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Chapter 11 of the book

The Social Animal

Other people are a signal too. Part Five follows the ones that come from company, from whatever competes for your attention, from stress, and from the wanting, loving, losing and meaning that fill a life.

ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.3 things to start with34 works cited

How the chapter opens

Roseto, Pennsylvania, should not have been unusual. The Italian-American town sat a short drive from Bangor and Nazareth, in the same corner of the state, eating much the same food. What set the town apart showed up only in the death certificates, and only once somebody thought to add them up.

From the 1930s through the 1960s, Roseto's death rate from heart attack ran at roughly half that of its two neighbors. Between 1954 and 1961, almost no man in Roseto under fifty-five died of a heart attack at all. On diet and smoking, Rosetans were no better off than their neighbors. What observers kept describing was the town itself: close-knit, its people tightly bound to one another.

What the chapter covers

The argument, the studies and the stories are in the book. Get the book.

  • ·What Your Body Expects
  • ·What It Gets Instead: Fewer Close Ties, Maybe
  • ·What It Gets Instead: The Inner Circle Left to Chance
  • ·What It Gets Instead: Parents Behind a Closed Door
  • ·Where Friendships Come From

Mismatch card

The system

The social brain and the stress physiology it regulates, from the threat circuitry that registers exclusion to the hormones that respond to touch.

What it expects

Daily, face-to-face contact with a small, stable group; touch as an ordinary event; many hands around every infant, from labor onward.

What it gets

A wide, thin network through a screen, inner circles left to chance, labor attended by rotating staff, and new parents largely alone behind a closed door.

What happens in the gap

Higher mortality among isolated and lonely people across dozens of cohorts, loneliness and depression in new parents, and a stress system that loses one of its regulators.

The handrail

Three to five named people on a schedule, a standing weekly activity with others, touch where it is welcome, continuous labor support and help recruited before a birth (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.)

Strength of evidence

ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials. The mortality association is large and consistent but observational; the mechanisms and the labor-support effect rest on small or low-quality trials.

The protocol

Each action carries the book's evidence grade. How the grades work.

Start here

  1. Name your three to five people, and schedule them

    ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.

    How: write down the people you would call at two in the morning, and who would call you. Give each a recurring slot, in person where you can and a call where you cannot: the same Tuesday, the same table, the same walk. No trial has tested a dose, so pick a rhythm you can keep, such as a real conversation with one of them every week. If you can write only one name, or none, start there: pick one dormant tie, an old friend, a sibling or a former colleague, and send one message this week suggesting a specific time. Why: the health evidence points at the quality of a few close ties, not the size of a network.

  2. Join one standing weekly thing done with other people

    EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.

    How: a class, a choir, a team, a volunteer shift, a shared meal. Same time, same faces, and if you can, something done together in time, such as singing, dancing, rowing or a group class. Choose what you will still be doing in three months over what sounds best. Why: recurrence is the likeliest way to build the ties linked to longer life, though that part is inference; moving in time raised closeness in single sessions.

  3. Expecting or raising young children? Recruit helpers on purpose, before you need them

    EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.

    How: before the birth, line up specific people for specific jobs: meals, a night off, laundry, an adult to talk to at midday. If there are two of you, agree in advance who covers which nights. Ask in detail; offers of help tend to arrive vague. Why: low support is among the strongest predictors of depression after birth; no trial has tested a particular arrangement.

Then, pick from this menu

  • **Take on a recurring role others depend on (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).** About two hours of volunteering a week is the level linked to lower mortality in a large US cohort of adults over fifty. Healthier people are also likelier to volunteer, so treat it as a link, not a proof; Chapter 14 sets out the evidence.26

  • **If your closest relationship is in trouble, get couple therapy (StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism. for relationship satisfaction).** Nothing ancestral recommends it; it is here because it has some of the best trial evidence in this territory (Chapter 14).

  • **Bring someone with you (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials. for weight loss; EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested. for other routines).** Start a weight-loss plan, or a new class or walk, with a friend and agree to back each other up. In the trial above, that kept weight off far more often; exercise habits were not tested.

  • **Keep touch in the repertoire, where it is welcome (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.).** A hug, a hand held, a shoulder rub with a partner. The trial dose was thirty minutes of reciprocal touch three times a week, but no minimum has been established. Consent and the relationship decide.

  • **Put the phone in another room for the conversations that matter (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** A phone merely lying nearby made conversations feel less close in two small experiments (Chapter 12).

  • **Count your week (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** Hours in the same room as someone, meals shared, conversations held live rather than typed. Then change one of those numbers on purpose. No trial tests this framing; it follows from the difference between isolation, which you can count, and loneliness, which you feel.

  • **In England, ask your doctor about social prescribing (EmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.).** A link worker can connect you to groups near you; the health outcomes are still unsettled.

If this is you

Having a baby

arrange continuous support in labor from a doula, midwife or trained companion who stays throughout (ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.), alongside clinical care and never instead of a medically needed intervention. At home, room-share without bed-sharing for at least the first six months (StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.): baby on its back, on a firm, flat surface of its own, with no pillows, bumpers, soft bedding or loose blankets, and not too warm. If you have had depression before, or are otherwise at higher risk, ask about counseling such as cognitive behavioral therapy during pregnancy or after the birth (StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.; Chapter 15).27

Parent of school-age kids, no spare eveningsEmergingEvidence grade: Emerging. Early, small, animal-only, or actively contested.

you already have a standing weekly thing in the practice, the lesson or the school gate. Stand with the same parents each week instead of in the car on your phone, and turn one of them into a coffee.

New in a city

keep the far-away friends on fixed calls, and give the local layer time to form in one place where the same people recur, week after week.

Widowed, or living alone after a loss

health risks are highest in the first months after a death, so let people take on specific tasks, and keep one standing contact that does not depend on you starting it each time (Chapter 14).

Night shifts

your coworkers may be your weekly group. Add one daytime contact on days off, planned around your sleep slot.

Seeing a child on a schedule

make the time you have predictable, with the same routine each visit and a fixed call in between.

Over 50, or conversation has become hard work

get your hearing tested (Chapter 10).

Bad knee, or walking is hard

choose a standing thing that is seated or low-impact, such as a choir, a card or book group, or a volunteer desk shift.

Tight budget

almost everything here is free. Library events, parks, volunteering and, if you belong to one, a religious community all supply the same faces week after week. Continuous labor support need not come from a paid doula; in the trials it also came from midwives, nurses and other trained companions, so ask what your hospital or birth center offers.

Short on time

combine. Walk with a friend instead of alone, or do the week's strength session with someone else.

Safety

Withdrawal is a symptom as well as a cause. Depression and anxiety both shrink social contact, and a person in that state needs treatment as well as company, not company instead of it (Chapter 13). If low mood lasts more than two weeks, including after a birth, talk to a clinician; with any thoughts of suicide or self-harm, call 988 in the US or your local emergency number. Couple therapy is not appropriate where there is violence or coercive control; the person at risk needs individual safety support first. For infants, bed-sharing risk rises sharply with parental smoking, alcohol or sedating medication, prematurity, low birth weight and age under four months, and sofas and armchairs are dangerous places to fall asleep with a baby at any age. If you might doze off feeding, plan where that will happen.23

The skeptic's box

What could overturn this chapter, from the chapter itself.

Almost every mortality number in this chapter is observational, and the arrow can run both ways. People who are already sick, poor or declining become more isolated, and isolation and ill health share causes that no adjustment fully removes. The size and consistency of the association across very different cohorts make a purely spurious link unlikely, but a trial that assigns people close friends is neither practical nor ethical, so the grade for cause and effect stays at ProbableEvidence grade: Probable. Good observational evidence with a plausible mechanism, or small or few trials.. The mechanisms rest on small studies: thirteen students in a scanner, sixty-eight people in the touch trial, single dance sessions measured through pain threshold, a proxy. No trial has followed a year of choir into a hard health outcome. The layers of a network are averages, and the 150 at their edge has not survived reanalysis. The labor-support trials were rated low quality by their own reviewers. What would overturn the advice is a large, well-controlled study in which people who deliberately increased their contact saw no change in health, or a clean null result from a trial of social prescribing. Neither exists yet.

Go deeper in the reference library

The research this chapter was built from, as longer reference entries: each with its own mismatch card, graded recommendations and the case against it.

See also in the book

Sources behind this page

  1. 27.Curry, S.J., Krist, A.H., Owens, D.K., et al., for the US Preventive Services Task Force (2019). "Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement." JAMA, 321(6), 580-587. https://doi.org/10.1001/jama.2019.0007 (Grade B: counseling for pregnant and postpartum people at increased risk; the topic was under update as of 2026.)
  2. 23.Carpenter, R., McGarvey, C., Mitchell, E.A., Tappin, D.M., et al. (2013). "Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies." BMJ Open, 3(5), e002299. https://doi.org/10.1136/bmjopen-2012-002299 ; Moon, R.Y., Carlin, R.F., Hand, I., et al. (2022). "Sleep-Related Infant Deaths: Updated 2022 Recommendations for Reducing Infant Deaths in the Sleep Environment." Pediatrics, 150(1), e2022057990. https://doi.org/10.1542/peds.2022-057990 ; McKenna, J.J., and McDade, T. (2005). "Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding." Paediatric Respiratory Reviews, 6(2), 134-152. https://doi.org/10.1016/j.prrv.2005.03.006 (Five major case-control studies; adjusted odds ratio 5.1; estimated 0.08 per 1,000 live births room-sharing and 0.23 per 1,000 bed-sharing in the lowest-risk group; the 2022 recommendations are the American Academy of Pediatrics'.)
  3. 26.Kim, E.S., Whillans, A.V., Lee, M.T., Chen, Y., et al. (2020). "Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach." American Journal of Preventive Medicine, 59(2), 176-186. https://doi.org/10.1016/j.amepre.2020.03.004 (12,998 US adults over 50; 100 or more hours a year versus none.)

Every work this chapter cites

The chapter's 27 notes cite 34 works, listed by note number. Each is also in the full source register.

  1. 1.Egolf, B., Lasker, J., Wolf, S., and Potvin, L (1992). The Roseto effect: a 50-year comparison of mortality rates. American Journal of Public Health. 10.2105/AJPH.82.8.1089
  2. 2.Hrdy, S.B (2009). Mothers and Others: The Evolutionary Origins of Mutual Understanding.
  3. 3.Eisenberger, N.I., Lieberman, M.D., and Williams, K.D (2003). Does Rejection Hurt? An fMRI Study of Social Exclusion. Science. 10.1126/science.1089134
  4. 4.Holt-Lunstad, J., Birmingham, W.A., and Light, K.C (2008). Influence of a 'Warm Touch' Support Enhancement Intervention Among Married Couples on Ambulatory Blood Pressure, Oxytocin, Alpha Amylase, and Cortisol. Psychosomatic Medicine. 10.1097/PSY.0b013e318187aef7
  5. 5.Field, T (2010). Touch for socioemotional and physical well-being: A review. Developmental Review. 10.1016/j.dr.2011.01.001
  6. 6.Cohen, S., Janicki-Deverts, D., Turner, R.B., and Doyle, W.J (2015). Does hugging provide stress-buffering social support? A study of susceptibility to upper respiratory infection and illness. Psychological Science. 10.1177/0956797614559284
  7. 7.Tarr, B., Launay, J., Cohen, E., and Dunbar, R (2015). Synchrony and exertion during dance independently raise pain threshold and encourage social bonding. Biology Letters. 10.1098/rsbl.2015.0767
  8. 8.Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T., and Stephenson, D (2015). Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science. 10.1177/1745691614568352
  9. 9.Holt-Lunstad, J., Smith, T.B., and Layton, J.B (2010). Social Relationships and Mortality Risk: A Meta-Analytic Review. PLoS Medicine. 10.1371/journal.pmed.1000316
  10. 10.Murthy, V.H (2023). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. ncbi.nlm.nih.gov
  11. 11.Waldinger, R.J., and Schulz, M.S (2023). The Good Life: Lessons from the World's Longest Scientific Study of Happiness. 10.1007/s10654-026-01424-z
  12. 12.McPherson, M., Smith-Lovin, L., and Brashears, M.E (2006). Social Isolation in America: Changes in Core Discussion Networks over Two Decades. American Sociological Review. 10.1177/000312240607100301Fischer, C.S (2009). The 2004 GSS Finding of Shrunken Social Networks: An Artifact? American Sociological Review. 10.1177/000312240907400408Paik, A., and Sanchagrin, K (2013). Social Isolation in America: An Artifact. American Sociological Review. 10.1177/0003122413482919
  13. 13.Cox, D.A (2021). American Perspectives Survey.
  14. 14.Waldinger, R.J., and Schulz, M.S (2023). The Good Life: Lessons from the World's Longest Scientific Study of Happiness. 10.1007/s10654-026-01424-z
  15. 15.Hill, R.A., and Dunbar, R.I.M (2003). Social network size in humans. Human Nature. 10.1007/s12110-003-1016-yZhou, W.X., Sornette, D., Hill, R.A., and Dunbar, R.I.M (2005). Discrete hierarchical organization of social group sizes. Proceedings of the Royal Society B: Biological Sciences. 10.1098/rspb.2004.2970
  16. 16.Dunbar, R.I.M (1992). Neocortex size as a constraint on group size in primates. Journal of Human Evolution. 10.1016/0047-2484(92Lindenfors, P., Wartel, A., and Lind, J (2021). 'Dunbar's number' deconstructed. Biology Letters. 10.1098/rsbl.2021.0158
  17. 17.Dunbar, R.I.M (2018). The Anatomy of Friendship. Trends in Cognitive Sciences. 10.1016/j.tics.2017.10.004
  18. 18.Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., and Cuthbert, A (2017). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. 10.1002/14651858.CD003766.pub6
  19. 19.Woody, C.A., Ferrari, A.J., Siskind, D.J., Whiteford, H.A., et al (2017). A systematic review and meta-regression of the prevalence and incidence of perinatal depression. Journal of Affective Disorders. 10.1016/j.jad.2017.05.003Wang, Z., Liu, J., Shuai, H., Cai, Z., et al (2021). Mapping global prevalence of depression among postpartum women. Translational Psychiatry. 10.1038/s41398-021-01663-6Robertson, E., Grace, S., Wallington, T., and Stewart, D.E (2004). Antenatal risk factors for postpartum depression: a synthesis of recent literature. General Hospital Psychiatry. 10.1016/j.genhosppsych.2004.02.006
  20. 20.Luoma, I., Korhonen, M., Puura, K., and Salmelin, R.K (2019). Maternal loneliness: concurrent and longitudinal associations with depressive symptoms and child adjustment. Psychology, Health & Medicine. 10.1080/13548506.2018.1554251
  21. 21.Richter, D., Krämer, M.D., Tang, N.K.Y., Montgomery-Downs, H.E., and Lemola, S (2019). Long-term effects of pregnancy and childbirth on sleep satisfaction and duration of first-time and experienced mothers and fathers. Sleep. 10.1093/sleep/zsz015
  22. 22.Vasquez, C., D'souza, A.R., Nowland, R., Taylor, B.L., et al (2026). Impact of interventions addressing perinatal mental health on loneliness and/or satisfaction with social support: systematic review. BMC Psychiatry. 10.1186/s12888-026-08035-8
  23. 23.Carpenter, R., McGarvey, C., Mitchell, E.A., Tappin, D.M., Vennemann, M.M., Smuk, M., and Carpenter, J.R (2013). Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies. BMJ Open. 10.1136/bmjopen-2012-002299Moon, R.Y., Carlin, R.F., and Hand, I (2022). Sleep-related infant deaths: updated 2022 recommendations for reducing infant deaths in the sleep environment. Pediatrics. 10.1542/peds.2022-057990McKenna, J.J., and McDade, T (2005). Why babies should never sleep alone: a review of the co-sleeping controversy in relation to SIDS, bedsharing and breast feeding. Paediatric Respiratory Reviews. 10.1016/j.prrv.2005.03.006
  24. 24.Wing, R.R., and Jeffery, R.W (1999). Benefits of recruiting participants with friends and increasing social support for weight loss and maintenance. Journal of Consulting and Clinical Psychology. 10.1037/0022-006X.67.1.132
  25. 25.NHS England. Social prescribing link workers, introduced under the NHS Long Term Plan (2019). (About 3,600 link workers and more than one million referrals by 2023/24; the evidence on health outcomes is mixed.
  26. 26.Kim, E.S., Whillans, A.V., Lee, M.T., Chen, Y., et al (2020). Volunteering and Subsequent Health and Well-Being in Older Adults: An Outcome-Wide Longitudinal Approach. American Journal of Preventive Medicine. 10.1016/j.amepre.2020.03.004
  27. 27.Curry, S.J., Krist, A.H., Owens, D.K., et al., for the US Preventive Services Task Force (2019). Interventions to prevent perinatal depression: US Preventive Services Task Force recommendation statement. JAMA. 10.1001/jama.2019.0007

The full source register

This page carries the chapter's apparatus. The chapter itself, and the fifteen others, are in the book.

Get the bookThe 30-day protocolAll sixteen chapters