Web Version of my Presentation for NAMI
(National Alliance on Mental Illness)
12/11/24
page 1
I spent three weeks gathering information for this talk. The topic was “How animals can be great for mental health, and we specifically want to talk about the difference in Emotional Support Animals versus Therapy Dogs, versus Service Dogs.”
Overview
Part 1: The U.S. Surgeon-General’s 2023 declaration that loneliness is a national epidemic
Part 2: Dr. James J. Lynch’s research proving loneliness can lead to health problems that can take up to 20 years off a person’s life
Part 3. History of animals being used as therapy
Part 4: Dr. Lynch’s research discovering how having animals in our lives can reverse the damage caused by loneliness
Part 5: Benefits of having a dog
Part 6: Therapy Dogs, including Dr. Lynch’s research about the health damages of toxic talk and school failure in a child’s life
Part 7: Service Dogs
Part 8: Emotional Assistance Animals
Part 9: Questions
Part 1
The U.S. Surgeon-General’s 2023 declaration that loneliness is a national epidemic
Two days before my presentation, I was highly stressed because just reading through my notes took two hours, and the presentation was to be about 45 minutes long with about 15 minutes at the end to field questions. I was frantically trying to delete info – even if it spoke to my heart very strongly – just to get down to 45 minutes’ worth of talk. My dogs began driving me crazy, bumping my arm or putting their head under my arm and lifting it up as I tried to work on my computer. My therapy dogs were the worst. I finally realized that they were responding to my stress and change in breathing and were trying to break that unnatural process. In training service dogs for anxiety disorders, we teach them “Deep Pressure Therapy,” which is pressing their bodies against a person as hard and long as needed until their breathing pattern returns to normal and their anxiety is under control. As therapy dogs, my dogs weren’t trained to do DPT; they were doing it instinctively. I realized that a lot of my material needn’t be used in the presentation but that I could keep it for a detailed response to questions. I relaxed – and my dogs did, too.
Our Epidemic of Loneliness and Isolation 2023
The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community
Vivek H. Murthy, M.D., M.B.A.
“When I first took office as Surgeon General in 2014, I didn’t view loneliness as a public health concern. But that was before I embarked on a cross-country listening tour, where I heard stories from my fellow Americans that surprised me.
People began to tell me they felt isolated, invisible, and insignificant. Even when they couldn’t put their finger on the word “lonely,” time and time again, people of all ages and socioeconomic backgrounds, from every corner of the country, would tell me, “I have to shoulder all of life’s burdens by myself,” or “if I disappear tomorrow, no one will even notice.”
It was a lightbulb moment for me: social disconnection was far more common than I had realized.
In the scientific literature, I found confirmation of what I was hearing. In recent years, about one-in-two adults in America reported experiencing loneliness. (1-3) And that was before the COVID-19 pandemic cut off so many of us from friends, loved ones, and support systems, exacerbating loneliness and isolation.
Loneliness is far more than just a bad feeling—it harms both individual and societal health. It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day,4 and even greater than that associated with obesity and physical inactivity. And the harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished.
Given the profound consequences of loneliness and isolation, we have an opportunity, and an obligation, to make the same investments in addressing social connection that we have made in addressing tobacco use, obesity, and the addiction crisis. This Surgeon General’s Advisory shows us how to build more connected lives and a more connected society.
If we fail to do so, we will pay an ever-increasing price in the form of our individual and collective health and well-being. And we will continue to splinter and divide until we can no longer stand as a community or a country. Instead of coming together to take on the great challenges before us, we will further retreat to our corners—angry, sick, and alone.”
Therapy Dogs respond to sorrow or pain in the people they visit.
Here’s a story from my early days doing therapy dog visits:
‘The woman was no longer able to receive her visitors while sitting in her wheelchair. Although obviously weaker than on our last visit, she was still excited to see her one of her favorite friends – my German Shepherd named Pepper. Patting the coverlet, in a whisper she asked if Pepper could come up on her bed. I looked inquiringly at the aide and received immediate permission to bend the rules. Pepper seemed intuitively to understand what was requested of her and carefully, gently, climbed onto the bed, stretched her body alongside the woman’s, and rested her head against a bony shoulder. The dying woman stroked her over and over, whispering endearments, “Pepper, I love you. Pepper, you’re such a good girl. Pepper, Pepper, my friend…” The aide and I, tears streaming down our cheeks, could have been a million miles away as far as the two of them were concerned. Finally, after about 20 minutes, the woman fell into a peaceful sleep and Pepper looked around for me, signaled her job was done, and allowed herself to be helped off the bed. The woman died that night.’
Loneliness can increase the risk for dementia, a large study shows
https://www.msn.com/en-us/health/medical/loneliness-can-increase-the-risk-for-dementia-a-large-study-shows/ar-AA1u4LXV?ocid=msedgdhp&pc=U531&cvid=b163c620c851469ba068bc7cc4dda800&ei=333
Part 2
Dr. James J. Lynch’s research proving loneliness can lead to health problems that can take up to 20 years off a person’s life.
Out of 295 references in the Surgeon General’s report, I found none referring to Dr. Lynch’s work, yet it is referenced in Therapy Dog work.
I highlighted items I wanted to emphasize during my talk, and I left those parts highlighted in this web version of my notes.
Stories of my therapy dog visits, and some quotes, are italicized.
James J. Lynch, PhD is a board member of The American Institute of Stress, on the staff of the Cardiovascular Rehabilitation Program at Lifebridge Health, and was Director of the Life Care Health Center in Baltimore, Maryland. For more than 30 years, he served on the full-time medical school faculties of the John Hopkins University, the University of Pennsylvania and the University of Maryland. He has authored 15 chapters in medical textbooks and over 100 articles in peer-reviewed medical journals.
In 1977, he became the first to document how loneliness contributed to all forms of premature death, especially from heart disease.
Prior to his research, the whole medical metaphor was Descartes’ teaching from the 17th century. The 17th century was when scientific investigation really took off, and Descartes applied the scientific approach to human beings, teaching that the body is an independent, self-sufficient machine – that hearts are merely pumping machines with problems that can only be corrected by some mechanical means and that emotions and intellect are separate from the “real” body. Dr. Lynch commented in an interview, “When I first meet heart patients who resent being forced to see a psychiatrist after heart surgery, I ask them ‘Do you think that you and your heart pump are two separate entities? What other pump not only talks, but wants to be understood?’ They often smiled when I asked if they believed that they and their bodies are two separate entities or if they rented their bodies from Hertz or Avis. I would then show them graphs vividly demonstrating that virtually all cardiac rehabilitation patients exhibit far greater rises in blood pressure when they talk than during maximal treadmill exercising.”
In 1965, Dr. Lynch started learning that other factors than the mechanical approach are important as a post-doctoral student at John Hopkins Medical School under Dr. W. Horsely Gantt, who was the last living American student of Ian Pavlov (famous for studies on conditioned responses). They were trying to create hypertension in animals to develop drugs to control blood pressure in humans. By accident, they started to notice the powerful effect that humans had on these animals’ cardiovascular system. They observed that if you pet a dog – and other members of the animal kingdom – its blood pressure will drop 50%. They published a number of papers on that, but that was in the 1960’s and was eclipsed when Dr. Christian Barnard performed the first heart transplant.
Dr. Lynch went on to do research where they asked the question, “If human beings can affect the hearts of animals, can we affect other human beings’ hearts in similar ways?” They monitored and watched patients around the clock. What happened if a wife sat by a patient’s bedside? What happened when a nurse took a patient’s blood pressure? They began to see that the most transient human contact had marked effects on heart rate and blood pressure. They monitored patients in trauma units who were in induced comas and couldn’t move a muscle. Even there, there was an immediate heart rate reaction to human touch.
That led to the next question: If transient contact between human beings has such an effect on the cardiovascular system, what does the long-term absence of human contact do to our hearts? Does human loneliness have an effect on our hearts?
1970 was the first census year that marital status was taken into account on health surveys; prior to that it wasn’t even considered an important variable. When he looked at the date, he was shocked that single people in the United States, whether never married or widowed or divorced, had 2-10 times the death rate than married people. This was true of all ages, races and both sexes, across the country. That’s when he wrote his first book, The Broken Heart: The Medical Consequences of Loneliness (1976). This much-publicized and oft-quoted best seller caused a huge social and medical stir and was translated into 10 languages.
As they continued their research, they began to understand that although people thought talking was mental, but actually, when we speak to people, we’re touching their hearts – and we need to pay attention to that. They discovered several important interactions of blood pressure with talking. First, the higher a person’s baseline blood pressure, the more it rose when they talked. Even individuals whose physical condition was excellent but who had trouble communicating exhibited far greater increases in blood pressure than others when they began to talk, especially about emotionally evocative topics. Virtually all patients with documented coronary heart disease (even on multiple antihypertensive drugs) exhibit far greater increases while talking than during maximal treadmill exercise. Hypertensive individuals increased their pressure significantly more than normotensive individuals – and no medications seemed to be able to block that reaction; sometimes they made it worse. People who spoke rapidly and breathlessly, with rapid, forceful speech (the typical Type A Behavioral Pattern) increased their blood pressure more than those who spoke slowly, in a softer and more relaxed manner. Older people increase blood pressure when talking more than young people. They eventually realized that patients with coronary heart disease were particularly vulnerable to increases in blood pressure when they talked, especially when they talked about emotionally meaningful topics. That was documented in A Cry Unheard: Medical Consequences of Loneliness (2000). In A Cry Unheard, Dr. Lynch discussed why Jim Fixx, the original guru of running, died prematurely of a myocardial infarction. As I noted, he may truly have personified “The loneliness of the long-distance runner”, a phrase that became popular because of a 1962 movie with that title. Jim Fixx, the paragon of cardiovascular fitness whose Complete Book of Running started the 1970’s jogging craze, died suddenly at the age of 52 while jogging alone on a remote Vermont road. His autopsy showed that one of his coronary arteries was 99% clogged, another was 80% obstructed, and a third was 70% blocked and that he had had three other apparently silent heart attacks in the months or weeks prior to his death. He had just gone through his second divorce and was indeed an example of a lonely person as well as a lonely long-distance runner.
Dr. Lynch began to develop the concept of a “Physiology of Inclusion.” He realized that the “Physiology of Inclusion” body reflex operates exactly opposite to the “Physiology of Exclusion” he wrote about in his 2000 book, A Cry Unheard: New Insights into the Medical Consequences of Loneliness. That “Physiology of Exclusion” bodily reflex includes dysfunctional dialogue, a withdrawal from dialogue or in a social context where other people (and animals) are seen as a threat, triggers the repetitive activation of the “fight/flight response. That flight or fight reflex, regulated by the autonomic nervous system, developed in higher mammals in the early centuries of evolution. Heart rate did not increase, but blood pressure skyrocketed. Faced with danger, humans and other mammals would react quickly to preserve their lives. The human body still responds to symbolic or perceived threats as if they were the real thing. Repeated, continual activation of that reaction wears down the human body, leading to physical illness such as heart conditions.
As they continued their research, they began to understand that although people thought talking was mental (thus separated from the body’s working a la Descartes), actually, when we speak to people, we’re touching their hearts – and we need to pay attention to that. They discovered several important interactions of blood pressure with talking. First, the higher a person’s baseline blood pressure, the more it rose when they talked – and their blood pressure dropped when they listened to another person (called ‘vascular see-saw). Even individuals whose physical condition was excellent but who had trouble communicating exhibited far greater increases in blood pressure than others when they began to talk, especially about emotionally evocative topics. Patients with coronary heart disease were also particularly vulnerable to increases in blood pressure when they talked, especially when they talked about emotionally meaningful topics.
Quotes from A Cry Unheard, Chapter 1, pp 4-6
“For the first time, I was able to appreciate the devastating health consequences of varied life experiences, including school failure, which made human dialogue either difficult or impossible.
In those situations, the normal rhythm of the “vascular see-saw” could be disrupted. In its place were rapid, marked surges in blood pressure, reflecting the hidden “vascular cries” of shame, anxiety, anger, and fear that had previously gone unrecognized, undetected, and unheard.
“It also became easier to observe the potent health consequences of talk between and among adults who used language not to reach, understand, and share with each other, but to hurt, manipulate, control, and offend. These communicative problems, and the accompanying vascular cries, frequently occurred outside of the person’s awareness. From all external appearances, patients were calm, cool, and collected, while internally their bodies were reacting in terrible distress.
“Communicative difficulties could be traced back to earlier training and traumatic experiences with parental use of language in childhood. Outside of their own conscious awareness, parents far too often instilled this type of dysfunctional and abusive rhetoric in their own children, who then carried it into adulthood, and passed it along to their own unwitting offspring.
“The repetitive and cumulative exposure to language used to hurt, manipulate, control, and offend inexorably led to the serious wounding of self-esteem during childhood. If compounded by other traumatic developmental experiences such as school failure, the effects were both toxic and fatal. Irrespective of the original source of the wounding, however, the result was always the same – one that made it increasingly difficult for the victim to communicate with others without physiological distress. The greater the developmental damage, the greater the physiological distress whenever a person tried to communicate. Exposure to this “toxic talk” produced in its victims a hopelessness that language could be used in a constructive manner to reach others, and that, in turn, made human communication for them increasingly difficult and physiologically taxing.
Exposure to such talk proved “toxic” precisely because it led to premature death.
“Let us observe what happens when we first seek to build up our hearts. When I think about what I’m going to say, the word or message is already in my heart. When I want to speak to you, I look for a way to share with your heart what is already in mine.
In my search for a way to let this message reach you, so that the word already in my heart may find place also in your heart, I use my voice to speak to you. The sound of my voice brings the message of the word to you and then passes away. The word which the sound has brought to you is now in your heart, and yet it is still also in mine. The sound of the voice has made itself heard and has gone away, as though it were saying: My joy is complete.”
St. Augustine, Sermon (Sermo 293,3: PL. 1328-1329)
“Eventually, I came to realize that it was the repetitive activation of one of two opposing bodily states during everyday dialogue that either enhanced health or conversely contributed to the premature development of disease and death. One bodily state I label the physiology of inclusion, and the other the physiology of exclusion. In essence, dysfunctional dialogue, withdrawal from dialogue, or the type of dialogue that occurs in a social context where others are seen as a threat, triggers the repetitive activation of what scientists have long recognized as the “flight/fight response. ” It is this “wired-in” posture of exclusion towards others, one that is rooted in prior experience with toxic talk or linguistically-based injury, which activates the fight/flight response. That flight or fight reflex, regulated by the autonomic nervous system, developed in higher mammals in the early centuries of evolution. Heart rate did not increase, but blood pressure skyrocketed. Faced with danger, humans and other mammals would react quickly to preserve their lives. The human body still responds to symbolic or perceived threats as if they were the real thing. Repeated, continual activation of that reaction wears down the human body.
“Yet, the new technology helped to make it apparent that a chronic exclusion of others –an orientation where other human beings were seen as a threat, especially during everyday human dialogue, could trigger repetitive activation of the fight/flight response in situations where neither fight nor flight was necessary. These repetitive, undetected, maladaptive fight/flight reactions, frequently “wired-in” by exposure to toxic talk early in childhood, would inexorably lead to physiological exhaustion, creating a biologically-based need to withdraw from dialogue for one’s “self-preservation.” This communicative reflex of exclusion, in turn, would lead inexorably to an increased sense of loneliness and social alienation, and ultimately to disease and premature death.”
Eventually they realized that people who had the most difficulty in communicating openly and honestly (as measured in blood pressure surges) were most likely to become isolated and lonely, withdraw from communication and social interactions and end up in a vicious, downwardly- spiraling cycle of events that led to ever-increasing stress, isolation and ultimately premature death. Dr. Lynch gradually realized that many instances of premature disease could be the result of a breakdown in dialogue and communication due to a failure to reveal or decode the language of one’s own heart or the hearts of others.
Interview published online by American Institute of Stress (couldn’t find any date)
https://www.stress.org/speaking-heart-to-heart-part-1-james-j-lynch/
https://www.stress.org/speaking-heart-to-heart-part-2/
https://www.linkedin.com/in/james-j-lynch-166643aa
The language of the heart : the human body in dialogue : Lynch, James J., 1938- : Free Download, Borrow, and Streaming : Internet Archive
to page 2, Parts 3-5, general ways that animals improve people’s lives)
to page 3 (Part 6: Therapy Dogs, including Dr. Lynch’s research about the health damages of toxic talk and school failure in a child’s life)
to page 4 (Part 7, Service Dogs)
to page 5 (Part 8, Emotional Assistance Animals)