This story is adapted from Heartbreak: A Personal and Scientific Journey, by Florence Williams.
The fall after my marriage ended, my physician was stumped about why my blood sugars were high. She sent me to an endocrinologist, who confirmed a surprising diagnosis: diabetes, type 1, or what’s sometimes called type 1.5, which comes from the immune system attacking the pancreas.
(In the more common type 2 diabetes, the pancreas typically still produces insulin, but the body’s cells are resistant to it and unable to metabolize sugar.)
Type 1 is usually diagnosed in children. It’s rare to be diagnosed as an adult, but when you are, it tends to progress more slowly. Since I still had some functional beta cells in my pancreas, I was told I might be able to delay the need for daily insulin shots if I could manage the carbohydrate load in my diet, work on my stress levels, and exercise after eating.
An old college friend, weirdly, had also been diagnosed with adult-onset type 1 diabetes some months after her marriage exploded. Now she wore an insulin pump 24 hours a day and worked out on a stationary bike after eating carb-heavy meals. There was no diabetes in my family, nor in hers. Was divorce diabetes a thing? It is impossible to know the answer to that, at least as far as she and I are concerned as individuals. What is known is that autoimmune diseases can appear after a stress “trigger,” according to Stanford University’s Michael Snyder, a molecular geneticist and himself a midlife diabetic.
“Diabetes is known to be associated with stress,” he said, explaining that under certain circumstances, our DNA can start expressing diabetes promoter genes. High levels of cortisol, known to be elevated during emotionally stressful times, interfere with the production and regulation of insulin.
While scientists have known for decades that death and disease increase (substantially!) after divorce, some are now trying to investigate which antibodies, inflammation markers, and gene sequences can lead to trouble. Researchers at Ohio State University found that adults who were struggling emotionally with their recent divorces (in this study, the time frame was within two years) produced fewer natural killer cells, which are important for fighting cancer and other diseases. They were also more likely to get sick from viruses like Epstein-Barr than their married peers.
But why? To find out, I reached out to Steve Cole, the founder of an emerging field called social genomics.
It all started in the mid-1990s, when Cole was a young researcher more interested in viruses than in social relationships. He joined a team of epidemiologists and psychologists wondering why some gay men with the HIV virus were getting sicker and dying at a faster rate than others. Cole, who works in psychiatry and biobehavioral sciences at the UCLA School of Medicine, looked at the blood samples of 72 men over an eight-year period. He found that closeted men, who faced the stresses of secrecy and possible discovery on top of the stress of their HIV status, got sick two to three years earlier than men with HIV who were out. Their nervous systems were easily triggered into a stress state by social circumstances. Cole found these men produced more of the hormone norepinephrine—a key driver of our fight-or-flight response. The hormone made T cells more vulnerable to attack by HIV, with the virus replicating 10 times faster than it would otherwise.
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People with a terminal, brutal, and stigmatized disease no doubt faced an unusual amount of stress. So Cole was surprised when he was approached in the early 2000s by a psychologist at the University of Chicago named John Cacioppo asking him to expand his genomics work into a far more common and mundane population: lonely people. Cacioppo had popularized the concept that people who self-identified as feeling lonely—as well as people who were literally socially isolated—were known to suffer from more diseases and early death than those with strong social-support networks. In fact, chronic loneliness increases the risk of early death by 26 percent, similar to being obese or smoking. Now Cacioppo wanted to know if there were unique cellular and genetic markers in lonely people that might yield clues to the pathways to disease.
Along with Cacioppo, Cole and four other colleagues published a remarkable paper in 2007. It was the first to consider the effect of social factors on gene expression in the immune system. What the team found in analyzing blood samples from a small group of relatively healthy adults was that social connectedness—how emotionally and socially connected people feel to others—altered the activity of two key sets of genes in white blood cells. One set ramped up inflammation-making leukocytes, while the other turned down cells that fight viruses. Cole was stunned to find such clear molecular signatures of our psychosocial state. He called the results “beautiful genomics,” as well as a call to arms. “As I thought about it more,” he told me, “I realized this is really bad. This is basically a molecular recipe for early death.”
After analyzing many other data sets, Cole now calls loneliness one of the most toxic risk factors known to human health. He’s been pioneering the field of social genomics ever since.
I first reached him by phone while I was driving in the Colorado flats between the Denver airport and Boulder. I pulled over, parking on a gravel shoulder, typing madly into my laptop as tumbleweeds blew across the hood of my car. I told him about my diabetes diagnosis and how it made me curious about the connection between our emotions and our immune systems. It didn’t seem helpful or adaptive that our bodies fall apart at the same time our social worlds crash down.
But it shouldn’t be surprising that our immune systems become implicated when we are emotionally crushed, he said. Still, we don’t expect it. We think the damage is all in our heads. “We think of relationship loss and isolation as pragmatic problems,” he said, “because we are overly cognitive beings.” We are fairly good at trying to solve problems like how to cook a meal for one person and how to transfer auto insurance. And yet that cognitive mode soon becomes insufficient. “Our bodies want what they want, warmth and the feeling of being understood by a partner, and now it’s not there. Shock and panic set in.”
Even though heartbreak is nearly universally experienced to greater and lesser degrees, we still don’t take it seriously enough, he said. And unlike Cole, we don’t all have the ability to witness the unexpected cellular carnage taking place.
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“This is one of the hidden land mines of human existence,” he said. And this was coming from a man who had spent years studying AIDS and cancer. If you can’t get through heartbreak—if it continues to pummel your self-esteem and ability to interact meaningfully with others—you’re in trouble. Being a functioning, relational person “depends on morale and enthusiasm and sparkle, and if you can’t muster that, we now know, it’s a death spiral.”
Death spiral. The words reverberated through my rental car.
Before we hung up, he gave me a helpful pep talk about doing things I loved and staying attuned to the grounding presence of my kids. He also extended an invitation to stop by UCLA to give him some of my own blood. We’d take a look inside my immune system. Specifically, he would peer into my monocytes, which are white blood cells. Unlikely as it sounds, they listen for loneliness.
I closed the laptop and looked out over the featureless prairie. To my left stretched the Great Plains. To my right, beyond the passenger mirror, rose the Rocky Mountains.
More than ever, I felt the urgency to recover from the stress and trauma of the split. I needed, for my heart’s sake and now my white blood cells’ sake, to jump-start the process of calming down. As I looked at the mountains, I realized I knew one place I could do that: outside.
Excerpted from Heartbreak: A Personal and Scientific Journey. Copyright (c) 2022 by Florence Williams. Used with permission of the publisher, W. W. Norton & Company, Inc. All rights reserved.
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