frustrated.
Many physicians complain that it's not a lot of fun to practice medicine these days, and the quality of care is often compromised. According to recent surveys, most doctors would not recommend medicine as a career to their sons or daughters--a telling indictment of our profession. Many physicians are finding that practicing medicine only as a technician, mechanic, or plumber does not feed their souls any more than it leaves patients feeling nourished in the ways that most matter.
Dr. Mimi Guarneri is an interventional cardiologist who directs a reversing-heart-disease program, based on my work, at the Scripps Clinic and Hospital in La Jolla, California. She spends part of her time performing angioplasties and part of her time teaching her patients how to change their lifestyle.
"I recently gave a lecture to a large group of cardiologists," she told me. "At first, I talked with them about radioactive stents, a wire mesh designed to keep angioplastied arteries open by exposing them to high doses of localized radiation. Although it's a new, totally unproven method with the possibility of highly toxic long-term side effects, the cardiologists just loved the idea of these radioactive stents. They couldn't wait to try them. In the second half of my presentation I talked about our lifestyle program. Even though we have twenty years of randomized controlled trial data supporting your program, the cardiologists got so skeptical and even hostile to the idea that patients could change their lifestyle and that emotions play a role in health and illness that many left the room."
Along the same lines, about two years ago I gave a lecture to more than five thousand cardiologists who make their living performing angioplasty--about why diet and lifestyle may sometimes be a better choice than angioplasty. Not exactly the most receptive audience. I was introduced by the director of the conference, Dr. Martin Leon, an internationally admired interventional cardiologist, who said, "You're probably wondering why I invited Dean Ornish to speak at a conference on aggressive interventional cardiology. Well, because his program is aggressive interventional cardiology of a different type."
The irony is this: At a time when there is so much scientific evidence about the importance of spending time talking with people about their lifestyle and psychosocial factors, most doctors have neither the time nor training to do it. If a physician has to see a new patient every eight minutes, he or she doesn't have time to talk about the problems at home with the wife or the husband or the kid on drugs or whatever the stress happens to be at work. There is time only to listen to the heart and lungs, write a prescription, and go on to the next patient.
This frustration, in part, is why interest in alternative medicine is growing so rapidly. According to the New England Journal of Medicine, more money is spent out of pocket for alternative medicine than for traditional medicine--even though most insurance companies do not yet cover these costs.2
Why?
The desire for connection and caring is so compelling that many people will pay out of their own pocket in order to have these needs met. Doctors who make fun of these "touchy-feely" practices ignore these basic human needs at their own economic risk. Patients are voting with their feet. As a result, even conservative and prestigious medical schools are beginning to add alternative medicine (also known as "integrative medicine") programs to their curricula. This would not have happened even a few years ago.
At the School of Medicine, University of California, San Francisco (UCSF), for example, I am a cofounder of the new Center for Integrative Medicine. In this program, we are teaching and studying innovative approaches in medicine that integrate the best of traditional and nontraditional approaches to health and healing to medical students, interns, residents, fellows, practicing physicians, nurses, and other health professionals.
Whatever the differences in modalities of alternative medicine provided--acupuncture, yoga, massage, chiropractic, therapeutic touch, for example--what almost all integrative medicine practices have in common is that the practitioners spend time with their patients, they listen to them, and they often touch and help them feel nurtured and nourished.
In 1977, when I was a second-year medical student, I began conducting research to determine if the progression of even severe coronary heart disease may be reversible. At that time, the idea that heart disease was reversible was considered impossible by most doctors. It was hard even to get funding to do the research--"Why should we waste our money funding research that we know can't possibly work?" It was a catch-22: Without the funding, we couldn't do the research to see if it was possible to reverse heart disease; since most funding agencies thought it was impossible, they didn't want to support the research.
Now, this "impossible" idea has become mainstream. Why heart disease is reversible, though, has been the subject of much debate.
In a series of randomized controlled trials, my colleagues and I used high-tech, state-of-the-art technology to assess the power of ancient, low-tech, and low-cost interventions. We found that even severe heart disease often can begin healing in only a few weeks, without drugs or surgery. Using tests such as thallium scans, radionuclide ventriculograms, and cardiac PET scans, we measured overall improvement in blood flow to the heart and in the ability of the heart to pump blood; using computer-analyzed quantitative coronary arteriograms, we found that even severely blocked coronary arteries became measurably less blocked.3-24
As important as these findings were, most of these research participants and their families said that even more meaningful to them were changes that were more difficult to quantify:
* Rediscovering inner sources of peace, joy, and well-being
* Learning how to communicate in ways that enhanced intimacy with loved ones
* Creating a healthy community of friends and family
* Developing more compassion and empathy for themselves and others
* Experiencing directly the transcendent interconnectedness of life
When I have presented our research findings at scientific meetings, many of the other physicians and scientists told me that they believed the benefits of my program were due solely to diet and exercise. They thought that the stress management techniques and group support had little, if any, benefit. The fact that there are many well-done studies demonstrating the role of emotional stress in heart disease made little difference to them; neither did our finding that adherence to the stress management techniques was as strongly correlated with changes in coronary artery disease as was adherence to the diet.
Even those who believed that cholesterol is important often asked, "Why bother to change your diet and lifestyle when you can just take a pill to lower your cholesterol? Cholesterol-lowering drugs can help reverse heart disease, too."
Medications can be very useful in some cases, but they may not be the best first choice. Why take powerful drugs for the rest of your life to lower cholesterol when you can often achieve similar results with diet and lifestyle at a fraction of the cost--literally billions of dollars per year--and without the known and unknown side effects? The only side effects of changing diet and lifestyle are good ones. Also, the same diet that can help reverse heart disease also may help prevent prostate cancer, breast cancer, colon cancer, lymphoma, osteoporosis, diabetes, hypertension, arthritis, and obesity.
In addition, pills to lower cholesterol do not make you feel better. Comprehensive changes in diet and lifestyle cause most people to feel so much better, so quickly, that it reframes the reason for changing from risk factor modification or living a few months longer or fear of dying to increasing the joy of living.
More important, taking pills to lower cholesterol without addressing the psychological, emotional, and spiritual dimensions of health and healing misses an opportunity to transform one's life in ways that make it more joyful and meaningful.
If you were to look up stress in the index of summaries of one of these scientific presentations--at the annual scientific session of the American Heart Association or the American College of Cardiology, for example--you would find stress echocardiography, exercise stress testing, and stress Doppler testing, but very little about emotional stress or any other psychological factors, and nothing at all on the spiritual dimensions of the heart--even though the heart has been the symbol of love, compassion, emotions, and spirituality for thousands of years. Love is not even in the index. You might think that love would be in the domain of psychologists, yet a review of the Annual Review of Psychology (twenty-three volumes!) found not a single reference to love.25
When I searched the National Library of Medicine database from 1966 to 1997, I found 6,059,652 research publications under human, 277,175 under heart, 2,205 under love, but only four articles that mentioned both love and heart disease. Of these four articles, one was on the inventor of a new technology in pediatric cardiology and his "love both of good times and difficult problems" and one was a Japanese article on how heart transplants should be offered "out of love for mankind." Only two of more than nine million articles in the National Library of Medicine Database described the relationship of love to heart disease.
As recently as May 1997, an article in the Journal of the American Medical Association reviewed all of the known risk factors for coronary heart disease.26 While listing esoteric factors such as apolipoprotein E isoforms, cholesteryl ester transfer protein, and lecithin-cholesterol acyl transferase, it did not even mention emotional stress or other psychosocial factors, much less spiritual ones.
I want to make it clear that I am not at all against the use of drugs and surgery; when used appropriately, they may have great value. I prescribe cholesterol-lowering medications and other drugs and refer people for surgery if, for whatever reason, they are not interested in making comprehensive lifestyle changes or if they need help in addition to these changes. We do not know if patients may experience even more improvement by including lipid-lowering drugs plus comprehensive lifestyle changes. Also, in a crisis, drugs and surgery can be lifesaving.
In May 1995, I ran in a seven-and-a-half mile race called the "Bay to Breakers." It's a very San Francisco kind of race. Serious runners compete alongside with people dressed in drag or wearing costumes--or nothing at all. I usually run only about two to three miles at a time, so by the sixth mile I was getting tired and looking for an excuse to slow down. At that moment, I was surprised to see a man lying motionless on the ground--a good excuse.
I helped perform CPR with another doctor and we administered intravenous medications. Some paramedics brought a defibrillator and we were able to shock the man's heart and get it started again, and he was taken to the hospital where he underwent emergency bypass surgery.
I went on to finish the race; at the end, they gave everyone a T-shirt that said, "I survived the Bay to Breakers race," so I stopped by the hospital and gave it to the man as a souvenir. Interestingly, he is a high school English teacher in Seattle, and the surgery was performed by one of his former high school students.
Of course, I didn't feed him vegetables or teach him how to meditate when he was lying in the street; there is a time and a place for drugs and surgery. Even when these are necessary, they are just the beginning. We can then ask, "What can be learned from this experience? How did you get in this position? What can you do to help keep it from happening again?"
After recovering from bypass surgery, this man came and spent a week with my colleagues and me at one of our weeklong retreats to reduce the likelihood of ever needing to undergo another cardiac operation. At the end of the retreat, his wife gave me a beautiful poem that I now keep over my desk:
the race
A message burns the wires: he's had a heart attack.
My world goes black; blood plummets to my feet.
Just blocks away, the seven-mile human ribbon ripples
lazily as thousands throng the streets of San Francisco
walking, jogging, joking, pushing prams, He made it
over Heartbreak Hill, past the Panhandle, into the Park
then fell. His heart stopped, full cardiac arrest, dead,
in any other time or place; but synchronicity, coincidence,
miracle or fate, whatever name we give to forces
that we cannot understand, gave him another chance.

If we lived back in ancient Greece where gods personify
these forces, deciding one man should pay the price for pride,
another for disobedience, perhaps Athena would have said
of him, It's not his time. There is something he has left undone.
In hours and days of waiting, I watch monitors and charts,
learning the foreign language of ischemia, infarction,
ventricular fibrillation, plaque and platelet--that stop
the flow of vital oxygen and blood.

But other nouns
and verbs can block the pathways to the heart: moments
of our lives we let slip by through inattentive fingers,
smug confidence that makes us feel invincible.
I walk the park where flowers assail me like battalions
of wild color, hyperboles of purple, rose, magenta,
vermilion, violet, and gold. Life takes me by the neck
and shakes me hard, wake up, it's right here all around you.
This time Monet and Rumi send their messages to me.
The heart is a pump that needs to be addressed on a physical level, but our hearts are more than just pumps. A true physician is more than just a plumber, technician, or mechanic. We also have an emotional heart, a psychological heart, and a spiritual heart.
Our language reflects that understanding. We yearn for our sweethearts, not our sweetpumps. Poets and musicians and artists and writers and mystics throughout the ages have described those who have an open heart or a closed heart; a warm heart or a cold heart; a compassionate heart or an uncaring heart. Love heals. These are metaphors, a reflection of our deeper wisdom, not just figures of speech.
When I lecture at scientific meetings, hospitals, or medical schools, I always start by providing the scientific data as a way of establishing credibility. I show objective evidence from our randomized controlled trials that the progression of heart disease often can be reversed by changing lifestyle. Then I talk about what most interests me: the emotional, psychosocial, and spiritual dimensions of "opening your heart."
Afterward, I sometimes hear, "Gee, Dean, your lecture was really good until you got into that touchy-feely stuff."
Yet we are touchy-feely creatures. We are creatures of community. Those individuals, societies, and cultures who learned to take care of each other, to love each other, and to nurture relationships with each other during the past several hundred thousand years were more likely to survive than those who did not. Those people who did not learn to take care of each other often did not make it. In our culture, the idea of spending time taking care of each other and creating communities has become increasingly rare. Ignoring these ideas imperils our survival.
That which seems the most soft--love, intimacy, and meaning--is, in reality, the most powerful. This part of my work is the least well understood and yet perhaps the most important. There is a deep spiritual hunger in this country as we approach the end of the twentieth century and the beginning of a new millennium. There has been a radical shift in our society in the past fifty years, and we are only now beginning to appreciate what that really means.
The real epidemic in our culture is not only physical heart disease, but also what I call emotional and spiritual heart disease--that is, the profound feelings of loneliness, isolation, alienation, and depression that are so prevalent in our culture with the breakdown of the social structures that used to provide us with a sense of connection and community. It is, to me, a root of the illness, cynicism, and violence in our society.
Sometimes when I lecture I'll ask, "How many of you can say all four of these statements are true?"
* You live in the same neighborhood in which you were born and raised and most of your old neighbors are still there
* You've been going to the same church or synagogue for at least ten years and most of your fellow congregants from ten years ago are still there
* You've been at the same job for at least ten years and most of your coworkers from ten years ago are still there
* You have an extended family living nearby whom you see regularly
In an audience of three thousand people, maybe ten or twenty of them will raise their hands. And not just in San Francisco or New York or Los Angeles, but also in Ames, Iowa, or Omaha, Nebraska, the heart of the heartland. Fifty years ago, most would have been able to say yes.
Well, so what? What does this have to do with heart disease? What does this have to do with other illnesses? What does this have to do with health and healing? What does this have to do with much of anything?
It has everything to do with health and illness, with our survival as individuals and as a species. That is what this book is about.
Loneliness and isolation affect our health in several ways:
* They increase the likelihood that we may engage in behaviors like smoking and overeating that adversely affect our health and decrease the likelihood that we will make lifestyle choices that are life-enhancing rather than self-destructive
* They increase the likelihood of disease and premature death from all causes by 200 to 500 percent or more, independent of behaviors, through different mechanisms, many of which are not fully understood
* They keep us from fully experiencing the joy of everyday life
In short, anything that promotes a sense of isolation often leads to illness and suffering. Anything that promotes a sense of love and intimacy, connection and community, is healing. I will explore these themes in more detail in later chapters.
There is a good deal of suffering in our culture these days. It is very difficult to motivate people to make even simple changes in behavior like quitting smoking, changing diet, exercising, or even taking their medications when they feel depressed, lonely, and isolated. There are many, many ways of numbing pain, killing pain, distracting or distancing themselves from emotional pain. Some people smoke cigarettes. Others overeat, abuse drugs and alcohol, channel-surf, work too hard. Our culture provides us lots of ways to avoid pain--temporarily.
A well-known musician with heart disease came to see me. "I've been spending a lot of time at the track."
"That's good--exercise is important."
"No, not that track; the horses, man." Gambling is his way of distracting himself from his pain.
Suffering, in any of its many forms, can be a doorway for real transformation, beyond just physical and behavioral changes. Why? Because change is not easy, at least at first. If you are suffering enough, and if the strategy for numbing the pain, distracting yourself from the pain, and killing the pain isn't working that well, then the idea of change begins to look more attractive.
You may say, in effect, "Well, it may be hard to change, but I'm in so much pain--almost anything is better than this. I will give your program a try." When people find how quickly they feel better, then the choices become clearer and, for many people, worth making. The reason for changing is reframed--people change not only to live longer, but also to live better.
Most physicians are not trained to deal with suffering as a doorway or as a catalyst for transformation. We are trained to view pain as an enemy and to kill the pain as quickly as possible. If somebody comes into the emergency room with a heart attack, we give them nitroglycerin. If that doesn't work, we are taught to go to morphine or Demerol or whatever it takes to kill the pain.
Not that we should seek out pain, but the pain is there for a reason. It says, "Hey! Listen up! Pay attention! You're doing something that's not in your best interest." Pain is a messenger. Pain is information. If we don't listen to it--if we just kill the pain without listening to the message and addressing the underlying problem--it's like clipping the wires to a fire alarm and going back to sleep without putting out the fire while the flames rage higher and your house burns down. You're not really dealing with the cause of the problem.
Healing and curing are not the same. Disease and illness are not the same. Pain and suffering are not the same.
Curing is when the physical disease gets measurably better. Healing is a process of becoming whole. Even the words heal and whole and holy come from the same root. Returning healing to medicine is like returning justice to law.
In my work with people who have heart disease, both healing and curing often occur. When the emotional heart and the spiritual heart begin to open, the physical heart often follows. In our research, my colleagues and I found a remarkable correlation between adherence to my program and changes in coronary artery blockages and blood flow to the heart. In other words, the more people changed, on average, the better they got. The amount of reversal of coronary artery disease was primarily a function neither of age nor disease severity but of how much patients changed their lifestyles.
Although most people got better, not everyone did. You can follow my program perfectly, but there are no guarantees that your heart disease will begin reversing. There is an element of mystery or destiny or luck or karma to all of this. Healing may occur even when curing is not possible. We can move closer to wholeness even when the physical illness does not improve. In the process of healing, you reach a place of wholeness and deep inner peace from which you can deal with illness with much less fear and suffering and much greater clarity and compassion. While curing is wonderful when it occurs, healing is often more meaningful because it takes you to a place of greater freedom from suffering.
Just as healing and curing are not the same, neither are pain and suffering. Pain is a physical process, the neural transmission of information to your brain when you injure yourself. Suffering is the perception of that experience. Even when pain cannot be modified, the experience--suffering--can be greatly reduced. Similarly, disease is the physical manifestation of biological dysfunction. Illness is your experience of that process and your relationship to it.
Victor Frankl was a physician and psychiatrist who was imprisoned during World War II in Auschwitz, a Nazi concentration camp. He wondered why some people survived and others did not. Some people who were relatively young and healthy seemed to give up and often died soon thereafter; others who were old, frail, and quite sick were able to survive and function despite overwhelming odds. He noticed that their survival was much less a factor of age or infirmity than their ability to find a sense of meaning in the midst of this horrible experience.
This sense of meaning in their lives was not necessarily religious or spiritual, although often it was. Some people wanted to live to bear witness; others for love--to help a parent or spouse or child who was there with them. Although the reason for each person may have been different, the deep sense of meaning that the reason provided enabled them to endure the most profound pain with much less suffering. The prison guards couldn't touch it or take it away. In short, the sense of meaning helped them survive.
Many patients have told me, "Having a heart attack was the best thing that ever happened to me." Part of the physical heart may remain damaged and scarred, yet their emotional and spiritual hearts may open in ways that transform the joy and meaning in their lives. Not everyone needs to have a heart attack for this to occur, but some people have told me that without having experienced a major traumatic event like that, it would have been unlikely for these other changes in their lives to have occurred. Their suffering got their attention.
Of course, I would never go up to someone and say, "Hey, isn't it great that you've had a heart attack!" If I did, the proper response would be a punch in the nose. Nevertheless, suffering of any kind can be a doorway for opening our hearts in ways that might not otherwise have occurred. Not that we look for suffering, but we can understand its alchemy and the possibilities for transformation when it happens.
Dr. Julia Rowlands is the head of psycho-oncology at Georgetown Medical School. When she interviews breast cancer patients, she has noted that if she took the word "cancer" out of their interviews and they just talked about what kind of change in life had taken place for them, that this often would sound like some extraordinarily positive experience. In other words, they often say things like "I've gotten in touch with my values and what's important to me in a way I haven't before." "It is much clearer to me what matters." "My relationships have gotten better or it's become more apparent to me which ones I shouldn't continue."
There is an enormous clarification process that tends to take place that often leads to healing. A recent guest editorial in the Journal of the American Medical Association by Dr. David Mumford, one of my mentors during medical school, was entitled, "Thank God I Have Cancer."27 He described a patient who said:
"David . . . let me tell you something. I've been imagining how it would be if my coming death were caused by a stroke, heart attack, or some other abrupt ending. When I do, I thank God I have cancer." He paused a moment and explained. "Without this extra time, I never would have known what love and tenderness are possible between people on this earth."
This is often where healing is the most profound, even when it is difficult to measure. This is often where healing is the most personally meaningful, even when it is difficult to describe.
Telling someone who is depressed, lonely, and isolated that they're going to live longer if they simply stop smoking, exercise, and eat a low-fat diet is not terribly motivating. Fewer than 50 percent of the people who were prescribed Mevacor, a cholesterol-lowering drug, are still taking it after just one year. Just one pill a day, and it doesn't have that many side effects.
Why? We take it for granted that people want to live longer, but many do not. After all, who wants to live longer if they're unhappy, depressed, and lonely?
When we address the deeper issues--the pain, loneliness, and isolation--then people are often much more willing to make lifestyle choices that are life-enhancing than ones that are self-destructive.
Many people in our culture walk around in varying degrees of chronic emotional pain. Some have told me that if they could just go to sleep and not wake up, that would be fine with them. They may not talk about this pain because they feel as if they have no one with whom they can talk openly and share these feelings--if they did, they wouldn't feel so lonely. Since they don't talk about their emotional pain with other people, it often seems they are alone in feeling this way; everyone else seems to have it all together. With such a perception, a person becomes even more lonely, more isolated, and more depressed.
Robert Reich was Secretary of Labor from 1993 to 1997. In a review of his book, the New York Times wrote:
In Mr. Reich's Washington, everyone, including the author, wears a mask of self-assurance and competence in public. Privately, they are as befuddled and mistake-prone as everyone else, stumbling into success and failure alike.28
On the surface, it might seem that very successful people would have less emotional pain--but most of them do not. Trying to fill that void with success--whether measured in dollars, position, beauty, power, name, or fame--is like trying to quench a fire by pouring gasoline on it.
When people are unable to experience the feeling of connection and community in healing ways, they will often find it in ways that are dark and destructive. The powerful human need for intimacy, connection, and community can be harnessed for healing, as we have discussed, but also can be distorted in ways that may lead to disease, despair, and darkness.
This need for intimacy is so powerful that it may even override our basic survival instincts. Joining a gang is becoming a popular way of getting a sense of community and family, even if you have to rob or to kill somebody to join the gang. Joining a cult is another way. In Japan, a cult of people tried to poison the entire country. The members were, in many cases, the elite of the academic world in Japan. In San Diego, thirty-nine people chose to commit suicide together in 1997, many of whom already had undergone surgical castration in order to be part of that community. The need for a sense of community goes beyond us as individuals. Community can be developed in ways that bring us toward healing or, as these examples show, closer to suffering.
One way to have a sense of community is to form smaller and smaller tribes around the hatred of a common enemy. What we are often seeing around the world now is this balkanization and tribalization, the breakdown into smaller and smaller units based on seeing the differences between "us" and "them," the true believers and the heretics. Not only in Bosnia or in Chechnya, but also in the rise of political, religious, and social fundamentalism in all parts of the world. I imagine that one of the reasons why the movie Independence Day was so successful is that the entire world came together to fight the alien invaders, just as during the Gulf War Americans huddled together to watch CNN as the war unfolded on television.
When we revert to tribes to find community based on having a common enemy, we fight those who are different from us. Ultimately, it is a false sense of community, because a tribe that is unified by anger, fear, and paranoia is likely to turn that suspicion on its own members until it breaks down further and further.
We can create communities and relationships that are based on love and intimacy rather than fear and hatred. We can learn from the suffering of others. Awareness is the first stage in healing.
Likewise, we can create a new model of medicine as we move into the next century that is more competent and cost-effective as well as being more caring and compassionate. In 1984, I founded the Preventive Medicine Research Institute, a nonprofit organization dedicated to research, education, and service. This institute has enabled me to bring together an extraordinary community of dedicated people who are highly accomplished and well trained and who are very nurturing and loving. While we do not always practice what we preach, all of us share the intention to model in our relationships with each other what we are trying to teach others.
Our work is based on the premise that addressing the underlying causes of a problem is ultimately more effective than addressing only its symptoms. In this context, efforts to contain medical costs that do not address the more fundamental lifestyle choices that determine why people become sick--rather than literally or figuratively bypassing them--inevitably result in painful choices. Our program of comprehensive lifestyle changes addresses not only behaviors like diet and lifestyle but also the underlying causes that often motivate these behaviors--including the lack of love and intimacy that so many people perceive in their lives.
For the past five years, we have conducted a demonstration project to learn if our program can be an alternative to coronary bypass surgery, angioplasty, and a lifetime of medications for selected people with severe coronary heart disease. We trained teams of nurses, physicians, dietitians, group support leaders, yoga/meditation teachers, chefs, exercise physiologists, and administrators in a very diverse group of hospitals across the country.
In the past, insurance companies have been reluctant to pay for lifestyle interventions because they were viewed as increasing costs in the short run for a possible savings years later. In the new model we are studying, every patient who can avoid surgery by changing lifestyle saves the insurance company tens of thousands of dollars immediately that otherwise may have been spent, not to mention sparing the patient the trauma of having his or her chest and leg cut open.
We found that most of the people who were eligible for surgery were able to avoid it by changing lifestyle, thereby saving thousands of dollars per patient. Mutual of Omaha was the first insurance company to cover our program; now, more than forty major insurance companies are covering it in the hospitals we have trained. They are finding it is good business to help patients open their hearts.
We are grateful that the Health Care Financing Admin-
istration is reviewing the data from the patients who have been through our program in the hospitals we have trained. If they find that our program is cost-effective and medically effective in the Medicare population, then these practices may save billions of dollars per year. Medicare coverage is the primary determinant of both medical practice and medical education in this country, because we physicians get trained to do what we get paid to do. If Medicare chooses to make this a defined benefit, then other insurance companies will likely follow their lead and also provide coverage for our program, thereby making it available to those who most need it.

This book chronicles my personal journey of exploration along with my experience as a physician and a scientist. For me, the most interesting books are ones in which the writer recreates his path for the reader, rather than acting like a guru coming down from the mountain to deliver a message. I usually find that the process of discovery is more interesting than the answers.
I have written this book from my own experience, as a researcher and from my inner life. The only person I'm trying to change is myself, and that's hard enough. Sections of this book are very self-revealing in order to share with you how I came to understand the healing power of love and intimacy--my loneliness and feelings of isolation earlier in life, the mistakes I have made, and some of what I have learned along the way. I hope you will find at least some of it useful.
Chapter 2 of this book is a systematic review of the science supporting the important role of social support and intimacy in health and illness. Science gives us knowledge, but we also need wisdom; chapter 3 describes in very personal and self-disclosing terms my own struggles with intimacy in my personal life and what I am learning from that process. Chapter 4 describes some powerful strategies and techniques for enhancing intimacy that I have found to be helpful in my own life and in working with others. Chapter 5 gives a meaningful example from my clinical experience.
The scientific evidence I review in chapter 2 leaves little doubt that love and intimacy are powerful determinants of our health and survival. Why they have such an impact remains somewhat a mystery. In chapter 6, I have interviewed an eclectic group of leading authorities from disparate backgrounds--eminent scientists, psychologists, physicians, healers, theologians, authors, and others--each of whom brings a unique perspective to answering the question of why love and intimacy have such a powerful effect on our health and survival.
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  • Anonymous

    Posted November 18, 2002

    Way better than a heart attack.

    The first thing that struck me in this book is a big chapter summarizing studies showing how much impact closeness with people can have on your health. Ornish has been running a clinic for people who¿ve had a heart attack and want to recover. Research at the clinic was the first ever to show that heart disease can be reversed. Until then, it was an established ¿fact¿ that you couldn¿t reverse heart disease. You might be able to slow it down, but you could never reverse it. Ornish did. One of the key factors at the clinic is teaching people to become closer to the people they love. The patients come to the clinic after they¿ve had a heart attack and their doctor told them they probably will have another one and it¿ll probably kill them. They come to Ornish highly motivated to try anything. Ornish says, ¿Learn to be closer to people or your doctor will probably be right.¿ For the first time in their lives, relationships take priority. They learn how to become closer. Ornish tells you in the book what they teach these patients. A year or two later, these people come back to tell Ornish they¿ve never been happier in their lives! It took a heart attack for them to take relationships seriously. I decided when I read it I wasn¿t going to wait for a heart attack. This book has been a revelation to me. I have known for a long time relationships are important. I have learned how to get along with people, how to win friends and influence people, how to get people to like me and how to make them feel good about themselves, but that is all beginner material. Important, but not in the same league as experiencing closeness. Closeness is better than anything. I have changed the way I interact with people and you know what? I¿ve been a lot happier! No kidding. You¿ll find some truly helpful guidance in this book. I'm the author of the book, Self-Help Stuff That Works, and I tell you sincerely: Love and Survival will help you be closer to the people you love. It works.

    1 out of 1 people found this review helpful.

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  • Anonymous

    Posted May 1, 2009

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