The problem is that loneliness is not an actual, physical wound, so this inflammatory response is pointless. You could be lonely for days, weeks, months. The entire time, the immune system is gearing up to fight off bacteria that aren’t really there, pumping you full of inflammatory chemicals in the process. The inflammation shreds the blood-vessel walls, leading to plaque buildup, which is why lonely people have more heart attacks.185 Inflammation destroys cells, and as the cells are replaced, there’s a chance some of the new DNA might come with mutations, which can lead to cancer. This is one reason why lonely people have worse cancer outcomes.186 Scientists are still trying to figure out how, exactly, inflammation leads to neurodegenerative diseases, but it’s known that lonely people are more likely to develop dementia.187 Meanwhile, the immune system is so distracted by bracing for the supposed bacteria that it takes its eye off the virus ball—and indeed, lonely people are more prone to viral infections.188

Joi

As Toni Morrison put it, “In this country, American means white. Everybody else has to hyphenate.” Perhaps for no one is that truer than for African American women, who are weighted with modifiers and bombarded by both racism and sexism. As a result, they suffer some of the most intense effects of social exclusion.

In so many situations, black women are historically underrepresented, and they continue to face acute prejudice because of that underrepresentation. Researchers think the strain of being discriminated against189 might be one reason why African Americans tend to experience more of certain types of health problems than white Americans do.

When I first met Joi, a thin, pretty black woman with a degree in electrical engineering, she was not someone I expected to have a harrowing health story. She’s friendly, financially comfortable, and in a loving relationship. She shops at Whole Foods.

She hadn’t been trying to get pregnant when she did at age thirty-eight. A few months in, she developed a searing pain in her gut. The culprit was fibroids—tumors of the uterus, which black women are more likely190 to develop than white women are. Joi spent much of her pregnancy lying in bed in agony.

Her son, Alexander, was born three months early, bright red and weighing less than two pounds. In a photo taken on his first day, his arms were pinned into a t-shape by tubes. The next day, Joi was allowed to hold him for an hour.