Amanda: Hey guys, welcome back to the podcast. I'm Amanda.
Laura: I'm Laura.
Kendra: and I'm Kendra.
Amanda: And today we're going to talk about the importance of social connections and specifically something called the Roseto effect. So I'm going to start out. I had first heard of this phenomenon when I read Lisa Rankin's book, Mind Over Medicine. And then I read Malcolm Gladwell's book, Outliers. He also talks about the same thing. So then I became super fascinated with what happened in Roseto, Pennsylvania. Some background, in 1882, 11 residents from a small town in Southeast Rome or southeast of Rome, it's called Roseto Valfortore, Italy. I'm sure I butchered that. Somebody who's Italian is rolling over like, Oh My God! They relocated to Bangor, Pennsylvania. Those 11 sent word back home, because in the original home country town they all worked in marble quarries and in Bangor, Pennsylvania, there were slate quarries. So it was very similar work and they sent word back home that there were tons of jobs in America. So what ended up happening was 1200 people from this town in Italy, relocated to Bangor, Pennsylvania. Since there were so many of them, they ended up moving a little out from town and they developed their own little town that they named after their home country Roseto. But here is the weird part. At the time, this was like in the 40s, 50s, by the time everybody got there, heart disease was rampant in the United States and everyone was out trying to figure out how to prevent this, what to do. How do we fix this problem in the United States? A local doctor had mentioned it to Dr. Stewart Wolf, who at the time was the head of medicine at the University of Oklahoma, that there was this little pocket of native Italians in Roseto that didn't have any heart disease. Or phenomenally lower heart disease than what was prevalent in the United States. So for 17 years, Dr. Stewart Wolf came and was trying to figure this out so that they could extrapolate it and help the rest of the United States. They thought that, well, it probably, it's gonna be, you know, nutrition, the Mediterranean diet that they had brought with them from Italy. But it turns out, no, they had abandoned olive oils in lieu of lard. They were using lard just like everybody else at the time. They were eating the thick crust pizza. They were consuming sausages and hams and salamis and all of these processed foods that everyone cringes at now. They, in fact, there's a quote. “They ate salami with abandon”. 41% of their calories came from fat. They barely exercised. They smoked like chimneys and many were actually considered obese at the time. So that wasn't it. So then he thought, well, maybe it's genetics. So he studied their ancestors and turns out that wasn't the issue either. The other interesting thing about this town at the time was that there was no suicide. There was no alcoholism. There was no drug addiction. There was no crime. People died of old age, usually like 90’s or 100. Which is crazy at that time. So the only thing that they could come up with was that there was something about this town and their social solidarity that was somehow more important than any of the things that they thought, you know, medically were important for longevity. That this social solidarity was what it was. And they noticed that it was incredibly common to stop by each other's homes all the time, just to chat. They cooked for each other and attended church together. There was no welfare because they all took care of each other and many had multiple generations living in the same home. There is an article about one of the kids that grew up in these homes and they would gather every night and tell stories over the same stories over and over and over, there just was a shared culture that was very unifying and everyone was part of the group. A thing that stands out to me is that their elders were respected and included. And that's something that I think we do a particularly bad job of in the way that the United States is currently. So, what happened though was in the 1960s the kids moved away and this heart disease free town then normalized to the same statistics that the rest of the United States did. So it does seem like this pocket of social solidarity was the most protective thing. And that's why these people did not have any heart disease because the second everybody moved away, it went back to baseline. So I just thought that was absolutely fascinating and something that we don't talk about as much. You know, do you smoke? They did. What's your body weight? They were obese. Are you using olive oil? They use lard. You know what I mean? It just is incredible. And I feel like I don't pay very much attention to my patient's social connections. And maybe that's the most important thing. I don't know.
Laura: Well, I just find that amazing and not only for our patients, but for ourselves as well for this information. Like, maybe even we need to worry about it more for ourselves, because it seems like we are hearing more and more often about doctors having major problems, taking their own lives. Yeah. And it's just so hard. We do so much work. We're, you know, we are busy, busy people. Yes. We have families, but we're focused on helping them to succeed as well. And it's just, I don't know. I don't know. Seems like there's something we're missing that the people from Roseto, like they knew something that maybe we don't. So talking about loneliness, loneliness is something that is kind of the opposite of the Roseto effect. If we look at what it does, I guess not for our health, but against our health. It's striking. There was a study from EuroHeartCare 2018 that studied loneliness and its effect on our hearts. Loneliness apparently is associated with poor outcomes in all patients, regardless of their type of heart disease, even after adjusting for age, level of education or other diseases, BMI, smoking, and alcohol intake. It doubles mortality risk for women and nearly doubled the risk in men. A study out of Harvard, 36% of all Americans, including 61% of young adults and 51% of mothers with young children feel serious loneliness. Isn't that crazy? How many of us feel lonely? And I think that the pandemic probably has not helped that. We spent so much time isolated and we, especially since the advent of the iPhone, we have spent more time online than we have had face to face interactions with people. I think most of us would probably agree that social media doesn't generally make us feel less lonely. A lot of times, we feel increased stress because we spend time on social media. From the campaigntoendloneliness.org, there are some other interesting statistics. Loneliness is likely to increase your risk of death by 25%. Loneliness and living alone and poor social connections are as bad for your health as smoking 15 cigarettes a day. That is crazy to me. Loneliness is worse for you than obesity. It causes increased high blood pressure, heart disease, stroke, severe depression, early mortality and even dementia. Okay. That is terrifying. So, yeah, we need to really focus on, not just our patients' loneliness, but our own loneliness and the loneliness of the people immediately around us.
Amanda: And ourselves. I mean, it seems like female physicians, when we get together and we talk about this a lot. That we feel different than maybe other mom groups. And I don't know if that's self isolation. I don't know what that is, but I'm sure male physicians feel it too. I don't know. But we're gonna have to be very intentional with getting plugged into social support groups and the statistics you said about like the mothers with early children. I felt like that was a very lonely time. Like you're all of your energy is spent keeping these rugrats alive with no adult conversations. I thought it was terrible. I understand why villages exist now. Where it's just like a mass of people, that would've made it so much easier. But, that's not how my experience of raising young children was. I did feel very isolated and that's just something good to know that I'm not alone. 51% apparently feel that way, but maybe let's do something about it, you know?
Kendra: Yeah. I feel the same way. I think another way that even maybe increased that feeling of loneliness is not only energy you spent to keep your children just alive and fed and slept, but it was not realizing how much less that means we took care of ourselves. And so maybe being more intentional about that village or creating that village no matter where you are to help with that. Because number one, you show up as a better mom, if you have your own back. And we've talked about this in several podcasts, just considering that you also need, you know, a connection with someone to vent with someone or someone that, you know, is going through that same stage of life. So you can just bounce ideas off of each other.
Amanda: It's so funny to me too, cuz I think we're all genX, maybe not you Kendra, but like we got kicked out of the house for 15 hours a day. Like my parents had no idea where I was and that was normal. But, today, like you're expected to helicopter parent. It's exhausting. That's not how it was forever.
Kendra: Oh yeah. I remember being kicked out. Yeah. I remember my mom, like, “Okay, you gotta go out!” I'm sure she probably locked the door. I think we had the garage code and that was like the only way we could get in and get shade. And there was a refrigerator in the garage. You could get a bottle of water or the hose. But it was expected not to return until the dinner bell.
Amanda: Yeah. Yeah. And I don't know what they were doing. Hopefully they were hanging out with other adults and like bonding and making a little community or something. I don't know what they were doing because I wasn't allowed in.
Laura: They were drinking martinis and smoking their cigarettes.
Kendra: I'm sure. I'm sure they were getting those 15 cigarettes in for that brief couple hours that we were outside. Another study or another interesting phenomenon was this rat park phenomenon. Researchers in the 70’s conducted a study where they put rats in a cage with water and then drug-laced water. And if the rats were by themselves, then they would drink the water that was laced with drugs, OD and then die. Dr. Bruce Alexander wondered if it was more about the drug or the enticement of the drug or the way the drug made them feel that they just kept wanting more and more and died, or was it the setting? So he created what he called a “rat park”. This is where they would put rats in larger cages. They were free to socialize with each other, play with each other. They were free to mate and do all the normal rat activities. And they were also equipped with the same bottles, plain water and then water laced with drugs. In this scenario, the plain water was actually prefered. When the drug water was consumed, it was only consumed in small amounts and no rats overdosed. So when they were allowed to be in these free range cages and allowed to socialize with other rats and do their normal rat activities, play, mate. There were no rat overdoses. So he coined a term that a social community actually beat the power of drugs. Which is interesting because you would think rats in their primal sense on the animal level would be, what do I say, trained or they would have that drug water and then just be trained that, oh, I feel great and keep going back to it. But that wasn't the case, when there was a sense of community, when there were, you know, other rats around, they actually preferred to drink plain water. Man. What does that big picture say about how important community is?
Amanda: Yeah, totally. I just remember being paranoid. I don't know if it was the 80’s or 90’s or whatever. They were like, “one hit of crack and you'll never be back”, you know, all that sort of stuff, was terrifying. And maybe that is true for a lot of people, but they would never talk about how social support and communities are so healing for so many people. And I do think somebody who's terribly lonely, and all that, of course you would get addicted to drugs because you get that massive dopamine hit in the absence of social connections. So I don't know. It just kind of like, why were we not, we're so focused on the one, on the negative, right? But why are we not investing more money in making human rat parks, right?
Laura: You know, or like, or even fostering that, or even teaching kids how to interact with each other in a way that supports each other. You know, I had a patient recently who came in for suicidal ideation and his dad said he's on video games, many, many hours a day. As many of these kids who come in with psych issues are. And the kid was like, his dad was like, he's not even interacting with any of his friends from school. He's just interacting with people online. And kids, like the kids at school, are mean. The people who used to be my friends are mean to me now. And these are the people that I can interact with who are not mean. And if they're mean, I can just turn it off. And I feel like so much of this stuff starts in school and it's kind of like, Lord of The Flies, in school where kids just get to say whatever mean stuff and then they don't know how to connect with each other in a productive way.
Kendra: These kids don't even know how to connect with each other and build that community. They don't even know how to start a conversation where they discover their likes. I mean, I can remember early on in elementary you were friends with people that either liked to do what you did on the playground, or sat by you at lunch, or you already knew cuz you played tee-ball with them or gymnastics or something. You know, they went to your same school. So there was that sense of community there, even outside of school. And just like we talked about, I mean, even the kids in my neighborhood, you know, when I would get locked out of my house, you go ride bikes with your friends in your neighborhood for hours, you know, and you just had this neighborhood community. So what can we do about this? When we talk about community and we talk about the importance of, you know, a social structure or a social community, some questions we can ask ourselves. Like, who do you care about in your life? And we talked about how important families are or how important marriage is, if you're married.
Amanda: If you have a good spouse, cause the data might say something opposite. If you're in a bad marriage, it's a health hazard. So, working on having a good marriage would be good or getting out of a terrible marriage might be actually, you know, who knows, but a good marriage would be very protective.
Kendra: Yeah. And you know, the other thing about that is sometimes working through some of these issues, even if, just like in that colony or that community of Roseto I'm sure those families had drama. That community had drama. There's no way, despite all of that, it seems like even just having that community, you know, they had to work through some stuff and probably even a closer, tighter knit community when you work through stuff and go through stuff. Knowing that it wasn't all chirping birds and sunny skies, I'm sure they had to work through stuff and. You know, the importance of having, you know, a network where it not only helps you in your good and happy times, but also working through those tough times. Another question we can ask is, who cares about you? Just like we talked about a spouse in a marriage or your family, your mom, your dad, if that's a healthy relationship, your siblings. Once again, you know, if those are healthy relationships, regardless if they're even living close to you. Like we saw in the tight knit communities, you know, just being intentional about keeping that community fresh and on the regular so that you don't let it go months to days to weeks before you connect with those people that are important to you. Another question you can ask that goes along with this is, when was the last time you spent time with people who are good for you? I know as physicians, we are busy people, especially us as women who carry the burden of all the things at home, like raising kids, keeping your home from spontaneously combusting, and then holding down all of our responsibilities at work, you know, that can be extremely time consuming. And at the end of the day, really, you just wanna plop down on the couch and scroll, or we've talked about this before, binge and Netflix, or just something where you can just completely not think about anything and just numb out. But I guarantee you, some of my best memories are when I've either been intentional about setting a girl's night or something. And you go with a couple of girls out and even if it's for a couple of hours and you laugh, you talk about funny things, you vent about your husbands or your marriage, whatever, you vent about your kids and it's funny and you laugh until you almost pee your pants. I tell you that dopamine hit for me...I was never addicted to drugs, but I'll tell you that is so good for me. When I come home from that, I sleep better. I have great fond memories and, you know, as more intentional as I would like to be about that. I do have very great memories of coming home from just community with other women that are in my same season and just having such a great time.
Amanda: Yeah, I think that's one thing now that I am aware that it's more important than my BMI, more important than not smoking, like just making it a priority. I'm much more inclined to be. You know what? This is far more important than folding laundry. I mean, honestly, I don't need to check all the tasks off my to-do list. I need to go and be with my people. That is more important. I think now you have permission to choose yes. When it is a group of people who are good for you, say yes! It is more important than probably anything else you're gonna do that day.
Kendra: Especially when I just said we're so busy, if there's an opportunity that arises that you all can get together and have like a night or an afternoon, or like, let's go get coffee and the stars align where you're all able to do that, drop what you are doing and go! You have permission, just go! That is definitely something I need to work for, cuz I know in my own life. I almost see that as a reward. So I'm like, okay, I'm gonna get all this schoolwork done because I'm in my coaching training. And then I'm gonna do the laundry and unpack and my reward is going to coffee, whatever, you know, and I need to work on that. I need to change that thought that I just get these opportunities as a reward, but if I don't get all the things done, then I shouldn't be able to reward myself with that.
Laura: I love the idea of setting aside some of the mundane things that we do and prioritizing people instead. And I think, you know, we three are emergency physicians, so our schedules can be kind of crazy. And so that makes it harder to do regular social events, especially with our colleagues, but if we're intentional about it, we can make it happen. One way that we can do it is if we, when we're taking vacation, if we want to take a vacation with some friends. That is a great way to solidify those relationships and reconnect and get that additional social connection that we need.
Amanda: I think that's why church makes a lot of sense for a lot of people as long as you feel included and all of that sort of thing. If you aren't into church, then intentionally find a group that is interested in the same sort of thing. Just find something where you are being nourished in your soul, you know, and connecting with people, again, that are good for you. That's the big thing, that are good for you, that actually care about you. And so I identify as mostly an introvert, so I can hear the introverts, like, what are you talking about? That's awful. But you know, there are people who feed you. I am not saying you gotta do it like this place in Roceto. I'm like, I don't know if I could have made it if the people were just stopping in each other's homes all the time. Like, oh my God, that's my worst nightmare.
Kendra: Right. I totally identify with you, Amanda.
Amanda: But maybe I would get used to it. I mean, I don't know, but, but knowing that it's more important than not smoking 15 cigarettes. I'm like, okay. I see, I see this. Yes. I'm gonna seek out my people that I do love hanging out with, and I'm gonna do that a lot more.
Laura: Yeah. I also identify as an introvert, but can definitely see the value of this. It doesn't mean I don't want my alone time cuz I definitely do. And I seem to not get much of it. But spending time with other people. And when you talk about people who are good for you, just remember, those are the people who are going to help you feel good about yourself. They're not gonna be criticizing you. They're gonna be excited for your success and encouraging of you. That's what it looks like to be around people who are good for you.
Amanda: So I will say as a caveat, like we're down on social media, but I'm part of some social media groups that are very uplifting and are very encouraging and help each other. Just be aware of how you feel after you're interacting. If it's a positive thing, okay, fine. But then the stuff that is not good for you, then you will know.
Laura: I think that's totally fair. And like a prime example of that would be, Physician Moms Group. So many physician women felt lonely and here's this group of people who are like them and it has evolved into a huge phenomenon. So yeah, there's definitely groups that make you feel good, but if you're like scrolling Kardashians and stuff like that, you probably are not gonna be left feeling awesome afterwards. I don't know. Maybe you will, not me.
Kendra: So, this topic of community and getting out and feeling good about people that make you feel good. And all of these things that we've talked about today have really been a great awareness. But also have been a great conversation and a challenge we want you to leave today with is, who can you call or spend time with in the next couple of days that will be good for you? That will make you feel good. That will refresh your soul and above all, make you laugh and laugh hard and laugh without restraint. Because we know laughter is the best medicine.
There's a quote from Mother Theresa. It says, “If you want to change the world, go home and love your family”. So we challenge you today. Find your people. Call or spend time with them in the next couple of days. And until next time, you are whole, you are a gift to medicine and the work you do matters.
