"Marry Well for Better Health" by Dr. Christopher Lillis: A Singletude Response

Those of you who perused last Sunday's edition of "Singles in the News" may remember the article "Marry Well for Better Health" by Dr. Christopher Lillis, which sent me into spasms of singlist-inspired horror. To quote from the Singletude summary:

Written by a doctor who is a self-described "very biased" newlywed (and takes pride in his prejudice, too), it trots out unidentified research studies to "confidently make this claim. Married men survive longer and live healthier lives than their single or divorced counterparts." Although the author admits those results were contingent on how happy the marriage was and cautions single men not to grab the nearest woman and drag her to the altar, he'd still rather advance his pet theory about the miracle drug of marriage than present hard evidence.

So, Dr. Lillis tosses out a few health measures on which married people score well while failing to mention the measures on which singles score better. (Oh, sorry. He mentions one such measure--obesity--but dismisses it since he's sure his new bride will nag him to lose weight. Let's catch up with him in 10 years and see how that's working out, shall we?)

He also neglects to inform his impressionable readers that, in many cases, the differences that do exist between marrieds and singles who have never married are marginal. If anything, he exaggerates the differences by lumping in people who have always been single with those who are divorced or widowed, two groups that sometimes do show a marked difference on health measures as compared to marrieds. (Singletude's information, by the way, comes from the CDC study "Marital Status and Health: United States, 1999-2000" by Charlotte A. Schoenborn and "Is There Something Unique About Marriage? The Relative Impact of Marital Status, Relationship Quality, and Network Social Support on Ambulatory Blood Pressure and Mental Health" by Julianne Holt-Lunstad, et al., discredited here by Dr. Bella DePaulo. Lillis doesn't say where his comes from.)

Even worse, Lillis takes some of these correlations and makes causal statements about them, asserting that married couples are "healthier" because they have a sense of responsibility to each other or because "getting married reduces depressive symptoms." The fact is we have no way to measure whether marriage causes any of these minor health differences or, if it does, how or why. If studies of singles and marrieds do show significant differences in, say, risk taking, perhaps that's because single people tend to be younger, and youth is associated with risky behavior. If singles do have slightly higher resting blood pressure than marrieds, maybe that's not because they're alone in their beds but because they worry more about things like health care or social security, which are more accessible to married couples.

No matter what, we can't talk about what marriage causes or doesn't cause because marriage is not a variable you can manipulate like an electric shock to get an experimental result (though some would say divorce gave them quite a jolt). See, marital status is similar to traits like age, ethnicity, religious affiliation, and sexual orientation in that the researcher can't change them. In order for a researcher to claim that something causes an effect, he or she has to be able to add or remove it at will to demonstrate that it was solely responsible for the outcome of the experiment.

To use a nonsense example, if a researcher wants to prove that everlasting gobstoppers turn kids blue, then she has to take two groups of kids that have never eaten everlasting gobstoppers and make sure that one group eats them and the other doesn't. In addition, she has to make sure that there are no other dietary, environmental, genetic, or medical differences between the two groups that might explain why some kids look like they fell in a blueberry bush. If, after determining that there are no differences between the groups except that one is getting gobstoppers, the researcher finds that the kids who eat gobstoppers turn blue, then she can tentatively state that gobstoppers may cause kids to turn blue. Why tentatively? Because, as careful as she was, maybe there was some other difference between the groups that she missed. That's why studies are repeated over and over again for confirmation and why most scientists are very, very careful when they talk about causation.

However, let's say the researcher is faced with two groups of kids, one that's already blue and one that's not. She wonders why some kids are blue, and she asks all the kids a bunch of questions and notices that the blue kids all used to eat gobstoppers. Well, that's interesting, and the researcher can say that she found a relationship or correlation between gobstoppers and blue kids, but she can't know with any certainty that the gobstoppers caused the kids to turn blue. Maybe the kids who turned blue were also eating snozberries, and maybe it was actually the snozberries that did the damage. Or maybe the kids who turned blue were suffering from a rare, unknown sugar deficiency that affects skin tone, so they craved lots of sweet gobstoppers.

Saying that marriage causes anything is like saying that kids who are already blue definitely got that way because they ate gobstoppers. We just don't know. And even if we could randomly assign some people to be married and some to be single and observe the results, it would still be hard to make causal attributions because, just like the researcher in the first example, we might've overlooked something.

For some reason, though, when marriage is the subject, researchers and clinicians fall all over themselves with eagerness to make causal statements. I'm not sure why that is. Maybe it's because marriage is popular and relatively easy to enter into, so it encourages people to hear that something they perceive as desirable and ubiquitous is good for their health. It's also possible that the reasons are more sinister and revolve around a research agenda that favors the status quo for economic or political reasons. Whatever it is, medical professionals like Lillis are highly irresponsible when they jump on the bandwagon and repeat these fallacies to patients and readers who don't know any better.

Towards the end of the article, Lillis plays devil's advocate for a minute, but even his counterargument, which posits that healthier, "more genetically appealing" people are more likely to get married, is insultingly singlist. No, Dr. Lillis, the problem is not that we singles are all Quasimodos compared to you strapping, married bombshells. It's that we singles are less likely to have health care. It's that we can't take time off work to heal from illness or injury because we have no second income. It's that we have more financial woes in general because we earn less and pay more than you marrieds do, and that's stressful. It's that we face a lot of social discrimination (the kind of discrimination you're guilty of right now), and that's stressful, too.

Unfortunately, I'm not sure Lillis can understand this logic because in the most presumptuous statement of his presumptuous article, he demonstrates an appalling lack of it. Check out this statement in all its singlist glory:

There is no real way to prove this [that marriage does not cause better health]; it is just a bitter, jealous theory of a loveless set of scientists who spend too much time in the lab to find true love.

Oh, dear, dear, dear. Doesn't Dr. Lillis realize that the burden of proof is on him? The scientific method always assumes no cause-effect relationship until one is proven. To return to our blueberry bunch, the researcher must assume that gobstoppers don't turn kids blue unless she can prove conclusively that they do. In direct contradiction to universally accepted research practice (and logic), Lillis says the exact opposite--that gobstoppers must turn kids blue unless we can prove that they don't. Good news for quack researchers everywhere! Now you can assume Santa Claus, the Loch Ness Monster, and spontaneous human combustion exist until someone proves that they don't!

Lillis's lapse in logic might be forgiveable if it wasn't laced with all that singlist rhetoric. I'll tell ya what, Dr. Lillis, let's invert your statement so that it's both logically valid (instead of fallacious) and anti-marriage (instead of singlist) and see what we get:

There is no real way to prove that marriage causes better health; it is just an ignorant, narrow-minded theory of a codependent set of scientists who spend too much time at home to get out and see what the real world is like.

Here's another good one:

There is no real way to prove that marriage causes better health; it is just a desperate, envious theory of a bored-stiff set of scientists who spend too much time tied to the old ball and chain to have any fun.

Just gotta do one more! Here we go:

There is no real way to prove that marriage causes better health; it is just a sad, pathetic theory of a lonely set of scientists who've wasted too much time in loveless marriages to admit they'd be happier alone.

Now, do any of those statements sound appropriate to make to a married patient? Would you, Dr. Lillis, want someone to make such a statement to you? Then why, I wonder, do you believe it's appropriate to talk that way to your single patients and readers?

Even if Lillis's interpretation is right on the money and marriage is the fountain of youth (which I don't think it is), I'm not sure what would be the point of saying so. A marriage certificate is not a drug that you can dispense when a single person straggles in with the flu, and if it were, it would have a pretty poor track record. If you think of marriage like a drug (thanks, Bella DePaulo, for this analogy), it doesn't work for at least half the people who try it (those who divorce), not to mention the unknown percentage who stay married unhappily. What doctor recommends a drug that's effective for less than half the people who take it?

In conclusion, I want to state for the record that I am single and in good health. I don't smoke, drink heavily, or have other substance abuse problems. I'm not a risk taker. I am not depressed. My blood pressure is so low that it actually causes problems occasionally. Despite what Lillis says about singles who don't take care of themselves, I go to the doctor when I'm concerned that something's wrong.

Interestingly, my dad, who is married, does not. In fact, when I noticed a worrisome skin lesion on his back awhile ago, my mom, his wife, said that she'd been after him to get it looked at for months. You know who convinced him to go to the doctor?

Me. His daughter.


What do you think about Dr. Lillis's article? Do you think married people are really healthier than singles?


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