Is There a Place for Love in Medicine?

I’m a hospital-based physician. Several years ago, I saw a wiry 85-year-old patient named Ms. W., who came to me after weeks of increasing fatigue and shortness of breath.

“The results of the blood tests and CT scan have me concerned,” I had told her. “I am worried you might have an immune system cancer, lymphoma. So, we need to do some more tests.”

I concluded: “This might sound scary, but we have an awesome team to be at your side as we figure this out, and I believe this is something we can beat as a team.”

Saying this, I took her hands and met her gaze with what I hoped was a tender smile. That’s when she summoned in a powerful voice and said to me: “Oh Jesus, this doctor’s love and your love will heal me. Praise the power of love and the power of God!”

It was a moment that may have been the greatest gift I’ve ever received as a hospital-based physician. 

As a young doc, I don’t think Ms. W.’s words would have resonated with me the way they did that day. During the last decade, I have been on an emotional-educational journey. I’ve learned to see the gifts one can easily miss—and the ways in which we are all wonderfully indebted to each other.

For years, I met suffering with a kind of cheerful but guarded optimism. In retrospect, this was done as much for me as for my patients. Focusing on the positive kept me from feeling too much pain. Yet this optimism created a distance, too; I was keeping an arm’s length from their existential fears.

My first lessons were in gratitude. Through thankfulness, I learned to see shared intimacy around my patient’s struggles as an incredible gift, but one that required immediate reciprocation.

Then, I found myself needing to understand compassion: witnessing the suffering of others and moving to act to address this suffering in some way. While I often don’t entirely “cure” what ails my patients (who are often older with many health and life challenges), I learned that if I addressed it with authentic presence and kindness, I could feel enlivened even in the toughest situations at work. 

This is where Ms. W. comes in with her weakness, weight loss, and abnormal CT scan. I knew she was gravely ill, and so I acknowledged her suffering, offered her hope, and tried to provide a sense of support and connection with me and my colleagues. She took that as something that was quite new to me as a doctor: love.

I have asked myself: What is love anyway, in medicine and in the rest of life? And how could it heal?

It’s ironic something that seems so fundamental can be enigmatic at the same time. Love is so important, yet so hard to talk about. I have had to lean on experts to appreciate our misunderstanding of love and verify its importance, and to filter their work through my experience as a hospitalist. Through that reading and experience, I’ve identified four ways to talk about love and health, submitted for your consideration.

Love is more and less than you think

When most of us in the United States think of love, we first think of romantic passion, finding our “one and only.” Beyond that, we might think of the unconditional lifelong bonds that hold families together.

But could love be even more than that? How do emotion scientists understand this conundrum? Psychologists like Barbara Fredrickson suggest we focus on our body’s, rather than our culture’s, idea of love. She describes it as a “micro-moments of warmth and connection you share with another living being.”

More specifically, love is a positive emotion generated by shared biochemistry and behavior, which leads to care for the well-being of the other. What distinguishes love from other positive emotions is the sensory connection to another—voice, sight, or touch—and the coming together of tone of voice, facial expression, or gestures. There is mirrored behavior, warmth, and well-wishing, all happening in a few moments.

Emotions by their nature are fleeting. According to Fredrickson, love only happens with these encounters—but what builds with repeated encounters over time is an ease of reconnecting that promotes trust and enduring commitments. These bonds are what we typically think of as love. These bonds are powerful and essential for human flourishing, but distinct from the fleeting emotion love. 

Thus, love is the warmth we can feel with that person behind the lunch counter, in the hallway with a colleague, and even with strangers with whom we share a short conversation. When I am with a patient, I have the opportunity to let love in, as Ms. W. taught me to do: to feel a visceral physical connection that makes her well-being a part of mine. In this way, we both feel less alone, if only a little, if only for a moment.

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  Greater Good Resources for Love and Connection

  Articles, videos, and podcast episodes to help you strengthen your relationships and show love to those around you

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In short, love can be low-stakes and everywhere—but the most important thing about love is that it can build the bonds that help us to feel supported on our disparate journeys.

Focusing on our body’s idea of love gives us more opportunities to love. I believe that the more we understand and talk about this broader, lighter version of love, the easier it is to disentangle it from the more complicated romantic and familial relationships we associate with love.

Love is foundational for health

Air, food, water. What’s next? Love. The anthropologist William Goldschmidt says we are born with “affect hunger.” We have a need—an appetite—for positive interpersonal emotions, just as we do for more material nutrients. 

That can be readily seen in emotionally deprived children. When “foundling” children of past eras—those who were abandoned—are taken in and then given adequate food and shelter without emotional nurturance, they die in infancy at 10 times the rate of other kids. Those who do survive often fail to obtain their predicted height; they often have much worse physical outcomes.

Recently, some researchers have focused on the lack of love in later stages of life. Many studies in multiple countries now demonstrate that people who lack social interaction tend to have a shortened lifespan. While these studies don’t talk about love, per se, we can imagine that many of these social interactions would meet our definition of love—micro-moments of connection and warmth we share with one another.

Does that make sense biologically? For social creatures like us who have been dependent on a group for safety, we can experience unwanted isolation as a threat to survival. And then we begin to see threats more readily in this stressed state. Our sense of caution and distrust increases. Paradoxically, it then becomes harder to have moments of warmth and connection when the opportunities arise. As Kathi Heffner and her colleagues have documented, this developing hyper-vigilant state can come with signs of inflammation. Over a 20-year period, isolation and stress (as manifest in C-reactive-protein level) were associated with more heart attacks.

As other studies suggest, feelings of connection activate the parasympathetic nervous system. As a result, we become more trusting and cooperative, and we can express a move diverse behavioral repertoire. With small positive interactions, bit by bit, we develop the cognitive, behavioral, and social resources we need for a healthy, productive life. Barbara Frederickson calls this phenomenon the “broaden-and-build” framework of love—and now a decade of research lends some support to this idea.

We can learn to experience more love

The broaden-and-build theory suggests an upward spiral where a little love unconsciously teaches us to generate more love. Are there ways to jumpstart this virtuous spiral?

A form of mindfulness called loving-kindness meditation has been found to increase the frequency and quality of micro-moments. In multiple studies, this common form of meditation has been taught to one group of people and compared to a control group. According to this work, over time loving-kindness meditation practice increased daily experiences of positive emotions and, in turn, produced increases in a wide range of personal resources, such as purpose in life and social support. Depressive symptoms decreased, as well. In many observational studies, daily spiritual practices of many kinds are strongly associated with increased positive emotions.

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  Loving-Kindness Meditation

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For those of us disinclined to pick up a spiritual practice, I suspect that less formal practices might work: simply practicing kindness and seeing all our everyday and more personal interactions as an opportunity to bring nourishing moments of love to our life.

Health care providers can embody and promote love as a healing force and essential to healthy living

For those who are ready, I believe we need to demonstrate love in the way we engage with our staff, colleagues, and patients—with our body language, tone of voice, and kind words.

We need to advocate for programs that support social connections in our most vulnerable citizens, especially the isolated elderly. Cutting-edge organizations like Caremore have found that proactively reaching out to patients at risk for loneliness saves money while improving health and well-being. At the other end of the age continuum, we need to remind our younger patients about the risks posed by social media and suggest engaging in more in-person activities.

Providers ought to routinely prescribe activities that promote love and connection. When my patients leave the hospital, I routinely give out handwritten “prescriptions for health and happiness” along with prescriptions for medicines. I prescribe “spread the love” to almost everyone by saying that “love makes you live longer, and spreading kindness to those around you will do as much for your health as most of the medicines I recommend.”

More concrete prescriptions might involve joining a church choir or volunteering with Meals on Wheels, for those for whom that is possible. One of my heroes, Dr. Naomi Rachel Remen, believes that “service is the best cure for loneliness,” and I agree. Health care providers routinely screen for depression; perhaps we should screen for meaningful relationships and the measurements of loneliness and social engagement. 

Is it unrealistic to believe we can talk more about love in health care? It might help to remember that sexuality was even harder for health care folks to talk about, but through the HIV epidemic, we learned, painfully, that we can learn to talk about tricky subjects. Indeed, I see a focus on love as one of the next steps in the evolution toward a more relational and patient-centered form of medicine.

In his beautiful song “Jesus, etc.,” Jeff Tweedy of the rock band Wilco says, “Our love is all of God’s money.” That line has been a revelation for me. Put another way, love is our superpower; it is our special gift that allows us to create the relationships that weave the fabric of our society. Without it, we would still be naked apes fighting it out alone in a dangerous world.