Wednesday, April 27, 2016

O Ḥevruta O Mituta

A number of interesting scientific studies were reported on in the press this week.

It was just this week, for example, that Nicholas Bakalar wrote in the Times about a new study published in the journal Nutrients that proved definitively that overeating, and particularly the over-consumption of fats, leads to drowsiness. The study, undertaken at the University of Adelaide in Australia, considered 1,800 Australian men and took into account many different kinds of data (including the men’s eating patterns, their weight-gain and -loss statistics, their status as smokers or non-smokers, their predisposition to suffer from depression, their waist sizes, and their level of physical activity) to come to its riveting conclusion. The results were impressive by any yardstick, but they were particularly satisfying for me personally because, as it happens, I have been conducting a similar experiment over the last forty or so years and, although my test group was considerably smaller, my data—all of it, particularly when Joan wasn’t home, empirically gathered by myself—has led me to precisely the same conclusion as the one to which their study led them. I feel so validated! And I knew I wanted to share that with you as soon as I read about their study!  Vivat experimentiam scientia!
But the study that I wish to write to you about, published in the scientific journal Heart (the official journal of the British Cardiovascular Society) and also reported on in this week’s Times, is more surprising and far more provocative. This was a dramatically larger undertaking, one that analyzed data culled from the medical records of over 180,000 men and women. It did not, however, involve the testing or observation of actual patients, but was rather a kind of giant meta-study that drew from twenty-three different anterior studies of patients in an attempt to answer a question that I never thought even to wonder about: whether social isolation and/or a personal sense of loneliness could possibly be a meaningful predictor of future coronary disease or of a future stroke.

Social isolation and loneliness are not the same thing exactly. In terms of the study, the former term was used to denote adults who have few social relationships or friendships, while the latter was used to describe people who are basically unsatisfied and unhappy with the relationships they do have even if they are not few in number. There is something inherently quirky about a study like this because, there being no scientific way to test for either loneliness or a sense of being isolated, the patients under study were labelled with either or both those terms solely by virtue of their own self-definition: if patients qualified themselves as being among the lonely or the isolated, then they were considered to belong to that group for the purposes of the study. Their medical histories, on the other hand, were a matter of medical record: the researchers took no note of anecdotal evidence and depended instead solely on medical records or death certificates for the data regarding the subjects’ histories of heart attacks and strokes. So it was by its very nature a kind of a hybrid built on analyzable scientific data and patients’ own sense of their place in the world.

There was no divergence in the findings regarding men and women. That much was interesting without being particularly surprising, but the results were, at least to me personally, beyond arresting: self-defining as lonely or feeling socially isolated appears to increase the risk of having a heart attack, angina, or of eventually dying of heart disease, by 29%. The risk of stroke increases by 32%, almost a full third.  It is true, I should note, that the researchers attached a caveat to the effect that it was a review of observational studies and did not scientifically establish a medically-verifiable link between loneliness or isolation on the one hand, and heart disease or stroke on the other. But the data speaks for itself in a matter like this so clearly that it’s hard—at least for a non-scientist like myself—to imagine that it could be a mere coincidence that patients across the board—men and women, old and young, healthy and infirm—who described themselves as lonely or socially isolated were dramatically more likely to suffer from heart disease, and that this increased susceptibility seemed unrelated to any other obvious factors that might otherwise have put them in some different category regarding their likelihood for future heart problems or stroke.

The researchers themselves saw it the same way. In fact, the opening line of the introduction to the study sums up in a particularly stark way the way the scientists who conducted the study came eventually to understand their own data: “Adults who have few social contacts (i.e., who are socially isolated) or feel unhappy about their social relationship (i.e., who are lonely),” they wrote starkly, “are at increased risk of premature mortality.” And not only is that risk real, they went on to note formally, but it is statistically and scientifically comparable with other, far more widely accepted predictors of future heart disease, notably carrying too much weight and engaging in too little physical activity. So that sounds pretty definitive to me: feeling friendless or forlorn is not only a heavy burden to shoulder emotionally and psychologically, but has profound potential implications for an individual’s heart health and longevity. There’s a folk saying preserved and labelled as such in the tractate of the Talmud we’ve just finished learning at Shelter Rock that reads o chavruta o mituta, which means “either friendship or death.” Patrick Henry may have felt that living not-free was the social or moral equivalent of being a dead person, but our ancients had a more practical, apparently more medically correct notion: that living friend-free and without the support of a warm, sustaining community is not merely comparable to not being alive at all, it actually leads, or can lead, to an early demise.

And that thought brings me to take issue with one of the most famous passages in the Haggadah. As you know, I’m usually a great one for maintaining a sense of ongoing fidelity to the traditional text of our prayers. In Tzur Yisrael, we maintained almost all the most traditional phraseology, altering the received text here and there only to accommodate realities which seemed strange or even wrong to ignore. And I feel the same way about the Haggadah—attempts to “fix” this or that passage so as to make it conform more obviously to modern sensitivities always seem to fall flat when I consider them closely and the traditional text is almost always the one that speaks to me the most clearly.

But arguing for a traditionalist approach to liturgy doesn’t mean that I invariably agree with what I read. And I find myself at odds with one of our most famous passages this week: the story of the four sons who relate to their parents’ efforts to celebrate Passover so differently. I know most seder-attendees know the passage by heart, but let’s revisit it just for a moment. The wise lad is the one who asks all the right questions and he is appropriately rewarded for his curiosity with warm approval. No issue there! The simple lad is the one who takes note of the festival but can barely bring himself to formulate a coherent question. His mah zot (“what is all this?”) couldn’t be less eloquent, but he too is somehow rewarded for even his minor level of inquisitiveness with an answer simple enough for anyone at anyone to understand. No issue there either! Moving along, even the child who lacks the wherewithal to ask any sort of question is treated kindly…but the contrary son, the rasha, who excludes himself from the group is not to be treated kindly at all. Instead, he to be dealt with contemptuously and taunted with the possibility that, having taken himself out of the group in his own day, he would surely not have been taken from Egypt had he been a slave there in ancient times. And this, from a book that makes a special point of saying that all Jewish people are called upon to imagine that they themselves were slaves in the land of Egypt and would still be there had God not brought them forth with a mighty hand and an outstretched arm. All…but apparently not him!

That seems harsh to me. The lad is, after all, present at his parents’ seder table. He observes what’s going on around him. His question, particularly in the Hebrew, isn’t that different from the wise son’s…only he hasn’t come to the point just yet at which he feels that he belongs to the group. He’s present yet absent, involved yet aloof, included yet excluded, in yet out. In other words, he’s standing on the wrong side of the threshold looking in, and tradition has chosen to focus on the spot he’s standing on rather than the direction he’s looking in. In a perfect world of my own making, such a young person would be spoken to gently rather than harshly, kindly rather than with the kind of acidulous contempt that will only make him feel even less a part of the group he is being mocked for not feeling part of…or not enough part of. To shove him even further away seems cruel or, at the very least, counterproductive…and now I see that my sentiments are mirrored by scientific research: the strength of community is not only satisfying spiritually, but the sense of belonging that comes along with membership in any traditional Jewish community is actually something that can lead to a long life. To turn a child away because he’s not there yet is thus, at least potentially, to shorten his life. To turn any people away merely because they feel disengaged is, to say the least, counterproductive: the correct response to people who feel disengaged is to engage them as though their very lives depend on it, which they apparently do. O chavruta, o mituta indeed!

People occasionally tell me that they’re not sure about retaining their affiliation with the synagogue after their children are done with the Religious School and they’ve made all the bar- and bat-mitzvahs they’re going to make. There are several different ways that this thought is couched when it’s put to me, but my response is always the same: what you get by belonging to a thick, rich, caring community of like-minded co-religionists is that you get to belong to a thick, rich, caring community of like-minded co-religionists. The twin specters of loneliness and isolation will never haunt those who belong because the traditional Jewish community is designed specifically to guarantee that no one ever needs to feel abandoned or deserted. And because, ultimately, friendship is at the core of community and serves as its defining feature: family is blood, but community is amity. And that, it turns out, is not just important because it leads to warm, fuzzy feelings about the universe. It’s important because finding your place in a community of caring friends is one of the things that staves of heart attacks, angina, and strokes. I might have said that from the bimah in the past as a kind of rhetorical flourish intended poetically to tout the advantages of affiliation. But who knew it was scientifically true as well?  It turns out my mother was right—you really do learn something each and every day!

At Shelter Rock, we foster communal friendship as best we can and that, more than any specific service, is what we offer our membership: the chance to belong to the kind of thick community in which people are allied by a sense of familiarity and emotional intimacy, and in which no one ever needs to feel bereft or forsaken. I suppose that truth visits us all in different ways at different times of the year, but I myself feel it particularly in the course of our holidays when we gather in the great sanctuary of the synagogue for Yizkor and as a community find the courage and strength to face our own mortality by staring down the past and the future as one extended, caring family of friends. Yizkor is about our lost loved ones, obviously. But it’s also about the living, the people who have come to remember and to mourn. The antidote for the kind of sadness associated with grievous loss is not gain of any sort, but the strength of community and the support engendered by the sustaining relationships community by its nature fosters. The discovery that being part of that rich circle of friends and neighbors also apparently staves off heart disease, thus extended our lives meaningfully, only makes me feel prouder of my membership in our little shtetl, our village in which none needs to feel lonely and in which despondency brought on by social isolation is the fate of no one at all who wishes it otherwise.

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