Like most scientists, Steve Cole didn’t believe things happened without reason. But no matter which variable he tested—and he tried all the usual suspects, from sleep to sex—nothing seemed to explain why the gay men were dying.
It was the late 1980s, the age that gave us the personal computer, the disposable contact lens, and The Simpsons — but also the Challenger explosion, the global stock market crash, and “new” Coke. AIDS was raging in the United States.
Cole was a young psychology researcher who’d landed on a study of 988 HIV-positive, AIDS-free gay men¹, and he was trying to crack the workings of the lethal virus. Over nine years, Cole tracked 80 of these men. Every six months, they gave blood, sat for interviews, and filled in questionnaires. Every time, there were fewer and fewer of them. A significant number fell sick, many perished. And as they did, Cole wondered why some subjects succumbed to HIV while others were able to resist it. He looked at the obvious—age, socioeconomic status, overall health, sleep quality, exercise habits, sex life, anxiety levels, depression history—but none of these predicted who would get AIDS or how soon they’d die.
At one point, Cole thought to compare the openly gay men to those who hid their sexual identity. It turned out that closeted men got AIDS faster and died sooner than out men did. What about being in the closet made those men more vulnerable to HIV? A strand of research at the time implicated repressed emotions as a possible factor—closeted men bottled up their feelings, which made them sick—but the evidence was thin and the biological mechanism unknown. After all, how do you convert emotion into disease? How do feelings turn into something real?
In a follow-up study, Cole decided to test yet another variable: subjects’ sensitivity to rejection. He found that, on average, closeted men were more sensitive to rejection than openly gay men. It made sense: If you cared too much about others’ judgment, you’d want to hide the parts of yourself likely to be stigmatized, such as your sexual identity.
More importantly, Cole found that sensitivity to social rejection predicted an AIDS diagnosis and early mortality even better than whether one was openly gay. In other words, the mysterious deaths of the HIV-infected men appeared to stem not from their failure to express themselves but from a fear of being rejected if they did. Indeed, sensitive men who hid their sexual identity did not suffer more than those in the open: the closet, Cole theorized, probably protected them from social rejection and its dire health effects. Suppressing their emotions perhaps saved their relationships, and their relationships, in turn, saved their lives.
At the time, the impact of social connections on health wasn’t entirely new. For a long time, researchers had observed a curious link between social isolation and a number of diseases, from heart disease to cancer to some neurodegenerative disorders. But no studies had been conducted to test this link directly, and no one could really explain it. According to one theory, social relationships exert a positive influence on health because of peer pressure. If, the theory went, there are healthy people around you whose opinions you care about, you’ll be more likely to swing by the gym, slug kale juice every morning, and skip the second or third glass of wine at the end of a tough workday.
But Cole’s research showed that bad habits weren’t actually wrecking his subjects’ health. The gay men who contracted AIDS were just as physically fit and mentally well as those who resisted the disease. There seemed to be something else, something more direct, that was stripping some participants’ immune defenses and leaving them fatally exposed to the virus.