Always Talk to Strangers

People who know and trust their neighbors are less likely to have heart attacks. New research builds on the understated health benefits of a sense of belonging and community.

The first time I met my neighbor, my heart did stop, briefly.

Do you remember those cylindrical, metallic “neuralyzers” that the men in black in Men in Black used to erase people’s short-term memories? I think about those things all the time. Specifically how great it would be to have one. It would be unethical to use my neuralyzer on other people, because I’m not a man in black. I would just want it for myself, for when I see or hear things I can’t really deal with. Or when I say or do things I immediately regret, which is pretty often. It would also be great at times like when I first met my neighbor.

My building has three units, and I had been living in mine for a few days before Stephen and I actually crossed paths. We introduced ourselves, talked a little about the neighborhood and our mutual intentions to be respectful and communicative, possibly even social, and then said good night. He turned and started walking to the stairs. But then he stopped and turned back.

“Oh, and, I probably shouldn’t be telling you this.”

Of the sentences I realistically expect to hear in life, that may be my favorite. Do go on.

“The last tenant in your apartment, he was your age … he died in there.”

Stop.

“But everything should be fine now,” he continued, and turned to leave again. “Well, good night.”

No one brought up this fact prior to my moving in. Stephen was right, he probably shouldn’t have told me. He would have spared me nights and nights of unwanted speculation. Gas leak? Murderous robbery? Something to do with the plumbing? But on the whole, I’m better off for having met my neighbor.

Specifically, according to new research published today from psychologists at the University of Michigan, I’m less likely to die of a heart attack than I would be if I gave in to my more introverted tendencies.

Social connection at the neighborhood level has long been known to be associated with good mental health, and some aspects of physical health. But this is the first study to look specifically at neighborhood social cohesion and heart attacks, which hit more than 700,000 Americans every year and cost everyone billions of dollars.

"There's evidence suggesting that negative factors of the neighborhood, things like density of fast food outlets, violence, noise, and poor air quality impact health,” lead researcher Eric Kim, a psychologist in his final year of doctoral work at the University of Michigan, told me. I'd add broken windows. One 2003 study found that “boarded-up housing” predicts high rates of gonorrhea in a neighborhood, as well as premature death due to cancer or complications of diabetes. (And murder.) More recently, researchers from University of Pennsylvania looked at the health detriments associated with vacant land. By their understanding, abandoned buildings lead to isolation and erosion of social relationships, mutual trust, and collective efficacy, which leads to poor physical health.

Kim’s team is focusing on the other side of things: the positive elements of a neighborhood that “might perhaps be protective or even enhancing of health." For a young scientist, Kim is precociously well versed in the language of hedging.

The study du jour, published in Journal of Epidemiology and Community Health, is based on assessments of social connectedness in 5276 adults in urban, suburban, and rural areas. The subjects rated how strongly they agreed with the following four prompts:

  • "I really feel part of this area."
  • "If [I] were in trouble, there are lots of people in this area who would help."
  • "Most people in this area can be trusted."
  • "Most people in this area are friendly."

The responses landed the participants on a seven-point Likert scale. And then they were followed. Four years later, 148 of them had experienced heart attacks.

“On the seven-point scale,” Kim explained, “each unit of increase in neighborhood social cohesion was associated with a 17 percent reduced risk of heart attacks.”

“If you compare the people who had the most versus the least neighborhood social cohesion,” Kim continued, “they had a 67 percent reduced risk of heart attacks.”

But does it really matter if you feel connected in your community, as long as you have relationships and connectedness somewhere? (Like, on the Internet?)

Rare among studies of its kind, Kim and colleagues controlled for social connectedness at the individual level. "We also controlled for dispositional factors,” he said, “thinking that perhaps optimistic people might think that they are more socially connected.” The survey included measures of optimism, and the analysis also accounted for things like age, race, income, marital status, education, mental health, and known risk factors for heart attacks like diabetes, obesity, and high blood pressure.

"Are you saying that people should get out and meet their neighbors and join community groups?" I asked.

"I don't think there's enough evidence for that,” Kim said, like a rock. “This is only a correlation; we didn't really isolate causation. But I really don't see how that could hurt."

I immediately thought of several ways. But it's more fun to envision it going well. 

“Hey, I’m your neighbor from downstairs.”

“Oh, hi. I hear you singing sometimes.”

“Cool, I hear you dancing.”

“Oh, I wish I could dance! Will you teach me?”

“No. I’m a professional dancer, so that would just be too much for me.”

“I understand! Work-life balance. I just wanted to introduce myself because I heard it’s good for my health to know my neighbors.”

“Is it?”

“Yes.”

“Oh, come in, then. I was going to go to the gym, but let’s just talk instead.”

“Perfect. We’ll both decrease our risk of future heart attacks.”

“Lovely.”

“My name is Adam, by the way.”

“I’m Evelyn. But my friends call me Eve. Nice to meet you, Adam.”

“Nice to meet you, Eve. Nice to finally meet you.”

Well, I don’t know if the Adam and Eve bit makes sense. What if it was John Lennon and Paul McCartney? No. Then we’re just dealing less with allegory and more with factual error. The point is, serendipity, talk to people.

Kim suggests that the cardiac prosperity he documented may come through people checking in on one another and noticing health problems, sharing health-related information, lending money and sharing resources, and “eyes on the street”—sociologist Jane Jacobs’ famous sociological principle that people protect people. "Since I'm a psychologist,” Kim said, “I also really believe in how helpful emotional support can be in buffering against the toxic effects of stress."

The field of psychology has since the beginning, primarily focused on dysfunction. Researchers who identify as positive psychologists like Kim—a set that broke ground with eminent University of Pennsylvania professor Martin Seligman’s 2002 bestseller Authentic Happiness: Using the new positive psychology to realize your potential for lasting fulfillment—look at benefits of things like optimism and a sense of purpose in life. Kim and colleagues have specifically looked at the effects of “positive” dispositions on health.

New Yorkers crowd onto 42nd St to see "Manhattanhenge," July 2014 (Carlo Allegri/Reuters)

"We're finding things like that increased optimism is associated with reduced risk of heart failure and stroke,” Kim said.

"Is optimism something one can learn?" I asked, doubting that it was.

"Yeah, the great thing is there's already randomized control trials showing that optimism and life satisfaction can actually be reliably enhanced," Kim said.

"If we find enough of these correlational studies,” he continued, “maybe we can use the existing interventions and tailor them as health interventions. But that's kind of our five-year vision.”

It's difficult to build tight-knit communities, but it's less difficult to help people feel connected. A major point in this study is that it didn’t measure actual social cohesion, just the subjects' sense of it. The journal article concludes: "Higher perceived social cohesions may have a protective effect against myocardial infarction." Emphasis mine. Does it matter if you have something, or just that you believe you have it? Everyone will define and understand cohesion differently. What do you consider trustworthy? Friendly? Does helpful mean calling 9-1-1 if you believe your neighbor is being murdered, or do you have to bring them soup whenever they look sad?

In a scathing but very funny take on this line of research, writer Barbara Ehrenreich has called positive psychology “a crock.” Her 2010 book Bright-Sided: How positive thinking is undermining America makes a case that cultivating positive emotion actually just another Calvinist mechanization of happiness as a means to an end in a brutish world. Immersing ourselves in positive thoughts is akin to John Calvin’s notion that we should immerse ourselves in work. 

Seligman conceded in Authentic Happiness, "When an entire lifetime is taken up in the pursuit of positive emotions, however, authenticity and meaning are nowhere to be found." He distilled six virtues to which one might aspire: wisdom and knowledge, courage, love and humanity, justice, temperance, spirituality and transcendence. Confusing on its face, he implored readers to "strive for more gratifications, while toning down the pursuit of pleasure." Ehrenriech called out Seligman for advocating “higher” forms of pleasure like "playing three sets of tennis, or participating in a clever conversation, or reading Richard Russo,” where things like watching sitcoms, masturbating, and inhaling perfume he deemed base "pleasures."

“This seems unnecessarily judgmental,” Ehrenreich notes in the book, “and not only because Richard Russo is not exactly Marcel Proust.” Sizzle.

“Courage, for example, could take one very far from the ‘positive emotions,’” she wrote, describing an interview with Seligman while were walking through the Monet gallery, “with their predicted positive effects on health and success, and into dangerous and painful situations, just as spirituality could lead to social withdrawal, fasting, and self-mortification. In fact, I blathered on, the conventional notion of ‘character’ seems to include the capacity for self-denial, even suffering, in pursuit of a higher goal.”

So, there's a lot that goes into cultivating positive emotion. Maybe Kim's five-year projection is optimistic, but we’ll see.

Recently a guy came to my apartment to change out the window air conditioner, which had become basically a heat circulator. And, making conversation, he was like, “Looks good in here.”

“Thank you.”

“The guy before you, he was stinking up the joint.”

Even knowing the one thing I knew about the previous tenant, I assumed the repairman was talking about me not letting the place smell bad. “Well, I try to keep it clean.”

“No,” he said. “He was dead.”

What is it with people wanting to tell me this? But it's good to know that even if Stephen hadn't told me, I would’ve found out anyway. And it may be good for my heart to have had some social connection with the neighborhood handyman. But still, neuralyzer.

Presented by

James Hamblin, MD, is a senior editor at The Atlantic. He writes the health column for the monthly magazine and hosts the video series If Our Bodies Could Talk.

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