Bob Maunder and Jon Hunter, in their book Love, Fear, and Health: How Our Attachments to Others Shape Health and Health Care, discuss how attachment – the ways in which people seek security in their close relationships – can transform patient outcomes.
What is Love, Fear and Health about?
We wrote Love, Fear and Health to show that close relationships are central to health. We describe how health and illness emerge from interactions between individuals, as opposed to coming just from within individuals (e.g. from genes) or from individuals interacting with other aspects of the environment (e.g. with germs). This happens in several ways. First, interactions between parents and their children are critical to the development of the child’s physical regulatory systems, which will allow her to adapt to different environments and regulate responses to stressful situations effectively. How readily these systems adapt to their environments has big implications for diseases of “wear-and-tear” that will often emerge much later in life. Lifelong patterns of what to expect and how to act in close relationships, which are called patterns of attachment, are also shaped during early parent-child interactions. These patterns influence how willing people are to ask for help and how able they are to manage distressing situations independently, which are individual differences that have a big impact on how people use the health care system. Finally, since health care always occurs within the context of helping relationships, patterns of attachment influence what happens in health care provider-patient relationships, and are something we need to take into account to make health care truly patient-centered.
Who is it for?
The reader who we had in mind as we were writing is a colleague, someone working in one of the many professional disciplines that collaborate in the health care system. We had some ambivalence about narrowing our audience in this way because many of the ideas in this book will be new, interesting and relevant to general readers. However, we wanted to get to some recommendations about how this way of thinking about health care should change the way it is practiced, and those recommendations need to be framed in a different way for providers than for patients, so we had to make a choice. We don’t expect our colleagues to feel familiar or comfortable with psychological theory, so we have tried to write in a way that is accessible and relatively free of jargon. So it is a fairly easy read. We were very gratified that early reviewers picked up on our intent. Dr. Jeremy Holmes call it “readable, accessible, amusing and profound” and Dr. David Naylor said that “every health care professional concerned with the psychological well-being of his or her patients should read it.”
The book is written by two authors. How did you collaborate on the writing?
We have been working together for a long time. We were actually in the same medical school class although we didn’t work closely together until a few years after we graduated. It was when we were collaborating as psychiatrists to medically and surgically ill patients and as teachers in the 1990s, that we started meeting every week to have a conversation about the challenges that arose with patients or with students or colleagues.
We came back to attachment theory, which we hadn’t paid much attention to since undergraduate days because it was such a useful framework for understanding our challenges. Then we started teaching together and doing research on how attachment affects health. The book really emerged from those conversations and from a highly iterative process of teaching, pursing research ideas, and then revising based on feedback, questions, and new ideas.
As a result of this long history of working on these issues together and taking about them, our method is highly collaborative. We literally cannot remember who first suggested most of the ideas that are woven into Love, Fear and Health. Once we get to typing, Bob usually creates the first draft and then we pass it back and forth, often through many iterations, until it feels right. We are lucky that we long ago settled on the “speak plainly and don’t worry too much about each other’s feelings” method of editing and commenting. It has saved us a lot of time and we’re still friends.
What are the challenges of writing about the impact of relationships on health?
This is a subject that crosses many disciplines and perspectives, and that introduces quite a few challenges. The most general of these is that a reader of the book is almost certainly not going to be an expert in all of its subject matter – so we are challenged to provide an accessible point of entry to each of the books main topics while still staying true to the scholarship that informs us.
Another challenge has been to make the book useful. We weren’t interested in writing a book that would advance scholarship without also at least trying to improve how health care is practiced. We are influenced by perspectives on continuing education for health care professionals – providing education that is perceived to be helpful and that increases knowledge are the lowest standards of evidence for change. Actually changing behaviour and then improving patient outcomes is the real gold. We wanted to write a book that would be a step towards improving patients’ experience.
There are a couple of other troubles that come up again and again. One is how hard it is to describe quickly what this book and our research is about. The English word “relationships” has far too many meanings for our convenience. It seems that we can’t get very far into an “elevator pitch” without having to pause and say that we are talking about a very special class of close relationships that includes parents with children, romantic partners with each other, and under the right conditions also includes patients when they are with health care providers