Love Medicine: A Conversation with Dr. Rachel Abrams

Dr. Rachel Abrams is a family practice physician who is board certified in Integrative Medicine. Founder of the award-winning Santa Cruz Integrative Medicine Clinic, she has been voted "Best Doctor" in Santa Cruz County from 2009 – 2018. Dr. Rachel dedicates her practice, teaching, and writing to helping each person learn to listen to their body's innate intelligence.

1440: Your specialty is integrative medicine. How do you define that?

Dr. Rachel: The point of integrative medicine is really to make medicine whole again. In its early days, medicine included things like diet and exercise and even spirituality to some extent, but as Western medicine and science developed over the last couple of centuries, medicine became what I consider an orphan profession, i.e. all about science and somewhat divorced from the elements that make it whole. If you look at traditional Chinese medicine or you look at Ayurvedic medicine, there is a medical tradition, an herbal tradition, an exercise tradition, a spiritual tradition, and a sexual tradition, all in one. Western medicine has the biologic, medication, and treatment aspect, but it's missing spirituality, relationship, sexuality, exercise, diet, and lifestyle. That division is part of the reason we are failing, medically, in this country. According to the CDC, life expectancy in the U.S. has decreased for the past two years—for the first time in our history, and that is because of chronic illness—meaning diabetes, high blood pressure, cancer, and a variety of illnesses that are becoming more and more common because of lifestyle. Lifestyle-born illness is not fixable with medicine or surgery. It demands a more holistic way of looking at our health. Integrative medicine tries to meet that need.

1440: You write and speak quite a bit about the crucial role healthy relationships play in our health and well-being. Is this something you address with patients in your medical practice?

Dr. Rachel: There is no patient I see in my office that I don't ask about relationships. If you look at the medical and health impact of relationships—the impact of community, the impact of love, the impact of having a close person in your life—these elements are far more powerful than any other health behavior. More powerful than any drug you can take. More powerful than whether you smoke cigarettes. More powerful than what you eat, which is really saying something, because what you eat is actually a very powerful determinant of health. Relationships are more important than anything else, in terms of how they affect your morbidity and mortality—which are big, fancy medical words for how often you get sick and when you die. So yes, I talk about relationships with all my patients, because if I have someone with cancer but there is a dysfunctional alcoholic in that house, I'm not going to be able to keep them well without addressing how we're going to set boundaries and create a safe environment for my patient. Or if I have a woman with chronic pain who's being domestically abused, I can't get her out of pain unless she becomes physically safe. Or if I have an older person who's losing weight and wasting away and suffering from stomach pain, I can't help him if I don't deal with the fact that he's isolated and doesn't have love and friendship in his life. In all three situations, the relationship is actually the key ingredient to well-being. I often say that what I'm looking for with each patient is What's the key in the lock for this particular person to make the changes they need? because often, extensive behavioral changes are necessary in order to improve. People know that. People are very smart. They know how they're supposed to eat, and they know they're supposed to get enough sleep. But the question really is why is this person, right now, choosing not to do those things? I can't help them with their issue unless I also look at and consider the impact of the web of love, relationship, and conflict in their life.

1440: Let's talk about the health impact of being in a difficult relationship. What are some of the ways this shows up in your office?

Dr. Rachel: I have seen all sorts of examples of relationship difficulty showing up in physical symptoms—beyond just complaints of abdominal pain or headaches. I have seen patients with rashes that crop up when they're in a bad relationship, and as soon as they leave the bad relationship, the rash goes away. I have seen women with recurrent, documented urinary tract and vaginal infections that appear when they're sexually active with someone who is either emotionally or physically abusive, and as soon as they leave that relationship, they no longer get the infections. The body can be a direct correlate to manifesting the negative effects of bad relationships. I spend a lot of time talking to patients about dysfunctional relationships, because there are so many, and some of them we have choice about, but some of them we don't—because they're our parents or our children. That's not to say that because dysfunctional relationships have an impact, that all conflict is bad. I don't believe that. Research shows that the amount of conflict in a relationship does not predict whether the relationship will last or not. There are plenty of good relationships that are high-conflict, and there are plenty of good relationships that are low-conflict. The issue has less to do with conflict and more to do with how the conflict happens. You can have disagreement in a way that's respectful, and you can have disagreement in a way that is demeaning, insulting, and damaging. The first type of conflict is not damaging. But the second type is very damaging.

1440: What about lack of relationship? How does loneliness show up in the medical picture?

Dr. Rachel: A study of the Social Network Index shows that people with higher levels of community in their life—and by community, I mean connection to a variety of groups, like their church or their temple or their synagogue, but also their bowling league or maybe their work colleagues or a girl scout troup they lead—were 4 times less likely to become ill from a cold virus than those who had a low number of social networks. So even in response to the most simple Am I going to get sick?, we know that having community and relationships in your life is very protective. Another study of older men showed that subjects with the highest stress levels had triple the risk of dying in the next 7 years, but that risk was erased if they had a dependable web of intimacy in their lives. Having a broad and active social network protects us from stress, improves our immune response, and reduces all types of illness. Kate Green Tripp is the Managing Editor of 1440 Multiversity.