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By Frank Moher On this dreadful day, I don’t want to write about the shootings in Orlando. I want to write about my friend, Rick. Rick lives just outside of Nanaimo, a city of about 80,000, across the water from the island I live on. He’s been a celebrity there for a long time, first as the city’s […]

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I’m not known for wearing outfits that are as completely covered up as this. Often, you are uncomfortable on the red carpet, worried that something is going to pop out, unzip or break. There was something about this look that felt like protection and armour to me. I wore it to the 2018 CFDA fashion awards and I loved how extreme it felt: chic and strong, slightly androgynous but with a femininity to it. It came together nicely with no stress – until I was in the car, when I realised I was having some kind of allergic reaction to my makeup! One of my eyes swelled up right before I was stepping out on to the red carpet. I panicked and put on my reading glasses to camouflage the fact that one eye was almost completely shut!

As a teenager, my relationship with apparel was fraught because I never cultivated my own style. My mom and I bought everything from thrift shops – I would wear the same jeans all year and then cut them into shorts – but every time I would go on a set I would be decked out in designer clothes. There was a disconnect: clothes were just something belonging to other people that I would embody, and then shed.

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2 What was the destination of the First Fleet?
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8 Thomas Neuwirth won Eurovision under what stage persona?
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14 Harmost; satrap; voivode; bey; subahdar?
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Roy Uwe Ludwig Horn, whose collaboration with Siegfried Fischbacher created the well-known animal training and magic duo Siegfried & Roy, died of complications from COVID-19 Friday in Las Vegas. He was 75. Horn had revealed on April 28 that he had tested positive for coronavirus. “Today, the world has lost one of the greats of […]

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My mother-in-law, Carol, lives alone. It was her 75th birthday the other day. Normally, I send flowers. Normally, she spends some part of the day with the family members who live nearby and not across the country as my husband, Mark, and I do. And normally, she makes plans to celebrate with a friend. But these are not normal times. I was worried about sending a flower delivery person. Social distancing means no visiting with friends or family, no matter how close they are. So, my sister-in-law dropped off a gift and Mark and I sang “Happy Birthday” down the phone line with our kids. But I could hear the loneliness in Carol’s voice.

This was hardly the worst thing anyone experienced in America on that particular April day. We are fortunate that Carol is healthy and safe. But it upset me anyway. People over 60 are more vulnerable to COVID-19 than anyone else. They are also vulnerable to loneliness, especially when they live alone. By forcing us all into social isolation, one public health crisis—the coronavirus—is shining a bright light on another, loneliness. It will be some time before we have a vaccine for the coronavirus. But the antidote to loneliness is accessible to all of us: friendship.

Those who valued friendship as much as family had higher levels of health and happiness.

All too often we fail to appreciate what we have until it’s gone. And this shared global moment has illuminated how significant friends are to day-to-day happiness. Science has been accumulating evidence that friendship isn’t just critical for our happiness but our health and longevity. Its presence or absence matters at every point in life, but the cumulative effects of either show up most starkly in the later stages of life. That is also the moment when demographics and health concerns can conspire to make friendships harder to find or sustain. As the world hits pause, it’s worth reminding ourselves why friendship is more important now than ever.

Friendship has long been understood to be valuable and pleasurable. Ancient Greek philosophers enjoyed debating its virtues, in the company of friends. But friendship has largely been considered a cultural phenomenon, a pleasant by-product of the human capacity for language and living in groups. In the 1970s and 1980s, a handful of epidemiologists and sociologists began to establish a link between social relationships and health. They showed those who were more socially isolated were more likely to die over the course of the studies. In 2015, a meta-analysis of more than 3 million people whose average age was 66 showed that social isolation and loneliness increased the risk of early mortality by up to 30 percent.1 Yet loneliness and social isolation are not the same thing. Social isolation is an objective measure of the number and extent of social contact a person has day to day. Loneliness is a subjective feeling of mismatch between how much social connection you want and how much you have.

Once the link between health and relationships was established in humans, it was noticed in other species as well. Primatologists studying baboons in Africa remarked that when female baboons lost their primary grooming partners to lions or drought, they worked to build bonds with other animals in place of the one they’d lost. When the researchers analyzed the social behavior of the animals and their outcomes over generations, they found in multiple studies that the animals with the strongest social networks live longer and have more and healthier babies than those that are more isolated.2 Natural selection has resulted in survival of the friendliest.

Since baboons don’t drive each other to the hospital, something deeper than social support must be at work. Friendship is getting “under the skin,” as biologists say. Some of the mechanisms by which it works have yet to be explained, but studies have demonstrated that social connection improves cardiovascular functioning, reduces susceptibility to inflammation and viral disease, sharpens cognition, reduces depression, lowers stress, and even slows biological aging.3

We also now have a clearer definition of what friendship is. Evolutionary biologists concluded that friendship in monkeys—as well as people—required at least three things: it had to be long-lasting, positive, and cooperative. When an anthropologist looked for consistent definitions of friendship across cultures, he found something similar. Friendships were described as positive, and they nearly always include a willingness to help, especially in times of crisis. What friendship is about at the end of the day is creating intensely bonded groups that act as protection against life’s stresses.4

Social connection reduces depression, lowers stress, and even slows biological aging.

That buffering effect is particularly powerful as we age. Those first epidemiology studies focused on people in the middle of life. In 1987, epidemiologist Teresa Seeman of the University of California, Los Angeles, wondered if age and type of relationship mattered for health.5 She found that for those under 60, whether or not they were married mattered most. Being unmarried in midlife put people at greater risk of dying earlier than normal. But that did not turn out to be true for the oldest groups. For those over 60, close ties with friends and relatives mattered more than having a spouse. “That was a real lightbulb that went on,” Seeman says.

In a 2016 study, researchers at the University of North Carolina found that in both adolescence and old age, having friends was associated with a lower risk of physiological problems.6 The more friends you had, the lower the risk. By contrast, adults in middle age were less affected by variation in how socially connected they were. But the quality of their social relationships—whether friendships provided support or added strain—mattered more. Valuing friendship also proved increasingly important with age in a 2017 study by William Chopik of Michigan State University. He surveyed more than 270,000 adults from 15 to 99 years of age and found that those who valued friendship as much as family had higher levels of health, happiness, and subjective well-being across the lifespan. The effects were especially strong in those over 65. As you get older, friendships become more important, not less; whether you’re married is relatively less significant.7

There’s a widespread sense, especially among younger people, that people are lonely post-retirement. The truth is more complicated. Social networks do get smaller later in life for a variety of reasons. In retirement, people lose regular interaction with colleagues. Most diseases, and the probability of getting them, worsen with age. It’s more likely you will lose a spouse. Friends start to die as well. Mental and physical capacities may diminish, and social lives may be limited by hearing loss or reduced mobility.

Yet some of this social-narrowing is intentional. If time is of the essence, the motivation to derive emotional meaning from life increases, says Laura Carstensen, director of the Stanford Center for Longevity. She found that people choose to spend time with those they really care about. They emphasize quality of relationships over quantity. While family members fill much of a person’s inner social circle, friends are there, too, and regularly fill in in the absence of family. A related, more optimistic perspective on retirement is that with fewer professional and family obligations, there are more hours for the things we want to do and the people with whom we want to do them.

At all stages of life, how we do friendship—whether we focus on one or two close friends or socialize more widely—has to do with our natural levels of sociability and motivation. Those vary, of course. I recently spoke with a man who had retired to Las Vegas. When he and his wife moved to their new house, his wife began baking cookies and distributing them to neighbors. She started throwing block parties for silly holidays and those neighbors showed up. No one had bothered to organize such a thing before. Even in retirement, this woman is what psychologists call a “social broker”—someone who brings people together. She has most likely always been friendly.

What best predicted health wasn’t cholesterol levels, but satisfaction in relationships.

How you live your life before you reach 60 makes a difference, experts on aging say. Friendship is a lifelong endeavor, but not everyone treats it that way. Think of relationships the way we do smoking, says epidemiologist Lisa Berkman of Harvard University. “If you start smoking when you’re 14, and stop smoking when you’re 65, in many ways, the damage is done,” she says “It’s not undoable. Stopping makes some things better. It’s worth doing but it’s very late in the game.” Similarly, if you only focus on friendships when your family and professional obligations slow, you will be at a disadvantage. Damage will have been done. The payoff in making friendship a priority was born out in the long-running Harvard Study of Adult Development, which followed more than 700 men for the entire course of their lives. What best predicted how healthy those men were at 80 wasn’t middle-aged cholesterol levels, it was how satisfied they were in their relationships at 50.8

Fortunately, it is possible to make new friends at every stage of life. In Los Angeles, I met a group of 70-something women who bonded as volunteers for Generation Xchange, an educational and community health nonprofit. The program places older adults in early elementary classrooms as teachers’ aids for a school year. As a result of the extra adult attention in class, the children’s reading scores have gone up and behavioral problems have gone down. The volunteers’ health has improved—they’ve lost weight, and lowered blood pressure and cholesterol. But they have also become friends, which is just what UCLA’s Seeman had in mind when she started the program. “One of the reasons our program may be successful is that we are motivating them to get engaged through their joint interest in helping the kids,” Seeman says. “It takes the pressure off of making friends. You can start getting to know each other in the context of the school and our team. Hopefully, the friendships can grow out of that.”

Concerns about loneliness among the elderly are well-founded. Demographics are not working in favor of the fight against loneliness. By 2035, older adults are projected to outnumber children for the first time in American history. Because of drops in marriage and childbearing, more of those older adults will be unmarried and childless than ever before. The percentage of older adults living alone rose steadily through the 20th century, and now hovers at 27 percent. And a digital divide still exists between older adults and their children and grandchildren, according to recent studies. That means older adults are less able to use virtual technology like Zoom to stay connected during the COVID-19 pandemic—though some are learning. Laura Fisher, a personal trainer in New York City, found that putting her business online meant training older clients one-on-one in videoconferencing. She now works out with one of her young clients in New York City and her client’s grandmother in Israel. Generally, older adults who use social media report more support from both their grown children and their friends. “For older people, social media is a real avenue of connection, of relational well-being,” says psychologist Jeff Hancock who runs the social media lab at Stanford University.

That is good news in this moment of enforced social isolation. So is the fact that being apart has reminded so many of us of how much we enjoy being together. For my part, I sent those flowers to my mother-in-law after all when I discovered contactless delivery. When the flowers arrived, we spoke again. And then I called her again two days later. “It’s great to talk to you,” she said.

Lydia Denworth is a contributing editor for Scientific American and the author of Friendship: The Evolution, Biology, and Extraordinary Power of Life’s Fundamental Bond.

Lead image: SanaStock / Shutterstock

References

1 Holt-Lunstad, J., et al. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science 10, 227-237 (2015).

2 Silk, J.B., Alberts, S.C., & Altmann, J. Social bonds of female baboons enhance infant survival. Science 302, 1231-1234 (2003).

3 Holt-Lunstad, J., Uchino, B.N., Smith, T.W., & Hicks, A. On the importance of relationship quality: The impact of ambivalence in friendships on cardiovascular functioning. Annals of Behavioral Medicine 33, 278-290 (2007).

4 Uchino, B.N., Kent de Grey, R.G., & Cronan, S. The quality of social networks predicts age-related changes in cardiovascular reactivity to stress. Psychology and Aging 31, 321–326 (2016).

5 Seeman, T.E., et al. Social network ties and mortality among tile elderly in the Alameda County Study. American Journal of Epidemiology 126, 714-723 (1987).

6 Yang, Y.C., et al. Social relationships and physiological determinants of longevity across the human life span. Proceedings of the National Academy of Sciences 113, 578-583 (2016).

7 Chopik, W.J. Associations among relational values, support, health, and well‐being across the adult lifespan. Personal Relationships 24, 408-422 (2017).

8 Vaillant, G.E. & Mukamal, K. Successful aging. American Journal of Psychiatry 158, 839-847 (2001).

We called Greg Carr the other day to talk about the spread of the coronavirus in Africa. Carr, who has been featured in Nautilus, is the founder of the Gorongosa Restoration Project, a partnership with the Mozambique government to revive Gorongosa National Park, that environmental treasure trove at the southern end of the Rift Valley. The 1,500 square-mile park, about the size of Rhode Island, was first given animal refuge status in the 1920s by the Portuguese, and for years was a favorite of European tourists. But in 1983 civil war broke out and the park became a no-man’s land. The place was poached to death, closed up and didn’t reopen until 1992.

Renewal began in 2004 and in 2008 the government signed a restoration agreement with Carr’s foundation. The agreement, which lasts through 2043, envisions a “human rights park” that will restore both ecosystems and economic vitality. After 11 years of rebuilding infrastructure, reintroducing animals, including hippos and wildebeests, and working with local communities, Gorongosa is thriving again. The park now serves as a model for future conservation. Today some 200,000 people live around the park in a “sustainable development zone” that includes education, employment opportunities, and health service. About 700 people have full time jobs in the park; another 300, part time. Naturalist E.O. Wilson calls Gorongosa “a window on eternity.”

“If there’s one thing the rest of the world can learn from Africans, it would be their resilience.”

Carr is a 60-year-old entrepreneur and philanthropist who grew up in Idaho and in his mid twenties co-founded Boston Technology, a voice mail company. By the time he turned 40 he had amassed his fortune and couldn’t see the fun in doing it all over again, and so turned to philanthropy. These days he’s in Idaho Falls, on the phone six hours a day, getting the latest reports from his staff in the park, now closed until further notice.

The coronavirus news from Mozambique is mixed, as it is in much of sub-Saharan Africa. With the exception of South Africa, with over 7,500 confirmed cases of COVID-19 and 148 deaths, some countries below the Equator have fewer than 100 cases. As of May 6, there were just 81 cases in Mozambique and no deaths. If these numbers don’t blow up, the quick explanation might hold that the median age in Sub Saharan Africa is under 20, just 17.6 in Mozambique; population density is low (103 people per square mile); and there’s relatively limited direct contact with heavily infected countries in other parts of the world. 

Still, many experts fear chaos is inevitable. Underlying conditions in Mozambique include implacable poverty and a 60-year history of colonial and civil wars. On another front, in early April, in northern Mozambique, an Isis group shot or beheaded 52 young people because they refused to be recruited. Add a 48 percent literacy rate for women, 60 percent for men. The country also suffers the world’s eighth-highest incidence of HIV; 1.5 million people have contracted the virus and nearly 40,000 people have died. Finally, a large number of Mozambicans go to South Africa for work and then return. Testing is rare in the entire country.

In March, CDC Africa sent out a national directive requiring social distancing. “People are going to pay more attention to that in the cities than they are in rural Mozambique, at least until the virus really comes,” Carr said the other day. “Now, if you live in rural Mozambique, you don’t have the luxury of saying, ‘I’m isolating at home.’ People have to go out every day, to get food and water, from 40 to 60 liters a day, they have to tend to their farms. The idea of social distancing is a bit impossible for these folks.” He added, “Schools are closed and we are making our own masks for people. We all know there’s no treatment per se or certainly vaccine. If this hits, we’ll only be able to offer people Tylenol and soup.”

Cases in Mozambique could shoot up as mine workers continue to return home from their jobs in South Africa. “In my opinion,” said Carr, “Mozambique does not have the capacity to deal with this type of pandemic, as there are few qualified health personnel and the high level of poverty leads people to resist isolating themselves, as they look for alternatives to take care of their families. Our Gorongosa teams are in the field, spreading prevention messages, distributing masks and water purification.” 

Berta Barros, head nurse at Gorongosa, told Carr recently she has three main worries: lack of COVID-19 test kits, lack of healthcare professionals to respond to sick patients, and shortage of medications for treatment. “Mozambique has a population close to 30 million and we only have 34 ventilators,” Barros said. “It’s beyond impossible to work and choose who to save.”

Carr often talks about Mozambique as though he was Mozambican. “We’re very practical people,” he’ll say. “We’re not really theoretical. We’re just going to work our way through this.” He shies away from broad, open-ended questions about Africa, much less cultural comparisons and grand conclusions. “Africa is more than 1 billion people in 54 countries with, what, 2,500 languages? To make a statement like, ‘Africa is this…’ Frankly, I just think a lot of it is complete baloney.”

At the same time, says Carr, “If there’s one thing the rest of the world can learn from Africans, it would be their resilience. We’ve had five years of war in Mozambique and then last year we had a cyclone that killed nearly 1,000 people. I didn’t even mention the two droughts we had in the last seven years and the armyworm that came through and ate everybody’s maize. These people had their homes washed away in a flood last year, lost everything. So they rebuild their homes and then someone says, ‘Hey, there might be a virus coming through.’ It’s just one thing after another.”

What impact might the pandemic have on animals in the park? What effect will it have on just recovered antelope populations, for example, and the inevitable increase in poaching as tourism subsides? How many resources will need to be taken away from the war on other diseases to fight this? Impossible to say. But an anecdote came to Carr’s mind that suggests the vagaries of death in Southern Africa. “I got a call from a dear friend of mine yesterday, a Mozambique good friend, who said her aunt had just died. I said, ‘Wow, do you think it was COVID?’ She goes, ‘No, she’d been suffering for a while with a bad kidney.’ Life is tough in Africa. Do we know for sure this woman didn’t also have COVID and that contributed? Maybe. The truth about Africa is that disaster is hardly news. Malaria is the most prolific killer. And when they turn 50, people die and often no one knows exactly what the cause was. It’s just the way life is.”

Mark MacNamara is an Asheville, North Carolina-based writer. His articles for Nautilus include “We Need to Talk About Peat” and “The Artist of the Unbreakable Code.”

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