Human Connection in Health and Illness

  • Mohammadreza Hojat


  • Humans are evolved to connect together for survival. Among the factors that fulfill the human need for affiliation and connectedness are social institutions, such as marriage, family, and the social support network, including clinician–patient empathic relationships.

  • Human connection serves to promote health and prevent illness. Conversely, an absence of satisfactory human connection, experienced as loneliness, is detrimental to physical, mental, and social well-being.

  • The mechanisms involved in linking the quality of human connection to health or illness are not well understood. However, opportunities for empathic engagement and involvement of a multisystem of psychoneuroimmunology may provide some explanations for the beneficial effects of human connections.

  • The clinician–patient relationship is formed in part by the drive for connectedness which increases with illness. The empathic connection between clinician and patient can serve as a special kind of social support system with all of its beneficial effects.


Human connection Social support Group therapy Factor x Contagious yawning 


  1. Balint, M. (1957). The doctor, his patient and the illness. New York: International Universities Press.Google Scholar
  2. Berkman, L. F. (1995). The role of social relations in health promotion. Psychosomatic Medicine, 57, 245–254.CrossRefPubMedGoogle Scholar
  3. Berkman, L. F. (2000). Which influences cognitive function: Living alone or being alone? Lancet, 355, 1291–1292.CrossRefPubMedGoogle Scholar
  4. Berkman, L. F., Glass, T., Brissette, I., & Seeman, T. E. (2000). From social integration to health: Durkheim in the new millennium. Social Science & Medicine, 51, 843–857.CrossRefGoogle Scholar
  5. Berkman, L. F., Leo-Summers, L., & Horwitz, R. I. (1992). Emotional support and survival after myocardial infarction. Annals of Internal Medicine, 117, 1003–1009.CrossRefPubMedGoogle Scholar
  6. Berkman, L., & Syme, S. (1979). Social networks, host resistance, and mortality: A nine-year follow-up of Alameda County residents. American Journal of Epidemiology, 109, 186–204.PubMedGoogle Scholar
  7. Blazer, D. G. (1982). Social support and mortality in an elderly community population. American Journal of Epidemiology, 115, 684–694.PubMedGoogle Scholar
  8. Bloom, B. L., Asher, S. J., & White, S. W. (1978). Marital disruption as a stressor: A review analysis. Psychological Bulletin, 85, 867–894.CrossRefPubMedGoogle Scholar
  9. Blumenthal, J. A., Burg, M. M., Barefoot, J., Williams, R. B., Haney, T., & Zimet, G. (1987). Social support, Type A behavior, and coronary artery disease. Psychosomatic Medicine, 49, 331–340.CrossRefPubMedGoogle Scholar
  10. Bohart, A. C., Elliot, R., Greenberg, L. S., & Watson, J. C. (2002). Empathy. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients (pp. 89–108). Oxford: Oxford University Press.Google Scholar
  11. Book, H. E. (1991). Is empathy cost efficient? American Journal of Psychotherapy, 45, 21–30.PubMedGoogle Scholar
  12. Boruch, R. F. (1982). Evidence and inference in research on mass psychogenic illness. In M. J. Colligan, J. W. Pennebaker, & L. R. Murphy (Eds.), Mass psychogenic illness: A social psychological analysis (pp. 101–125). Hillsdale, NJ: Erlbaum.Google Scholar
  13. Boscarino, J. A. (1995). Post-traumatic stress and associated disorders among Vietnam veterans. The significance of combat exposure and social support. Journal of Trauma Stress, 8, 317–336.CrossRefGoogle Scholar
  14. Cacioppo, J. T., Hawkley, L. C., Crawford, E., Ernst, J. M., Burleson, M. H., Kowalewski, R. B., … Berntson, G. G. (2002). Loneliness and health: Potential mechanisms. Psychosomatic Medicine, 64, 401–417.Google Scholar
  15. Case, R. B., Moss, A. J., Case, N., McDermott, M., & Eberly, S. (1992). Living alone after myocardial infarction: Impact on prognosis. Journal of the American Medical Association, 267, 515–519.CrossRefPubMedGoogle Scholar
  16. Christenfeld, N., & Gerin, W. (2000). Social support and cardiovascular reactivity. Biomedicine and Pharmacotherapy, 54, 251–257.CrossRefPubMedGoogle Scholar
  17. Cohen, S. (1988). Psychological models for the role of social support in the etiology of physical disease. Health Psychology, 7, 269–297.CrossRefPubMedGoogle Scholar
  18. Cohen, S. (2004). Social relationship and health. American Psychologist, 59, 676–684.CrossRefPubMedGoogle Scholar
  19. Cohen, S., & Matthews, K. A. (1987). Social support, type A behavior, and coronary artery disease. Psychosomatic Medicine, 49, 325–330.CrossRefPubMedGoogle Scholar
  20. Colligan, M. J., & Murphy, L. R. (1982). A review of mass psychogenic illness in work settings. In M. J. Colligan, J. W. Pennebaker, & L. R. Murphy (Eds.), Mass psychogenic illness: A social psychological analysis (pp. 33–52). Hillsdale, NJ: Erlbaum.Google Scholar
  21. Durkheim, E. (1951). Suicide: A study in sociology, (J.A. Spaulding & G. Simpson, Trans.). Glencoe, IL: Free Press.Google Scholar
  22. Egolf, B., Lasker, J., Wolf, S., & Potvin, L. (1992). Featuring health risks and mortality: The Roseto effect, a 50-year comparison of mortality rates. American Journal of Public Health, 82, 1089–1092.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Fox, C. M., Harper, A. P., Hyner, G. C., & Lyle, R. M. (1994). Loneliness, emotional expression, marital quality and major life events in women who developed breast cancer. Journal of Community Health, 19, 467–482.CrossRefPubMedGoogle Scholar
  24. Fratiglioni, L., Wang, H. X., Ericsson, K., Maytan, M., & Winblad, B. (2000). Influence of social network on occurrence of dementia: A community-based longitudinal study. Lancet, 355, 1315–1319.CrossRefPubMedGoogle Scholar
  25. Galanter, M., Talbott, D., Gallegos, K., & Rubenstone, E. (1990). Combined alcoholics anonymous and professional care for addicted physicians. American Journal of Psychiatry, 147, 64–68.CrossRefPubMedGoogle Scholar
  26. Glynn, L. M., Christenfeld, N., & Gerin, W. (1999). Gender, social support, and cardiovascular response to stress. Psychosomatic Medicine, 61, 234–242.CrossRefPubMedGoogle Scholar
  27. Goodwin, J. S., Hunt, W. C., Key, C. R., & Samet, J. M. (1987). The effect of marital status on stage, treatment, and survival of cancer patients. Journal of the American Medical Association, 258, 3125–3130.CrossRefPubMedGoogle Scholar
  28. Goubert, L., Craig, K. D., Vervoort, T., Morley, S., Sullivan, M. J. L., Williams, A. C. C., … Crombez, G. (2005). Facing others in pain: The effects of empathy. Pain, 118, 285–288.Google Scholar
  29. Greenberg, L. S., Watson, J. C., Elliot, R., & Bohart, A. C. (2001). Empathy. Psychotherapy, 38, 380–384.CrossRefGoogle Scholar
  30. Hartup, W. W., & Stevens, N. (1999). Friendships and adaptation across the life span. American Psychological Society, 8, 76–79.Google Scholar
  31. Hirshberg, C., & Barasch, M. I. (1995). Remarkable recovery. New York: Riverside Books.Google Scholar
  32. Hislop, T. G., Waxler, N. E., Coldman, A. J., Elwood, J. M., & Kan, L. (1987). The prognostic significance of psychosocial factors in women with breast cancer. Journal of Chronic Diseases, 40, 729–735.CrossRefPubMedGoogle Scholar
  33. Hojat, M. (1982a). Loneliness as a function of selected personality variables. Journal of Clinical Psychology, 38, 137–141.CrossRefPubMedGoogle Scholar
  34. Hojat, M. (1982b). Psychometric characteristics of the UCLA Loneliness Scale. Educational and Psychological Measurement, 42, 917–925.CrossRefGoogle Scholar
  35. Hojat, M. (1983). Comparison of transitory and chronic loners on selected personality variables. British Journal of Psychology, 74, 199–202.CrossRefPubMedGoogle Scholar
  36. Hojat, M. (1992). Social and economic factors in patients with coronary disease. Journal of the American Medical Association, 268, 195–196.CrossRefPubMedGoogle Scholar
  37. Hojat, M., & Crandall, R. (Eds.). (1989). Loneliness: Theory, research, and applications. Newbury, CA: Sage.Google Scholar
  38. Hojat, M., Mangione, S., Kane, G., & Gonnella, J. S. (2005). Relationships between scores of the Jefferson Scale of Physician Empathy (JSPE) and the Interpersonal Reactivity Index (IRI). Medical Teacher, 27, 625–628. doi: 10.1080/01421590500069744.CrossRefPubMedGoogle Scholar
  39. Hojat, M., Michalec, B., Veloski, J., & Tykocinski, M. L. (2015). Can empathy, other personality attributes, and level of positive social influence in medical school identify potential leaders in medicine? Academic Medicine, 90, 505–510. doi: 10.1097/ACM.0000000000000652.CrossRefPubMedGoogle Scholar
  40. Hojat, M., & Shapurian, R. (1986). Anxiety and its measurement: A study of psychometric characteristics of a short form of the Taylor Manifest Anxiety Scale in Iranian students. Journal of Social Behavior and Personality, 1, 621–630.Google Scholar
  41. Hojat, M., Shapurian, R., & Mehryar, A. H. (1986). Dimensionality of the short form of the Beck Depression Inventory. Psychological Reports, 59, 1069-1070. Hojat, M., & Vogel, W. H. (1989). Socioemotional bonding and neurobiochemistry. Journal of Social Behavior and Personality, 2, 135–144.Google Scholar
  42. Holland, J. C. (2001). Improving the human side of cancer care: Psycho-oncology’s contribution. Cancer Journal, 7, 458–471.Google Scholar
  43. House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241, 540–544.CrossRefPubMedGoogle Scholar
  44. House, J. S., Robbins, C., & Metzner, H. L. (1982). The association of social relationships and activities with mortality: Prospective evidence from the Tecumseh Community Health Study. American Journal of Epidemiology, 116, 123–140.PubMedGoogle Scholar
  45. Kaplan, G. A., Salonem, J. T., & Cohen, R. D. (1988). Social connections and mortality from all causes and from cardiovascular disease: Prospective evidence from eastern Finland. American Journal of Epidemiology, 128, 370–380.PubMedGoogle Scholar
  46. Keller, S., Shiflett, S. C., Schleifer, S. J., & Bartlett, J. A. (1994). Human stress and immunity. San Diego, CA: Academic Press.Google Scholar
  47. Kennedy, S., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Immunological consequences of acute and chronic stressors: Mediating role of interpersonal relationships. British Journal of Medical Psychology, 61, 77–85.CrossRefPubMedGoogle Scholar
  48. Kiecolt-Glaser, J. K., Garner, W., Speicher, C. E., Penn, G. M., Holiday, J. E., & Glaser, R. (1984). Psychosocial modifiers of immunocompetence in medical students. Psychosomatic Medicine, 46, 7–14.CrossRefPubMedGoogle Scholar
  49. LaRocco, J. M., House, J. S., & French, J. R. P. (1980). Social support, occupational stress, and health. Journal of Health and Social Behavior, 21, 202–218.CrossRefPubMedGoogle Scholar
  50. Larson, D. (1993). The helper’s journey: Working with people facing grief, loss, and life-threatening illness. Champaign, IL: Research Press.Google Scholar
  51. Levy, D. (Ed.). (1999). Medical milestones from the National Heart, Lung, and Blood Institute’s Framingham Heart Study. Center for Bio-Medical Communication.Google Scholar
  52. Lewis, J. M. (1998). For better or worse: Interpersonal relationships and individual outcome. American Journal of Psychiatry, 155, 582–589.CrossRefPubMedGoogle Scholar
  53. Lieberman, M. D. (2007). Social cognitive neuroscience: A review of core processes. Annual Review of Psychology, 58, 259–289.CrossRefPubMedGoogle Scholar
  54. Lynch, J. J. (1977). The broken heart: The consequences of loneliness. New York: Basic books.Google Scholar
  55. Marmot, M. G., & Syme, S. L. (1976). Acculturation and coronary heart disease in Japanese-Americans. American Journal of Epidemiology, 104, 225–247.PubMedGoogle Scholar
  56. McClintock, M. K. (1971). Menstrual synchrony and suppression. Nature, 229, 244–245.CrossRefPubMedGoogle Scholar
  57. McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338, 171–179.CrossRefPubMedGoogle Scholar
  58. Morgan, J. D. (Ed.). (2002). Social support: A reflection of humanity. Amityville, NY: Baywood Publishing Company.Google Scholar
  59. Murray, H. A. (1938). Explorations in personality. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
  60. Newberg, A., & Waldman, R. (2010). Yawn, it’s one of the best things you can do for your brain. In How god changes your brain? New York: Ballantine books/Random House.Google Scholar
  61. Nicholas, D. (2002). Social support of the bereaved: Some practical suggestions. In J. D. Morgan (Ed.), Social support: A reflection of humanity (pp. 33–43). Amityville, NY: Baywood Publishing.Google Scholar
  62. Novack, D. H. (1987). Therapeutic aspects of the clinical encounter. Journal of General Internal Medicine, 2, 346–355.CrossRefPubMedGoogle Scholar
  63. Ornish, D. (1998). Love and survival: The scientific basis for the healing power of intimacy. New York: Harper Collins.Google Scholar
  64. Orth-Gomer, K., & Johnson, J. V. (1987). Social network integration and mortality: A six-year follow-up study of random sample of the Swedish population. Journal of Chronic Diseases, 40, 949–957.CrossRefPubMedGoogle Scholar
  65. Ortmeyer, C. F. (1974). Variations in mortality, morbidity, and health care by marital status. In L. L. Erhardt & J. E. Beln (Eds.), Mortality and morbidity in the United States (pp. 159–184). Cambridge, MA: Harvard University Press.Google Scholar
  66. Papadakis, M. A., Teherani, A., Banach, M. A., Knettler, T. R., Rattner, S. L., Stern, D. T., … Hodgson, C. S. (2005). Disciplinary action by ethical boards and prior behavior in medical school. New England Journal of Medicine, 353, 2673–2682.Google Scholar
  67. Pennebaker, J. W. (1990). Opening up: The healing power of confining in others. New York: William Morrow.Google Scholar
  68. Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, K. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56, 239–245.CrossRefPubMedGoogle Scholar
  69. Penninx, B. W., van Tilburg, T., & Kriegsman, D. M. (1997). Effects of social support and personal coping resources on mortality in older age: The Longitudinal Aging Study, Amsterdam. American Journal of Epidemiology, 146, 510–519.CrossRefPubMedGoogle Scholar
  70. Platek, S. M., Critton, S. R., Myers, T. E., & Gallup, G. G. (2003). Contagious yawning: The role of self awareness and mental state attribution. Cognitive Brain Research, 17, 223–227.CrossRefPubMedGoogle Scholar
  71. Platek, S. M., Mohamed, F. B., & Gallup, G. G. (2005). Contagious yawning and the brain. Cognitive Brain Research, 23, 448–452.CrossRefPubMedGoogle Scholar
  72. Platt, F. W., & Keller, V. F. (1994). Empathic communication: A teachable and learnable skill. Journal of General Internal Medicine, 9, 222–226.CrossRefPubMedGoogle Scholar
  73. Raynolds, P., Boyd, P. T., & Blacklow, R. S. (1994). The relationships between social ties and survival among black and white breast cancer patients: National Cancer Institute, Cancer Survival Study Group. Cancer Epidemiology, Biomarkers & Prevention, 3, 253–259.Google Scholar
  74. Rodriguez, M. S., & Cohen, S. (1998). Social support. In H. S. Friedman (Ed.), Encyclopedia of mental health (pp. 535–544). San Diego, CA: Academic Press.Google Scholar
  75. Romano, J. M., Jensen, M. P., Turner, J. A., Good, A. B., & Hops, H. (2000). Chronic pain patient-partner interactions: Further support for a behavioral model of chronic pain. Behavior Therapy, 31, 415–440.CrossRefGoogle Scholar
  76. Russell, D., Peplau, L. A., & Cutrona, C. B. (1980). The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. Journal of Personality and Social Psychology, 39, 472–480.CrossRefPubMedGoogle Scholar
  77. Sapolsky, R. M. (2004). Why zebras don’t get ulcers (3rd ed.). New York: Times Books.Google Scholar
  78. Schachter, S. (1959). The psychology of affiliation. Stanford, CA: Stanford University Press.Google Scholar
  79. Schoenbach, V., Kaplan, B. H., Fredman, L., & Kleinbaum, D. G. (1986). Social ties and mortality in Evans County, Georgia. American Journal of Epidemiology, 123, 577–591.PubMedGoogle Scholar
  80. Seeman, T. E., Berkman, L. F., & Kohout, F. (1993). Intercommunity variation in the association between social ties and mortality in elderly: A comparative analysis of three communities. Annals of Epidemiology, 3, 325–335.CrossRefPubMedGoogle Scholar
  81. Seeman, T. E., & Syme, L. (1987). Social network and coronary artery disease: A comparison of the structure and function of social relations and predictors of disease. Psychosomatic Medicine, 49, 341–354.CrossRefPubMedGoogle Scholar
  82. Shamasundar, M. R. C. (1999). Reflections: Understanding empathy and related phenomena. American Journal of Psychotherapy, 53, 232–245.PubMedGoogle Scholar
  83. Shapurian, R., & Hojat, M. (1985). Psychometric characteristics of a Persian version of the Eysenck Personality Questionnaire. Psychological Reports, 57, 631–639.CrossRefGoogle Scholar
  84. Spiegel, D. (1990). Can psychotherapy prolong cancer survival? Psychosomatics, 31, 361–366.CrossRefPubMedGoogle Scholar
  85. Spiegel, D. (1993). Living beyond limits: New hope and help for facing life-threatening illness. New York: Times Books.Google Scholar
  86. Spiegel, D. (1994). Health caring: Psychological support for patients with cancer. Cancer, 74, 1453–1457.CrossRefPubMedGoogle Scholar
  87. Spiegel, D. (2004). Mind matters—Group therapy and survival in breast cancer. The New England Journal of Medicine, 345, 1–3.Google Scholar
  88. Spiegel, D., & Bloom, J. R. (1983). Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosomatic Medicine, 45, 333–339.CrossRefPubMedGoogle Scholar
  89. Spiegel, D., Bloom, J. R., Kraemer, H. C., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2, 888–891.CrossRefPubMedGoogle Scholar
  90. Spiegel, D., Bloom, J. R., & Yalom, I. D. (1981). Group support for patients with metastatic breast cancer. Archives of General Psychiatry, 38, 527–533.CrossRefPubMedGoogle Scholar
  91. Spiro, H. M. (1986). Doctors, patients and placebos. New Haven: Yale University Press.Google Scholar
  92. Stephan, W. G., & Finlay, K. (1999). The role of empathy in improving inter-group relations. Journal of Social Issues, 55, 729–743.CrossRefGoogle Scholar
  93. Taylor, S. E., Klein, L. C., Gruenewald, T. L., Gurung, R. A. R., & Fernandes-Taylor, S. (2003). Affiliation, social support and biobehavioral response to stress. In J. Suls & K. A. Wallston (Eds.), Social psychological foundations of health and illness (pp. 314–331). Malden, MA: Blackwell.CrossRefGoogle Scholar
  94. Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996). The relationship between social support system and physiological processes: A review with emphasis on underlying mechanisms and implications for health. Psychological Bulletin, 119, 488–531.CrossRefPubMedGoogle Scholar
  95. Uvnas-Moberg, K. (1997). Physiological and endocrine effects of social contact. Annals of the New York Academy of Sciences, 807, 146–163.CrossRefPubMedGoogle Scholar
  96. Valliant, G. E. (1977). Adaptation to life. Boston: Little, Brown.Google Scholar
  97. Verbrugge, L. M. (1979). Marital status and health. Journal of Marriage and the Family, 41, 267–285.CrossRefGoogle Scholar
  98. Wellman, B. (1998). Social network. In H. S. Friedman (Ed.), Encyclopedia of mental health (pp. 525–544). San Diego, CA: Academic Press.Google Scholar
  99. White, K. L. (1991). Healing the schism: Epidemiology, medicine, and the public’s health. New York: Springer-Verlag.CrossRefGoogle Scholar
  100. Wiklund, I., Oden, A., & Sanne, H. (1988). Prognostic importance of somatic and psychosocial variables after a first myocardial infarction. American Journal of Epidemiology, 128, 786–795.PubMedGoogle Scholar
  101. Williams, R. B., Barefoot, J. C., Califf, R. M., Haney, T. L., Saunders, W. B., & Pryor, D. B. (1992). Prognostic importance of social and economic resources among medically treated patients with angiographically documented coronary artery disease. Journal of the American Medical Association, 267, 524.Google Scholar
  102. Windholz, M. J., Marmar, C. R., & Horowitz, M. J. (1985). A review of research in conjugal bereavement: Impact on health and efficacy of intervention. Comprehensive Psychiatry, 26, 433–447.CrossRefPubMedGoogle Scholar
  103. Wittstein, I. S., Thiemann, D. R., Lima, J. A. C., Baughman, K. L., Schulman, S. P., … Chapman, H. C. (2005). Neurohormunal features of myocardial stunning due to sudden emotional stress. New England Journal of Medicine, 352, 539–548.Google Scholar
  104. Wolf, S. (1992). Prediction of myocardial infarction over a span of 30 years in Roseto, Pennsylvania. Integrative Physiological & Behavioral Science, 27, 246–257.CrossRefGoogle Scholar
  105. World Health Organization. (1948). World Health Organization Constitution: Basic documents. Geneva: Author.Google Scholar
  106. Zuckerman, M. (2002). Zuckerman-Kuhlman Personality Questionnaire (ZKPQ): An alternative five-factor model. In B. DeRaad & M. Perugini (Eds.), Big five assessment (pp. 377–396). Seattle, WA: Hogrefe & Huber.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Mohammadreza Hojat
    • 1
  1. 1.Sidney Kimmel Medical College Thomas Jefferson UniversityPhiladelphiaUSA

Personalised recommendations