A Cry Unheard: New Insights into the Medical Consequences of Loneliness. Lynch, James J. Baltimore, MD: Bancroft Press, 2000. iii + 345 pp. $26.95.
As its subtitle suggests, this book provides an update of The Broken Heart: The Medical Consequences of Loneliness published 25 years ago, as well as the author’s 1958 The Language of the Heart, which expanded on the cardiovascular effects of human dialogue and contact. The 12 chapters of this work are divided into four sections entitled: Loneliness in Adulthood and Its Links to Premature Death; School Failure, Childhood Loneliness, and Links to Heart Disease and Premature Death; Bridging the Gap; and Healing Dialogue. The increases in loneliness over the past two decades as well as its adverse health effects are documented in a compelling fashion. Twenty-five percent of American households now consist of one person living alone, half of marriages now end in divorce (affecting more than a million children), and 30% of U.S. births in the last decade were to unmarried children. Lynch explains how all of these factors contribute to premature death, noting that “It is a striking fact that U.S. mortality rates for all causes of death, and not just heart disease, are consistently higher for divorced, single, and widowed individuals of both sexes and all races. Some of the increased death rates in unmarried individuals rise as high as ten times the rates for married individuals of comparable ages” (p. 97).
However, the major message is the stunning revelation of how educational failure leads to a form of loneliness that can be a long-term time bomb. School dropouts may suffer from the loss of companionship of classmates but are particularly prone to subsequent social isolation because they lack the language and communication skills needed to establish new relationships. As a result, they have significantly higher premature death rates in adult life, particularly from cardiovascular disease. Dropping out of school is much more common in children of unwed mothers or those living in single-parent households, and the rise in these and other contributors to educational failure are illustrated by numerous graphs and tables. Very recent statistics and projections furnish further support for Lynch’s concern about these trends. The March 2001 U.S. census report showed that between 1990 and 2000, unmarried partners increased 72%, single dads rose 62%, and there were 7.6 million single moms, up 25%. Unmarried birth rates have doubled for white women since 1980 but are still five times higher for African Americans, and more than 75% of births in our nation’s capital are illegitimate. Hispanics are expected to surpass blacks as the largest minority group within a few years and will represent 40% of our population by mid century. Forty-two percent of Hispanic births are to single mothers, and in one report, the proportion of Hispanics with less than a fifth-grade education was more than 14 times higher than for others.
These children, especially those who are Mexican, often have serious language problems, which contribute to their alarmingly high rates of unemployment and poverty. Educational failure can cause other problems that increase risk for heart attacks, including emotional stress and elevated cholesterol. However, the major contributor to cardiovascular mortality results from the inability of school dropouts to adequately communicate their feelings or even engage in everyday dialogue, without suffering damaging psychophysiological consequences of which they are completely unaware. Such difficulties in communication can cause alarming but unappreciated spikes in blood pressure that can have disastrous consequences.
Other contributors to coronary heart disease are diminished face-to-face dialogue and personal contact because of technological advances “that lead people to believe they can speak ‘from no-place to no-body.’” Lynch has referred to this “as the ‘disembodiment of dialogue,’ a type of language one speaks outside of one’s own body, and outside of one’s feelings, which amounts to language literally spoken ‘by nobody to nobody’” (p. 120).
He explains what can be done to counteract these effects of “toxic talk.” Strong social support, physical contact, and the power of touch may be helpful, but the real solution lies in being made aware of the problem and learning how to correct it with healing dialogue. The book is peppered with examples of how the author has been able to help patients achieve this through the use of a simple device that allows them to recognize their otherwise unappreciated inner turmoil so they can learn how to reduce their risk for premature death from “communicative disease.” But the real message of A Cry Unheard is that our school system must drastically change the way we communicate with children. The urgent need for educational reform is also reflected in the high priority this topic has been given by President Bush. It provides a practical and cost-effective approach to prevent school dropout and its large-scale adverse health and socioeconomic consequences. This book should be required reading for educators, policymakers, legislators, and parents who want to see children succeed in society and avoid the long-term hazards of loneliness that stem from what Lynch labels as “communicative disease.”
Paul J. Rosch, M.D., F.A.C.P.
President, The American Institute of Stress