Forging Healthy Chains: Social Support and the Roseto Effect

Posted on Wed, Jul 27, 2016 @ 03:14 PM

Chances are, you already know that love is better for your health than hate or indifference. It's a no-brainer that physical health and mental health are interdependent, although the nature of the bidirectional link is only just beginning to be understood by researchers. Studies testing the direction of the link seem to indicate that depression is more likely to lead to inflammation in the body rather than occur as a consequence of inflammation in the body—but in any case, the evidence has been stacking up for some time that social support has a profound effect on mental health, which in turn pays dividends to our physical health. The story of a little town in Pennsylvania illustrates this well.

During the 1950s, a Pennsylvania physician named Benjamin Falcone had been treating patients near the small towns of Bangor and Nazareth for 17 years when he noticed that older residents from a third nearby town, called Roseto, hardly ever needed to be seen for heart problems, even though the rate of heart attacks within the other two towns and across the United States in general was on the rise.

Roseto was a close-knit community consisting of about 1,200 inhabitants who had emigrated almost en masse in the 1890s from an Italian village called Roseto Valfortore. After arriving in America, the immigrants built a relatively isolated hillside community—separate from nearby English, Welsh or German communities. By 1912, Roseto’s population had exceeded 2,000 and it incorporated to become the first American municipality governed by Italians. By the time Dr. Falcone began to notice the extraordinary heart health of its residents, Roseto was a thriving town, accepted—and even admired—by neighboring Bangor and Nazareth, and served by the same doctors and hospitals.

One day, Dr. Falcone attended a local medical society talk given by a visiting physician from the University of Oklahoma, Dr. Stewart Wolf, who frequently spent summers at a nearby farm. Dr. Falcone invited Dr. Wolf out to a local pub for a beer and in the course of their conversation, mentioned the strange phenomenon he had noticed in the Roseto residents.

It was now 1961, and Wolf was intrigued enough to engage some of his colleagues from the University of Oklahoma in taking a deeper look at the Roseto effect. Along with sociologist John G. Bruhn, the research team began to compare medical histories, physical exams, and lab tests in a large sample of Rosetans—as well as the inhabitants of Bangor and Nazareth—hoping to find the key to the apparent health and happiness of this unusual community.

What they found stymied them. Yes, the evidence confirmed it was true that coronary heart disease and death from myocardial infarction (heart attack) was strikingly lower in Roseto than in its neighboring towns. Importantly, mental illness (including senile dementia) was also much lower: half the rate of Bangor, and only a third the rate of Nazareth. But at first, no one could understand why.

“The findings were surprising because of a greater prevalence of obesity among the Rosetans,” wrote Wolf and Bruhn in their report, published in 1979 under the title, The Roseto Story: An Anatomy of Health. “A meticulous study of dietary habits established that Rosetans ate at least as much animal fat as did the inhabitants of Bangor and Nazareth.” This was reflected, not only in the high obesity rates of Roseto, but also in the fact that the town’s rates of hypertension, diabetes, and measures of serum cholesterol concentration closely matched those of the other communities. Smoking and exercise habits were also similar, and the researchers were able to eliminate ethnic and genetic factors from the mix. After all, inhabitants who left Roseto to live in other communities soon became subject to the higher death rates that plagued the rest of the nation.

What, then, could explain Roseto’s strange effect? (And no, people weren’t drinking from a special communal well or making mysterious concoctions from South American miracle plants). Having already ruled out diet, exercise, genetics, and other factors that the medical community has long believed to be “risk factors” for heart disease, the researchers turned to studying the way Rosetans lived.

What they discovered was that their initial rejection by outlying communities had forced Rosetans to turn to one another for support and mutual help. Ultimately, the researchers found, the only real differences between Roseto and its neighboring communities were social ones. Roseto’s citizens enthusiastically took on the responsibility of being their neighbors’ keepers.

The researchers described the character of the townsfolk as buoyant, fun-loving, enterprising, optimistic, cohesive, and mutually supportive. “Our first sociological study of Roseto revealed that crises and problems were coped with jointly by family members with support from relatives and friends,” wrote Bruhn and Wolf. “Following a death in the family, interfamilial differences were forgotten, and the bereaved received food and money from relatives and friends, who at times temporarily assumed responsibility for the care of the children of the bereaved. When financial problems arose, relatives and friends rallied to the aid of the family, and in instances of abrupt, extreme financial loss the community itself assumed responsibility for helping the family.”

In addition, families weren’t secretive. Their problems were shared—and then worked out with the help of the local priest or family “pillars.” Pillars were often older single women in the community who had taken on the responsibility of aging parents and who were highly respected and valued for their role in maintaining cohesive family and community ties.

In Roseto, nearly everyone had a vital role to fulfill—whatever their age or gender. At the end of the day, they gathered together in each other’s homes, social clubs or the local diner. But the cornerstone of life in Roseto was the family. “Family traditions provide a buffer in times of crisis and a source of stability for the community,” wrote the researchers in their 1979 report.

Of course, even in Roseto life wasn’t always rosy, and a good study wouldn’t be complete without taking a look at the “outliers,” or those whose circumstances were remarkably different from the main sample. There were some who were marginalized in Roseto, either because they had no ethnic or social ties within the community or because, for whatever reason, they had been excluded or had excluded themselves from the community’s social culture. Like their neighbors in Bangor and Nazareth, these marginalized Rosetans showed a higher incidence of illness and myocardial infarction than the general population. Indeed, in one case history, a seemingly healthy “Mr. F.” commented to the researchers (five years before he died of a heart attack) that “I don’t fit in the town—I don’t live like they do—I’m not like the Rosetans.”

He was not the only marginalized inhabitant who missed out on the health benefits of living in Roseto. “Hard work and family and personal problems were common to most of them,” wrote Bruhn and Wolf. “In addition they emphasized self-reliance and responsibility for their own actions and hence enjoyed little or no family or community support in times of crisis.”

With these observations in hand after two years of study, it wasn’t difficult for the researchers to predict in 1963 that, “If and when Roseto’s traditional close-knit, mutually supportive social structure began to crumble . . . the town’s relative immunity to death from myocardial infarction would gradually come to an end.”

In fact, that is exactly what happened. As Roseto gradually became Americanized, adopting what the researchers called “materialistic and individualistic values,” mortality from heart attacks shot up, reaching the prevailing rate in Bangor by 1975. 

Today, self-reliant attitudes are still pervasive in Western society: we don't like to accept help, nor do we like to offer it to others if we judge that they have brought their problems on themselves. Sitting in our emotional silos we watch distressing news stories that add burdensome weights to our everyday worries, and these leave us vulnerable to the accompanying advertisements that offer magic pills or dietary regimens to counteract the damage these stresses have inflicted on our health. 

Fixing broken relationships may be more difficult than taking a pill or latching on to a fad diet, but it's impossible to manufacture the joy, resilience, optimism and general well-being that is a natural byproduct when we are surrounded by love and support rather than criticism and mistrust. And it isn't only the receiver of love and support who benefits: research tells us the health of the giver benefits as well.

True, it can be difficult to maintain an atmosphere of love and support when we are constantly bombarded by the voices of those who assert their power by stirring up hate and controversy. But we don't have to allow self-righteousness, anger, fear, suspicion, and competition to rule our thoughts and actions. We don't have to be reactive, we can be proactive: purposefully and mutually accepting the role of my neighbor's keeper. We can show love toward the enemies that we are being asked to hate. When we fail to do this, we fall prey to precisely the “materialistic and individualistic values that brought Roseto into the myocardial mainstream.

A well-known quote from Martin Luther King Jr. points out that “Hate does not conquer hate. But there is much more in the context of that statement and it is just as relevant now as when it was written—if not more so:

“Returning hate for hate multiplies hate, adding deeper darkness to a night already devoid of stars. Darkness cannot drive out darkness; only light can do that. Hate cannot drive out hate; only love can do that. Hate multiplies hate, violence multiplies violence, and toughness multiplies toughness in a descending spiral of destruction. So when Jesus says ‘Love your enemies,’ he is setting forth a profound and ultimately inescapable admonition. Have we not come to such an impasse in the modern world that we must love our enemies—or else? The chain reaction of evil—hate begetting hate, wars producing more wars—must be broken, or we shall be plunged into the dark abyss of annihilation"(Strength to Love, p. 47).

Every day there is something in the news that begs us to respond with hate, mistrust and suspicion, and invites us to contribute to the chain of hate and violence that arises all too naturally in human relationships. But we can't break that chain by controlling our opponents, we can only do it by controlling ourselves. 

If, as Charles Dickens suggested, "we forge the chains we wear in life," we have a clear decision to make. We can wear the chains of hate and reactivity . . . or we can forge chains of love and social support, like the Rosetans did by taking on the responsibility to be their neighbors' keepers. The choice we make could mean all the difference to our health.



Beyond the Nuclear Family
Biography: Martin Luther King Jr.: A Man With a Dream
Words of Hope



Tags: relationships, family, health, social psychology, social relationships, social support