I wrote recently about love as the unspoken determinant of health. It gives us a sense of purpose, I argued, it connects us to others, and it sustains us when we wobble. The NHS and others should strive to keep families strong, to offer practical as well as emotional support to allow love to flourish. Love is a resource for health we ignore at our peril.
The counter side, of course, is what happens when love, or our hopes for love, are dashed: when somebody or something intervenes and leaves our dreams in fragments on the floor.
The scenarios are familiar: a spouse walks out for another, a brief but electrifying fling crumbles, or partners decree that their feelings have changed. To be left alone or thrown asunder can feel like the ultimate rejection. Individual responses are often emotional and physical. As a friend once confided: 'I felt like I had been kicked in the stomach.'
Of course, endings are a part of life. Every day we encounter losses and disappointments of varying sizes and effects. For many, when faced with rejection, their guard slips and they are confronted, helplessly, by despair. Others feel a sense of mourning when a relationship ends, as though aspects of their present and hopes for their future have perished. The resulting feelings are intensely personal and can have direct effects on our health.
Several questions arise for managers of health services. How many patients get sick because of personal turmoil? How does personal crisis affect physical and mental health? And what can be done to head off the potential burden on the NHS? Just how can we prevent heartbreak to the benefit of health services?
Some colleagues argue that practical programmes are essential. They focus on how to keep our heads in times of crisis and avoid health-threatening responses like getting drunk, taking drugs or having unsafe sex in a quest to reduce the pain or rekindle feelings of intimacy. They highlight the importance of rest and eating well. They aim to secure feelings of confidence so personal crises can be managed effectively. And they seek to change patterns of behaviour now and in the future, rather than digging into the past.
Others would argue that something else is required. For those people who avoid or repeatedly destroy potentially sound relationships, an analysis of what compels them to do so might be in order. What drives them to reel people in and then cast them afar? For the ones left or rejected, they might explore why some people rely so heavily on others and why their lives collapse when they leave. For practitioners with this perspective, looking to the past helps fathom, and change, the present.
Economics professor and happiness researcher Richard Layard recently called for happiness to be defined as an outcome of social policy, in addition to wealth and security. An objective of health service efforts to improve health and well-being might be to give people the tools to bounce back from adversity and not tumble into an abyss.
'Every day a little death', wrote lyricist Stephen Sondheim, 'in the curtains, in the silver, in the buttons, in the bread.'The ability to weather the ups and downs of life is crucial in keeping us healthy and well. Promoting good mental health and well-being has many components, but supporting individuals to manage endings would have a range of benefits.
Sometimes they stop beating and sometimes they break, but the hearts of the nation are vulnerable: a public health challenge indeed.