Introduction
People Who Need People
One June day in 2009, a rock musician named John McColgan was told that he needed a new kidney and he needed it fast. Every day in the United States, twelve people died waiting for a kidney, and when Johnâs name was added to the kidney transplant waiting list, the list was 86,218 names long. At the time he was living in Canada, though, where the list included only 2,941 people.1 Still, he took the news badly.
John is a drummer, an energetic, sinewy man with a smoothly shaved head. Though he had been diagnosed with progressive kidney disease when he was in his mid-twenties, heâd had few symptoms and until that moment hadnât spent much time worrying about his health. At forty-eight he was often on the basketball court with men a decade younger, and he liked nothing better than to shoot a few hoops with his seventeen-year-old son. John skateboarded around town in summer, snowboarded in winter, and did pushups and crunches every day on the floor of his living room, not to mention all the drumming, a workout in itself. Before turning thirty he had played with Linda Ronstadt and Kate and Anna McGarrigle, and a short time later he backed up Big Mama Thornton and opened for superstars such as James Brown and Stevie Ray Vaughan. Still, when money was scarce, he wasnât above digging irrigation ditches and working renovation jobs. Johnâs gas tank was often empty, his rent overdue. But his exuberance onstage and his lightheartedness offstage gave him the eternal charm of a schoolboy; he always got by with a little help from his friends.
John was rich in one important way: he had amassed a committed circle of friends, most of whom knew each other and regularly crossed pathsâa feature of the most powerful and effective social networks. A large bank balance wouldnât have helped him much in this situation in any case, as itâs illegal to buy or sell organs for transplantation everywhere in the world except Iran and Singapore.2 And in the current crisis, family couldnât help himâhis father had died at fifty of polycystic kidney disease, a genetic disorder heâd passed on to John, and his mother had died a few years earlier of cancer. After months of dialysis, John realized he couldnât simply wait for his turn for a new kidney. He had to go looking for one.
By the time I met up with John less than eighteen months later, the transplant ordeal was behind him. Iâd known him for at least twenty years and the change in him was stark. He seemed frail; the buzzed hair around the back of his bare skull was as short as a dayâs growth of beard, and his skin looked transparent in what little light filtered in through the high, grimy windows of the Montreal cafĂ© where we met. He told me that four people he knew had offered to give him a kidney.
The first was his ex-wife, Amy. But her drug addiction had savaged her health along with their marriage. Though she had recently kicked the habit, her organs had paid the price. His wifeâs sister had also offered, but John decided that would just be too complicated. (When I asked Jessie, a mother of three small children and a professional dancer, why she would take this huge risk, she was taken aback. âWell, you know John. Everyone loves him. Why wouldnât I give him my kidney?â)
Then a longtime friend, Kate, walked up to John at a gallery opening and blurted out that she wanted to help. She told me later that as soon as she offered her kidney, she felt scared. She then called the transplant nurse to ask what would be the worst thing that could happen if she went ahead. The nurse told her that one person in three thousand dies during the operation, and that the surgeon might accidentally knick her spleen. âThen I thought, Iâm not going to die. Thatâs just not going to happen to me.â
Still, the testing was grueling, and it didnât stop even after they found that her blood type and tissues were compatible with Johnâs. âDuring that year I went back more than five times. I gave sixteen vials of blood. They took various cells to test my compatibility. Then they tested my health. They did ultrasounds and CAT scans. I had a mammogram, which found a cyst, so they did a biopsy. Then I did a twenty-four-hour urine test, twice.â
She also underwent a long interview during which the transplant team examined her motives. âI could tell they were suspicious because I wasnât family.â As powerful anti-rejection drugs had been available for a decade, it was now less important for the donor and recipient to be related. Still, medical professionals needed to know: Why on earth would someone volunteer to go through this?
It turned out that Kate was ready for the surgery before John was, so in the end the timing didnât work out; she couldnât be Johnâs donor. The kidney John ultimately received was a gift from his longtime friend Fred, with whom he had listened to Hendrix and Zappa as a teenager, two fifteen-year-olds trying out guitar riffs in Fredâs basement. Thirty years later they saw each other perhaps once or twice a year. Still, when John needed a kidney, Fred came forward.
The probability that a person not biologically related to you will offer you a kidney is very smallâabout three in a thousand. The chances of two people doing so are infinitesimal.3 Then there is John, who received four serious offers. By virtue of his strong relationships, groomed over decades, John beat the oddsâand the disease that had killed his father.
Johnâs story is an unusually concrete example of how strong social bonds can prolong our lives. In the following pages Iâll show how those of us who invest in meaningful personal relationships with lots of real social contact are more robust and have better physiological defenses than those who are solitary or who engage with the world largely online. Digital networks and screen media have the power to make the world seem much smaller. But when it comes to certain life-changing transformations, theyâre no match for face-to-face.
Face-to-face interaction does not just spur selfless acts like those of Johnâs friends, it also affects how well we learn to read, how quickly we fight off infection, and ultimately how long we live. So how exactly does that happen?
Less than 0.01 percent of the Western worldâs population needs a new kidney.4 But every one of us needs a tight knot of friends and family in our corner, and not just when the chips are down. If we donât interact regularly with people face-to-face, the odds are we wonât live as long, remember information as well, or be as happy as we could have been. What do I mean by regularly? When my son was small and went to his first violin lesson, he asked his music teacher, an impish man from Belgrade, if the rumor was true: did he really have to practice every day? Crouching down to Ericâs level and putting a slender hand to his chin, Dragan considered the question. âNot every day. Just every day you eat.â
Social contact is like that. Itâs a biological drive. So I learned after spending three years delving into a fairly new fieldâsocial neuroscience. The field didnât exist when I trained as a psychologist, back when brain scans were as rare and expensive as private jets.5 But by the early 1990s brain imaging had become more accessible, with hulking fMRI machines proliferating in windowless rooms in most large hospitals and universities. Research psychologists started to use them, along with demographic and biochemical tools, to track the science underpinning human relationships, and vice versaâto spy on the way our relationships transform our bodies, including our hormonal and neural circuits. I was hooked. In the meantime, though the social parts of our brains had become easier to observe, the meaning of the phrase social network had morphed. Instead of referring to all the peo...