Chapter 11
Friendship — Part 1
In 2020, governments around the world responded to the Covid-19 crisis by encouraging or mandating isolation for long periods of time. The long-term consequences of this blunt approach to our gregarious populations are yet to be realised. In this chapter, we will explore how isolation is counterintuitive for humans and, just as it was for Jojo, bad for our physical and psychological health. One of the most compelling accounts of the nature and power of friendship is that expressed by the Roman orator Cicero (106– 43 bc), who in his classic essay ‘On Friendship’ (‘Dé Amicitiá’) wrote: ‘If the natural love of friends were to be removed from the world, there is no single house, no single state that would go on existing; even agriculture would cease to be. If this seems a bit difficult to understand, we can readily see how great is the power of friendship and love by observing their opponents, enmity and ill will. For what house is so firmly established, what constitution so unshakable that it could not be utterly destroyed by hatred and internal division. From this may judge how much good there is in friendship.’ Not far from Cicero’s birthplace, Arpinum, is the traditional hill town of Roseto Valfortore, which was the scene of one of the most groundbreaking studies on friendship and health as it firmly established the contribution of friendship to biological ageing. The comune lies in the Apennine foothills of the Italian province of Foggia. The town is organised around a large central square and the church. Narrow storey steps run up the hillside, flanked by closely clustered two-storey stone houses with red tile roofs. For centuries, the Rosetans worked in the marble quarries in the surrounding hills or cultivated the fields in the terraced valley below, walking four or five miles down the mountain in the morning and then making the long journey back up the hill at night. It was a hard life. The townsfolk were barely literate and desperately poor, and had little hope for economic betterment – until, at the end of the 19th century, word came of a land of opportunity across the ocean.
Chapter 3: Friendship
In January 1882, a group of Rosetans set sail for New York. They eventually secured employment in a slate quarry near Bangor, Pennsylvania. Thereafter, other families followed, joining their compatriots in the slate quarry. Those immigrants, in turn, sent word back to Roseto and by 1894, some 1,200 Rosetans had applied for passports to America, leaving entire streets of their village abandoned. However, when they reached the new land, they re-established their old familiar village, building two-and three-storey houses on the hillside and clearing and cultivating the land, planting onions, beans, potatoes, melons and fruit trees in the long backyards behind their houses. The town came to life. The Rosetans began raising pigs and growing grapes for homemade wine. Schools, a park, a convent and a cemetery were built. Small shops and bakeries and restaurants and bars opened.
Neighbouring Bangor was largely Welsh and English, and the next town over was overwhelmingly German, which meant that – given the fractious relationships between the English and Germans and Italians in those years – new Roseto stayed strictly for Rosetans. The precise southern Foggian dialect was the language spoken. Roseto, Pennsylvania, was its own tiny self-sufficient world, all but unknown by the society around it, and may well have remained so but for Stewart Wolf.
Chapter 3: Friendship
Stewart Wolf was a pioneer of psychosomatic medicine. He was born in 1914 in Baltimore and died of Alzheimer’s disease in Oklahoma City in 2005, aged 91. He began studying the people of Roseto, Pennsylvania, in the early 1960s after a doctor from Roseto told him that he hardly ever saw patients with heart attacks who were younger than 50. That was in stark contrast to neighbouring towns and elsewhere in the US, where death from heart attack in men over 40 was of epidemic proportions. The heart attack death rate in Roseto was half the rate of elsewhere in the USA. The statistics confirmed that Roseto was a starkly healthier place to live, and no one could guess why. Wolf thought that there might be something specific about the lifestyle of the town’s residents, most of whom were Italian immigrants, that had a beneficial effect on health.
Chapter 3: Friendship
In his publications, Wolf described Roseto, Pennsylvania, as a pretty but modest village with almost 2,000 inhabitants. In 1962, Wolf and his research team descended on Roseto with the full equipment of scientific investigators to establish why there was this remarkable difference in heart attack rates. After years of work, including extensive history taking, detailed physical examinations and blood analyses, the reasons were still not evident. It could not be explained by genetics, because Rosetans from nearby towns were not protected from early cardiac deaths, nor by differences in diet, smoking, exercise or body weight. It was a mystery. Then, one Sunday, it dawned on Wolf, as he sat in the square watching the Rosetans pour out of the church, loitering, chatting and laughing before returning home for a long lingering lunch with extended families and friends: the secret of Roseto was Rosetans themselves. What was different was the attitudes, friendships, respect for family, constant social contact and sense of fun that pervaded Roseto. In 1964, Wolf and colleagues published a paper in the Journal of the American Medical Association on the subject, concluding that it was indeed social interactions with friends and family that accounted for the low rate of heart attacks. With his long-time research associate John Bruhn, a social scientist, he coined the phrase ‘the Roseto effect’. Wolf noted how, often, three generations lived in one household and that there was constant interaction with family, neighbours and the community. There were 22 civic societies for a population of 2,000. Rosetans had firm family ties and friends and retained traditional and cohesive family and community relationships. There was no crime rate and few applications for social assistance. The society was egalitarian. Rosetans, regardless of income and education, expressed themselves in a family-centred social life. There was a total absence of ostentation among the wealthy, meaning that those who had more money didn’t flaunt it. There was nearly exclusive patronage of local businesses, despite nearby bigger shops and stores in other towns. The Italians in Roseto intermarried from regional cities in Italy. Families were close knit, self-supportive and independent, but also relied in bad times on the greater community for assistance and friendly help. No one was alone in Roseto. No one seemed unhappy or stressed out. Nearby wealthier towns suffered almost double the rate of heart disease, though their medical facilities, diet and occupations were either better or at least equal to Roseto’s. In their book, which I highly recommend, The Power of Clan, authors Wolf and Bruhn covered the story of the town 1935–1984. They emphasised how residents had avoided the internalisation of stress by sharing resources, worries and emotions. But as intermarriages (Italian to Italian) became less frequent, social ties between family and community were dismantled, wealthy Rosetans took up conspicuous consumption and adopted other modern behaviour, a clear correlation could be shown with an escalation in heart disease.
Chapter 3: Friendship
Eventually, the heart disease rates in Roseto were the same as elsewhere in the USA. Nonetheless, Roseto had unmasked the science behind social engagement and good health and its converse – social isolation, loneliness and early death. Macaques, like Jojo, and the rhesus monkey afford a unique opportunity to study such friendships and relationships. The monkey genome shares 93 per cent sequence identity with the human genome and numerous aspects of their anatomy, physiology, neurology, endocrinology and immunology directly parallel those of humans. Macaques have a lifespan measured in decades and develop, mature and age in similar ways to humans. The ageing process of the macaques looks very similar to our own, including greying and thinning of hair, redistribution of body fat, loss of skin tone, loss of vigour and loss of muscle tone. With age, they get diseases just like ours, including diabetes, cancer, muscle weakness (sarcopenia), bone loss (osteoporosis) and more. The monkeys also exhibit feeding patterns and sleeping behaviour similar to humans. These shared genetics and behaviours mean research in monkeys can often be translated into human observations and studies; extrapolation of the results from monkey studies to human studies is a valuable asset.
Another key advantage of research into monkeys is that we can control factors or variables that are difficult to control in humans. For example, monkeys can be reared in an environment which provides them all with the same diet and the same habitat. With humans, it is almost impossible to control each aspect of life that might affect heart disease. Where the factor being tested is something the monkeys eat, for example, it’s possible to give the foodstuff to one half of the monkey group and not to the other, but keep all the other elements of the monkeys’ habitat and diet the same, in what is known as a randomised control trial.