In an educational review for the American Psychological Association by Amy Novotney, The risks of social isolation tells how psychologists are studying loneliness in those most at risk, such as older adults. How to combat the risks?
First of all, the risks.
‘According to a 2018 national survey by Cigna, loneliness levels have reached an all-time high, with nearly half of 20,000 U.S. adults reporting they sometimes or always feel alone. Forty percent of survey participants also reported they sometimes or always feel that their relationships are not meaningful and that they feel isolated.
Such numbers are alarming because of the health and mental health risks associated with loneliness. According to a meta-analysis co-authored by Julianne Holt-Lunstad, PhD, a professor of psychology and neuroscience at Brigham Young University, lack of social connection heightens health risks as much as smoking 15 cigarettes a day or having alcohol use disorder. She’s also found that loneliness and social isolation are twice as harmful to physical and mental health as obesity
Loneliness is an experience that has been around since the beginning of time—and we all deal with it, according to Ami Rokach, PhD, an instructor at York University in Canada and a clinical psychologist. “It’s something every single one of us deals with from time to time,” he explains, and can occur during life transitions such as the death of a loved one, a divorce or a move to a new place. This kind of loneliness is referred to by researchers as reactive loneliness. Problems can arise, however, when an experience of loneliness becomes chronic, Rokach notes. “If reactive loneliness is painful, chronic loneliness is torturous,” he says.
Chronic loneliness is most likely to set in when individuals either don’t have the emotional, mental or financial resources to get out and satisfy their social needs or they lack a social circle that can provide these benefits, says psychologist Louise Hawkley, PhD, a senior research scientist at the research organization NORC at the University of Chicago. “That’s when things can become very problematic, and when many of the major negative health consequences of loneliness can set in,” she says.
Last year, a Pew Research Center survey of more than 6,000 U.S. adults linked frequent loneliness to dissatisfaction with one’s family, social and community life. About 28 percent of those dissatisfied with their family life feel lonely all or most of the time, compared with just 7 percent of those satisfied with their family life. Satisfaction with one’s social life follows a similar pattern: 26 percent of those dissatisfied with their social lives are frequently lonely, compared with just 5 percent of those who are satisfied with their social lives. One in five Americans who say they are not satisfied with the quality of life in their local communities feel frequent loneliness, roughly triple the 7 percent of Americans who are satisfied with the quality of life in their communities.
And, of course, loneliness can occur when people are surrounded by others—on the subway, in a classroom, or even with their spouses and children, according to Rokach, who adds that loneliness is not synonymous with chosen isolation or solitude. Rather, loneliness is defined by people’s levels of satisfaction with their connectedness, or their perceived social isolation.
As demonstrated by a review of the effects of perceived social isolation across the life span, co-authored by Hawkley, loneliness can wreak havoc on an individual’s physical, mental and cognitive health. Hawkley points to evidence linking perceived social isolation with adverse health consequences including depression, poor sleep quality, impaired executive function, accelerated cognitive decline, poor cardiovascular function and impaired immunity at every stage of life.
Among older adults in particular, loneliness is more likely to set in when an individual is dealing with functional limitations and has low family support, Hawkley says. Better self-rated health, more social interaction and less family strain reduce older adults’ feelings of loneliness, according to a study, led by Hawkley, examining data from more than 2,200 older adults “Even among those who started out lonely, those who were in better health and socialized with others more often had much better odds of subsequently recovering from their loneliness,” she says.
In addition, a 2019 study led by Kassandra Alcaraz, PhD, MPH, a public health researcher with the American Cancer Society, analyzed data from more than 580,000 adults and found that social isolation increases the risk of premature death from every cause for every race. According to Alcaraz, among black participants, social isolation doubled the risk of early death, while it increased the risk among white participants by 60 to 84 percent. “Our research really shows that the magnitude of risk presented by social isolation is very similar in magnitude to that of obesity, smoking, lack of access to care and physical inactivity,” she says.
In the study, investigators weighted several standard measures of social isolation, including marital status, frequency of religious service attendance, club meetings/group activities and number of close friends or relatives. They found that overall, race seemed to be a stronger predictor of social isolation than sex; white men and women were more likely to be in the least isolated category than were black men and women.
The American Cancer Society study is the largest to date on all races and genders, but previous research has provided glimpses into the harmful effects of social isolation and loneliness. A 2016 study led by Newcastle University epidemiologist Nicole Valtorta, PhD, for example, linked loneliness to a 30 percent increase in risk of stroke or the development of coronary heart disease. Valtorta notes that a lonely individual’s higher risk of ill health likely stems from several combined factors: behavioral, biological and psychological.
“Lacking encouragement from family or friends, those who are lonely may slide into unhealthy habits,” Valtorta says.
“In addition, loneliness has been found to raise levels of stress, impede sleep and, in turn, harm the body. Loneliness can also augment depression or anxiety.”
Last year, researchers at the Florida State University College of Medicine also found that loneliness is associated with a 40 percent increase in a person’s risk of dementia. Led by Angelina Sutin, PhD, the study examined data on more than 12,000 U.S. adults ages 50 years and older.
A 2015 study led by Steven Cole, MD, a professor of medicine at the University of California, Los Angeles, provides additional clues as to why loneliness can harm overall health. He and his colleagues examined gene expressions in leukocytes, white blood cells that play key roles in the immune system’s response to infection. They found that the leukocytes of lonely participants—both humans and rhesus macaques—showed an increased expression of genes involved in inflammation and a decreased expression of genes involved in antiviral responses.
Loneliness, it seems, can lead to long-term “fight-or-flight” stress signaling, which negatively affects immune system functioning. Simply put, people who feel lonely have less immunity and more inflammation than people who don’t.
Are the effects of the enforced Covid-19 lockdown the same as loneliness?
Time and meaning have become distorted says the psychological scientist Julia Shaw writing in the Guardian . She is the author of The Memory Illusion: Remembering, Forgetting, and the Science of False Memory.
She writes: ‘During lockdown, the passing of time has come to resemble a Salvador Dalí dreamscape. The surrealist artist’s famous painting of melting clocks includes a silver pocketwatch draped like a shirt hung up to dry over a dead tree branch. Like overripe cheese, his clocks are soft and malleable, and represent what Dalí referred to as “the camembert of time”. In an attempt to challenge our sense of reality, he titled this piece The Persistence of Memory. It reminds us that time and memory are inherently linked, and neither are as rigid as we seem to think.
‘The fact that every day is objectively the same length doesn’t matter nearly as much as how long every day feels. Research has shown that we perceive time passing more slowly if it is “empty” – bringing to mind the proverb that a watched kettle never boils. When there is little perceptible change, and it feels like nothing is really happening, time feels like it is stretched – like one of Dalí’s clocks.
But the opposite is true when we assess time retrospectively. When we are looking back, an eventful minute feels like it was longer than an uneventful one. Similarly, we find that when remembering the past, we perceive a year as longer if it included more memorable events. The more unique or important events you can remember from a period of your life, the longer that period is likely to feel in retrospect.
No matter who you are, your life has probably quite suddenly changed from having a diverse range of experiences – going to work, socialising with friends, going to events – to feeling much more repetitive. Perhaps you are now furloughed at home without the routine of work to structure your day, or living in a wild turmoil of childcare and remote working, or you’re an essential worker who can’t take part in the social activities that would normally break up your days.
Often when we perceive time, what we’re actually perceiving is change. If you have fewer changes in your life, you are going to struggle to perceive time as you normally would. This can help to explain why periods that are historically momentous seem longer. The lockdown could also have longer-term implications for how we remember time. The unprecedented situation we now find ourselves in will inevitably be recounted again and again once it’s over. How will we remember this lockdown in a year, a decade, or 50 years from now?
Our internal timelines, our autobiographical memories, need a “before” and “after”, or what memoryresearchers call “temporal landmarks”. These landmarks allow us to organise our lives into a story. Any good story relies on a narrative arc of emotional highs and lows, rather than a flat line of emotions and events. According to psychological researchers Johanna Peetz and Mariya Davydenko, “any important point in time that stands out in the everyday humdrum of life may be a temporal landmark”. Maybe you organise your memories according to a particular point in time: after you fell in love with someone, before you got ill, or after you were promoted at work. Landmarks often include flashbulb memories of very intense moments of your life. These landmarks are intricately linked with how your autobiographical memory is structured.
If we don’t have suitable landmark memories, we are more likely to mistake what we did in the past. As time passes, this may even allow more room for memories of events that we never experienced at all. As a false memory researcher, this worries me. I’ve found that it’s possible to implant false memories of criminal or highly emotional events in people’s minds – and that false memories of highly emotional events can seem as “real” as those that are true. Without temporal landmarks, the profound illusions our memories are capable of generating are likely to be magnified.
And the lack of temporal landmarks during the lockdown may lead to an increase in memory gaps.When we have gaps in our memories, our brains have a tendency to fill them, and sometimes we fill them with rubbish. Our memories are likely already being contaminated by the false information that circulates online, or family members with a propensity for confabulation. By the time we get to next year, it might be very difficult for us to establish what we actually did, or saw, or felt during this period.
But it’s not all bad news. By recognising what influences your perception of time, you can regain some control over how you will remember this period of your life. If you want to parse the flow of your memory into meaningful pieces again, one of the most important things to avoid is routine. Look for new experiences and ideas, ideally ones that are emotional and require effort. Recreate how you might have organised something before the lockdown – you probably planned it ahead of time, experienced it, and shared it with other people.
The ideal temporal landmarks involve short and intense spikes of emotion and interest. While learning a new language or reading an 800-page magnum opus is likely to be satisfying in the long term, activities that stretch over multiple weeks will not make good landmarks.
This approach will hopefully help time feel more normal in these abnormal times. To remember things with precision and clarity, however, it’s still not enough. The one thing that almost every memory scientist repeats ad nauseum is this: if there are moments in your life that you want to preserve for posterity, write them down. Now. Assume that no matter how emotional, or interesting, or historic your experiences during the coronavirus lockdown are, you will forget them. Recording these memories outside your brain is the only way to truly keep them safe.
Rafael Behr, an award winning regular columnist writing in the Guardian on the same day, headlines with: We have internalised the reason for staying apart, and coronavirus will leave us wary. Habits of trust will have to be relearned.
‘It is a measure of how well we have internalised the reason for staying apart that casual, pre-coronavirus intimacy looks so alien. When we cringe at an old photo of ourselves with bad hair or clothes (or both, in my case) it is because we apply the lens of new information to judge our naive former selves. And now a whole world of slack hygiene feels remote in that sepia-tinted way; not just in time, but in values.
The change is cultural, not political, and will not be undone by government decree. Even when some shops are allowed to trade or schools partially reopen, the duty to be distant will remain for as long as contagion is a risk. In the absence of a vaccine, that risk is open-ended. It will be a while before strangers shake hands again. Maybe the habit will be lost.
This is not a superficial aspect of the Covid-19 crisis. Societies are shaped by custom and ritual as much as they are held together by legislation. There is no law against queue-barging, for example, but British people still have a keenly developed sense of justice around the issue.
We must not underestimate the aggregate effect of curtailing millions upon millions of micro-niceties, even if we cannot predict what the impact will be. After the rules of lockdown are eased, the cordon sanitaire will remain in our minds. Each handshake or shared bag of chips is a little social contract – a declaration of affinity. And without physical proximity we have to work harder to negotiate those alliances.
It isn’t hard to see how our species evolved this way. There is an obvious cost in admitting predators and enemies into our personal space, so we are hard-wired to associate social distance with suspicion. The same applies in the case of hygiene, where we have evolved what the psychologist Mark Schaller has called a “behavioural immune system”. At an individual level that is the spasm of recoil from a foul smell. At a more complex level it informs antisocial human characteristics – wariness of all things unfamiliar, especially people from outside our immediate, trusted circle
Evolutionary biologists have observed a cross-cultural and historical correlation between the prevalence of infectious disease and authoritarian politics. The theory posits that “pathogen stress” leads to a more aggressive behavioural immune response, making societies less open, less tolerant and readier to sacrifice liberties for collective protection.
That might sound like a wild extrapolation from two-metre gaps at the supermarket checkout. I don’t think lockdown will activate some dormant genetic predisposition to tyranny. The opposite response feels closer to the surface – our pent-up social energies one day exploding on to the streets in a licentious touchy-feely carnival.
But that release might be further away than we hope. Meanwhile, it doesn’t take an evolutionary biologist to hypothesise that chronic insecurity ploughs fertile ground for toxic politics. That is a lesson from the rise of xenophobic nationalism across Europe and the Americas in the decade since the last financial crisis, amply corroborated by evidence from the first half of the 20th century.
History is not destiny, so it is reasonable to presume that 21st century societies will find innovative ways to manifest the consequences of mass anxiety. For a start, we have the digital infrastructure that means a lot of life in lockdown has migrated online. That journey is keeping many of us in financial solvency and mental equilibrium, but with an insidious cost in social cohesion. Before coronavirus, people were already burrowing into digital silos, selecting the information that suited their prejudices or having that information selected for them by algorithms that interpreted prejudices from their search history.
Social media is a brilliant centrifuge, separating us into discrete cultural channels, and an efficient engine for radicalisation, polarisation and paranoia within those channels. Shared attitudes are refined; the grit of contradictory evidence is expelled; moderates fall silent while members of the group bid each other up towards the most extreme iteration of any opinion.
That is how people make a journey at astonishing speed from unfocused alienation to murderous militancy; from vague mistrust of Westminster to deranged conspiracy theory. Politicians are as susceptible as everyone else, whipping each other into factional rages in their WhatsApp groups.
In normal times, that process is slowed by friction from everyday brushes with analogue reality. We might not have seen fleeting conversations at football matches or on the bus as part of our social life, but each interaction with a stranger exercised muscles of empathy and diplomacy that are atrophying.
We are now zooming deep into culturally reinforced comfort zones. It doesn’t have to be that way. The antidote to polarisation is solidarity and there is heaps of that around. The weekly ritual of doorstep applause for the NHS is rightly cherished as an expression of communal spirit to transcend isolation. Images of those moments will be displayed as icons of national togetherness for generations, like the photos of Londoners seeking shelter from the blitz in tube stations, except there won’t be so many people jammed together in the frame.
That is no minor difference. We know there is a vast reserve of solidarity available and that it could be a healing social balm after years of painful division. But it is also a perishable commodity that degrades if left up on the shelf of abstract rhetoric. It needs to be applied in person and it is hard to bring people together without physically bringing people together.
Economic redistribution is the traditional way to put solidarity into political practice, and there might be more public appetite for that than there has been for decades. But it isn’t guaranteed, nor is financial inequality the only gap that will need bridging. The politics of quarantine have focused on the sacrifices involved, on the requirement for discipline and the challenge of repressing our socialising urges. The presumption has been that the springs will uncoil as soon as the pressure is released, and the old ways will bounce back.
But not if the virus has corroded the mechanism. Some habits of trust might have to be relearned. It might require effort on a political and individual level to practice social un-distancing – to reach out of our digital boltholes. Repairing the damage done by this disease will be a project of cultural reconnection, not just economic redistribution. We will need new ways to feel joined for as long as we cannot take each other by the hand.’
And writing from Dunedin for the Guardian on 12 May, Eleanor Ainge Roy suggests those with social anxiety issues that had improved during lockdown, might find those feelings resurfacing.
‘While many are relishing the prospect of resuming their normal lives – and economists are sighing with relief that the economy can kick back into life – a small sense of anxiety is growing among some at what will be a very altered version of New Zealand’s “normal”.
Strangers are being asked to keep their distance from one another, and social gatherings are capped at 10. Many workplaces and public transport will operate in shifts to satisfy social distancing requirements, and up to a third of small businesses may be forced to close their doors for good, unable to recover from the lockdown.
Dr Dougal Sutherland, a clinical psychologist at Victoria University of Wellington, said for many, fears of catching the virus may flare up with the loosened restrictions, while others may feel they have become rusty when it comes to basic social skills such as friendships, dating and interacting with colleagues.
However, for a significant number the return to work and school may bring about a return of worry and anxiety,” Sutherland said.
“Despite the obvious downsides, Levels 3 and 4 did bring a sense of protection and security for some who suffer from anxiety. As we emerge from the shadows of strict lockdown old fears about becoming unwell may reappear. Triggers for anxiety that have lain dormant for weeks, such as the fear of social evaluation by others, may arise again.”
With many having lost their jobs or been forced to take pay cuts, Level 2 may also drive home the stark reality of the social and economic consequences of the pandemic, Sutherland said.
“Breaking out of our bubbles may bring with it feelings of loss, shame, and guilt as we come face-to-face with these harsh realities and have to front up to others.”
Ardern has urged Kiwis to think of Level 2 as “the new normal”; an idea Dr Hiran Thabrew a child psychiatrist and paediatrician at the University of Auckland, agrees with. Thabrew said if expectations were too high, some people could struggle with the ongoing requirements for social distancing and stringent hygiene practices.’
There’s plenty to think about here.
Enjoy the thoughts.
