“I want to speak in public again.”
Those were the first words I ever heard from the mouth of a stroke patient. His doctor, my colleague, had asked him how his recovery was going, and what his goals were. While his answer was slow and labored, it was perfectly understandable, and we were in public — in a neurology clinic at Brigham and Women’s Hospital in Boston. The speaker, a middle-aged man, was perfectly capable of the thing he desired. To his ear, however, his stroke-slowed speech was utterly unpresentable.
This encounter took place about a year ago. I had recently begun a postdoctoral fellowship at the hospital, the odd philosopher in an interdisciplinary neurology lab. I’ve since interacted with dozens of stroke patients, and I’ve heard the same sentiment echoed dozens of times. Many stroke patients — far too many — consign themselves to a more private, solitary life in the wake of a stroke, not out of practical inability, but out of shame. This shame is an old American disease, whose current-day symptoms, including an “epidemic of loneliness” and rising “deaths of despair,” are becoming impossible to ignore.
Post-stroke isolation is one more symptom, badly compounding the damage done by stroke itself. Most stroke patients ultimately remain able to get around, leave the house and socialize, albeit more slowly and awkwardly than before. But they often require extra time and help with things that used to be easy and fluid. Here is where they need their family, friends and acquaintances to rally around them. The worst thing for them, medically speaking, is to be isolated.
Unfortunately, studies show that stroke patients’ networks tend to contract in the wake of a stroke. Why? The causes are not perfectly clear, but we can say this: Too often in America, we are ashamed of being weak, vulnerable, dependent. We tend to hide our shame. We stay away. We isolate ourselves, rather than show our weakness.
If forced to appear in public, we bluster and pose and project strength we do not actually possess. Immigrants to the United States often express surprise and unease at the artificial cheerfulness they encounter here. We jovially shout across the street that yes, we’re doing fantastic, kids are thriving, business is good and the spouse just got a promotion.
There are many reasons our society has taken this shape. Some have deep roots in the nation’s religious history (consider the austere self-discipline of the Puritans), others are related to our market-driven culture of rugged individualism. Whatever the causes, it’s unnerving. Sociologists associate excessive, knee-jerk smiling with low-trust societies. We’re all kind of wary of each other in the United States, so either we smile to signal that we’re strong, happy and unthreatening, or we puff up our chest to show that we’re impervious to fear.
Weakness has a special sting if you understand it as a moral failing. Many stroke patients express frustration, even anger at themselves, that they haven’t been able to regain full functionality by sheer force of will. There is an assumption that mastery is our natural, proper condition, and if you aren’t capable of it, you’re defective.
But that is wrong. Mastery isn’t our default state of being. Mastery is a great accomplishment, achieved only temporarily and with tremendous help from other people. From birth, we fitfully climb the ladder from childlike clumsiness to adult virtuosity. Loss of that dexterity is part of life. We use our prime years to help the weak, to raise our own children, to ease our parents into old age. Or at least we should.
This interdependence is not a flaw in the human condition; it’s our great strength. Some evolutionary biologists argue that our uniquely broad range of intellectual and emotional capacities results from our tribal solicitude toward the weak, for instance to our children, who take an astonishingly long time to reach adulthood compared to other mammals. When your species is this interwoven, when there’s so much to be patient and forgiving about, virtues like empathy, kindness and sensitivity are adaptive for both individual and group survival.
The anthropologist Margaret Mead was once asked to identify the earliest material sign of human civilization. Obvious candidates would be tool production, agricultural methods, art. Her answer was this: a 15,000-year-old femur that had broken and healed. The healing process for a broken femur takes approximately six weeks, and in that time, the wounded person could not work, hunt or flee from predators. He or she would need to be cared for, carried during that time of helplessness. This kind of support, Dr. Mead pointed out, does not occur in the rest of the animal kingdom, nor was it a feature of pre-human hominids. Our way of coping with weakness, as much as our ingenious technologies and arts, is what sets us apart as a species.
In the aftermath of a stroke, many patients report feelings of anxiety, and are prescribed mood-altering medications. This doubtless provides some partial, temporary relief to many patients and may help with engagement in rehabilitation. But it leaves a key misunderstanding in place, perhaps even papered over. The better healing would be to teach stroke patients, to teach ourselves, that interdependence is nothing to be ashamed of. It’s our birthright, and the source of some of our deepest strength.
Ian Marcus Corbin (@ianmcorbin1) is a postdoctoral fellow at Harvard Medical School, where he helps direct the Human Network Initiative. He is working on a book about vulnerability and human solidarity.
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