- A friendly environment can trigger healing effects in our bodies, while a stressful one can cause harmful reactions and suppress immunity.
- Terence Ryan, Emeritus Professor of Dermatology, University of Oxford, suggests that restricting opportunities for friendship could have done significant harm to the mental health of COVID-19 patients.
- He explains the critical importance of adopting a ‘care attitude’ alongside scientific approaches to medicine.
- Using his own experience of treating leprosy, Ryan highlights the harmful effects of isolation on the body’s immune system in man and animals.
- Ryan asks us to consider how reducing isolation and embracing more friendliness could change the cause and outcome of any future pandemic.
In the coming years, society will reflect on how we dealt with the COVID-19 pandemic and look for lessons to learn. Positives will be the isolation and analysis of the causative virus and the development of effective vaccines. However, treating the factors that make humans and animals likely to transmit the virus were given too little attention. These include the lowered immunity of those bereaved or affected by loneliness or, in animals, of those affected by cruelty such as caging. The positive influence on wellbeing of friendly volunteers in vaccine centres was not studied. And although we realised that mental illness was far more common during the pandemic, the effect of isolation and social distancing from friendship was not taken into account.
The importance of ‘friendliness’ in the cold precision of science has significant precedence. The provision by ‘modern medicine’ of health and wellbeing is characterised by the ‘personal touch’ of medical staff as well as the support of family and community. And yet, it all but disappeared during the pandemic, replaced by treatment at a safe distance, smiles hidden behind masks, and family and friends separated by closed windows. Terence Ryan, Emeritus Professor of Dermatology, University of Oxford, believes we should explore how isolation when needed can be supplemented by what he calls ‘care attitude’ – a mix of sympathy, empathy, compassion, kindness, preserving dignity, and bringing joy, cheer, and friendship. ‘Friendship is the single most important factor influencing our health, wellbeing, and happiness,’ says Ryan, quoting from the recent studies of the Department of Experimental Psychology at the University of Oxford.
Beyond being a renowned specialist in dermatology with a particular interest in leprosy, Ryan is also the curator of the Oxford home of Sir William Osler, the father of modern medicine. Osler pioneered the instruction of medical interns at the bedside and believed students should connect directly with the patients they were learning to treat. Notably, that connection must be more than compassion. For Osler, compassion meant taking on another’s sadness. Rather it was friendliness that helped heal. In his words, ‘It is an unpardonable mistake to go about with a long face’: he always began an examination with a friendly greeting using the patient’s name, and with a smile.
The psychological and physiological effects of friendliness
Ryan has seen the injurious effects of the absence of friendliness in his research worldwide into leprosy. The disease is still seriously stigmatised and those infected were, for a thousand years, usually treated in the same way as seriously ill COVID-19 patients – by isolation. But Ryan has seen cases where expressions of genuine friendliness helped generate remarkable results in leprosy patients, as well as those with other disfiguring conditions that may cause onlookers to recoil in fear and disgust – a response that further reduces our ability to confront and treat infectious diseases.
The secret to the healing effects of friendliness lies in how our brain reacts to its visible expression in others. We are neurologically wired to respond to visual cues, human, animal, and environmental, and not only from humans – the wide eyes of a helpless puppy, or for children a rag doll or teddy bear, trigger an immediate sympathetic and protective reaction. The brain registers such cues in the frontal cortex and forwards them to its emotional centre, the amygdala, which then releases powerful chemicals to balance our nervous and endocrine systems, which regulate our bodily function. Ryan has studied psychosomatic disorders, inducing pain and bleeding, and suppression of inflammation in Asian body piercers and firewalkers. He believes from his experience as a dermatologist that psychological stress, an evolutionary adaptation to the fight-or-flight response to threat, can sometimes impact not only our mental health but also our physical health, triggering harmful physiological reactions such as rashes and other skin disorders. Ryan also knows the opposite is true: a caring attitude, hypnotism, acupuncture, and mindfulness, which create a pain-free response, can trigger physiological responses that heal.
COVID-19 and the absence of friendliness
For Ryan, pure science is not enough to care for disability following burns and trauma, or the effects of caging on animals and solitary confinement in humans. Doctors, nurses, and community health workers should acquire the skills of care technology applied with care attitudes – revisiting Osler’s teachings. These skills would also help trigger the neurological reactions, both central and peripheral, to flood our body with the chemicals we need to complement and accelerate the healing process.
Social distancing may have helped limit the spread of COVID-19, but it also kept people isolated and lonely. Ryan points to research that shows how physical and mental isolation and caging of animals depresses the body’s immune response thereby making it more susceptible to infections. The friendly interactions that are important for social bonding are also vital in protecting our health. Ryan makes the same appeal for our interactions with animals and the environment. As with humans, friendship and kindness can counter effects like immune suppression in animals arising from anxiety, cruelty, or loneliness, which medical intervention alone cannot resolve.
A holistic care attitude can help us avoid mistakes made by purely scientific practices, develop better approaches to resolving loneliness, and perhaps even tackling poverty by cross-class friendship in youth organisations. And as we start to review the way we tackled COVID-19, it’s worth asking if more lives could have been saved and depression avoided had patients not had to suffer isolation as well as the disease. In September 2022, the UK press cited several international studies that found loneliness triggers inflammation and ageing and is more harmful than smoking. ‘Such studies add to the evidence for the therapeutic value of friendship,’ says Ryan, ‘and are relevant to my arguments against social distancing in my mentoring of tropical disorders such as leprosy, podoconiosis, and lymphatic filariasis. It’s equally important for global epidemics such as COVID-19 and for the prevention of transmission of diseases by caged wild animals in Asia.’
‘Friendship,’ Ryan concludes, ‘is deserving of further research.’