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Human beings are social creatures by nature, wired to connect with friends, family, and with other people within their communities (See In Sync: How Humans are Wired for Social Relationships). Yet, according to the U.S. Health Resources and Services Administration (HRSA), a large number of Americans report feeling lonely or socially isolated from others – so much so that many experts are calling it a “loneliness epidemic.” In response to the COVID-19 pandemic, many communities are facing work and school closures and shelter-in-place orders, which may be further isolating vulnerable populations from the social interactions that are so vital to mental health and well-being.
Here, Myrna Weissman, Ph.D., the Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry at Columbia University’s College of Physicians and Surgeons, as well as a member of the Dana Alliance for Brain Initiatives (DABI), discusses the impact of loneliness on mental health, as well as ways to stay connected when circumstances dictate you must stay at home.
What do we know about the effect of social isolation on mental health?
Human attachments are a basic need. That’s why we live in families and communities where we can be connected to other people. It’s just part of the human condition. There is vast data to document that when these kind of attachments are disrupted in early life, like when a mother suffers from post-partum depression, which often disrupts the mother-infant bond, it can have long-term health consequences, ranging from low-birth weight to increased risk of depression, anxiety, substance abuse, or suicidal behavior later in life. Unfortunately, the studies also show that poor bonds early in life can also lead to more social isolation when you are older, as well as feelings of extreme loneliness.
We understand that attachments to others are very important. In fact, a lot of talk therapy focuses on dealing with disruptions to those attachments. You don’t need a lot of friends, but you need to have some people in your life that you can talk to and share your life with.
One of the things psychiatrists were seeing long before the COVID-19 pandemic is that loneliness and social isolation are huge factors in depression. Sometimes, a person has depression and they will avoid other people and become more isolated as their symptoms worsen. Other times, people are depressed because they are isolated from others and they don’t have people they can rely on. Maybe they are lonely because something has changed in their lives. Maybe something bad has happened and they’ve lost someone special. Maybe they don’t get along with their families or the people who should be closest to them. There are, unfortunately, many paths to loneliness. And, in the clinic, we consistently see a strong association between depression and social isolation. Finding ways to deal with that loneliness can be an important part of treatment.
Does it influence only depression?
No, it influences everything – including chronic medical illnesses like hypertension and diabetes. It’s also now been linked to dementia. People don’t just wake up one day with dementia, unless they’ve had a stroke. Rather, the lack of social interaction, the ability to talk and cooperate with others, leads to a graduate mental decline over time. These social interactions are an important part to health in general.
What might be the effect of the current work and school closures and shelter-in-place orders?
This new situation of forced social distance is an interesting paradox: the more we are ordered to stay apart, the more we realize how important our human connections really are. Some people live with their families and everyone gets along. What I’m seeing in those situations is that there is a new unity and involvement in shared activities, whether it’s cooking meals together or watching movies as a family. Because of that, the light is turned inward. For some, they are finding new connections with the people they live with and finding new things to do and enjoy within the household. That’s wonderful for them.
That said, some people have the opposite experience. They are living with people with whom they don’t get along. Being stuck at home makes things even more stressful as they no longer can do the activities that take them out during the day that can compensate for the underlying discord in the family. That’s of concern.
Then there are the people who live alone. They may be more used to a lowered level of social contact in general. But, on the other hand, many people who live alone have a large number of friends and family members who they see on a regular basis to compensate for that alone time. They could be made more vulnerable by what’s going on, too.
The truth is, we don’t know what the long-term consequences of this forced social distancing may be. It’s something we are actually trying to study with some of the families we follow at the clinic.
How can people best cope with this sort of forced isolation?
The good news is that human beings, in general, are very flexible and adaptable. There’s good evidence that when you can find ways to connect, it helps to reduce symptoms associated with isolation. Anecdotally, I’ve seen some very creative solutions over the past few weeks. People are using FaceTime and Zoom. I even know of one group who is having a regular cocktail hour online, an hour together with people from a variety of different locations who just get together to talk and laugh. So, finding ways to keep in contact with others, to find ways to still do things together, even virtually, is important. It’s not the same as going out and sharing a meal at a restaurant or walking through a museum together. It’s not the same as sharing a hug. But it does make a difference. It’s something.
How can people recognize when the isolation may be becoming too much?
It may not always be easy to recognize it in yourself. It may be easier to see in others. From my experience over the past 10 days, I’d say to watch out for the following situations. First, if there’s someone in your life that you are never hearing from – you send an email or call them and they don’t answer, that’s worrisome. That may be the kind of person who requires more attention during this time. Keep reaching out. Make sure they are okay.
The other kind of situation that may be of concern is a friend or family member who are hyper-focused on the disasters. They are on social media or sending out emails about the number of people who are dying, who are in the hospitals, or the lack of respirators. They are dwelling on the bad things. There, too, it is worthwhile to reach out to them and try to help them focus on something else, to help them see the positives in the situation.
How do you do that?
This time is a challenge, of course. But you can also look at it as an opportunity. Ask yourself, or those you are worried about, what are the things you’ve never had time to do that you’ve always wanted to do? You can get creative with it. You can take an online class or try a new recipe. You can clean out your closets or try a craft. You can call old friends and catch up. Watch old movies or take in an online lecture. Certainly, I’ve found that a lot of old friends I may not have heard from in a while are reaching out. That kind of renewed friendship, whether it’s over the phone or in a Zoom meeting, is lovely. You can also reach out to family. There are things you can do to connect and help make the situation a bit more positive. All of this can help people feel more connected, as well as enrich the input that goes into the brain while you are stuck at home.
Is there anything we can learn from this period of isolation that can help our mental health and well-being once the isolation from COVID-19 lifts so we can better connect with others in the future?
I’ve been thinking a lot about how the world might change after this is all over. What you take away from this experience will largely depend on your circumstances. Hopefully, you’ll learn something new about yourself. You’ll take stock of what is most vital to your wellbeing during this extraordinary period – both the things you need to be at your best and the things you need to avoid. My hope is that it will help people to reorder their priorities, examine what is important, and discover new ways to foster connections with others.
Some families, I hope, will see that they’ve enjoyed this time together and will make family time more of a priority even when everyone can be out and about again. Others may realize that they are in an unhealthy home situation and understand they need to renegotiate and find ways to make some improvements. There are a lot of things to be learned here but, ultimately, what you take away from it is going to be very personal. The important thing is to take the time to consider it.