The Neurology of Loneliness

In 1842, famed writer Charles Dickens visited a prison in Philadelphia, and he did not like what he saw. “The system here is rigid, strict, and hopeless solitary confinement,” he wrote. “I hold this slow and daily tampering with the mysteries of the brain, to be immeasurably worse than any torture of the body.” Unfortunately, solitary confinement continues to this day, and its psychological harms have not diminished: It drives incarcerated people to extreme instability and loss of function, and the American Civil Liberties Union cites solitary confinement in prisons as “fundamentally inhumane.”

Solitary confinement is an extreme and torturous variation of social isolation. Nonetheless, it still demonstrates how strongly social isolation and loneliness can impact mental health, quality of life and even life span. Even without the extreme scenario of solitary confinement, loneliness and social isolation can be detrimental to an individual’s well-being. 

Loneliness may be increasing with forced lockdowns during the COVID-19 pandemic, and exacerbated isolation has severely impacted mental health across the world, with experts rushing to understand the potential effects of prolonged isolation. In spite of, or perhaps because of, loneliness’s inextricable ties with depression and other mental illnesses, millennials and Generation Z’ers have become resourceful, coming up with innovative solutions such as creativity circles for bonding and sharing personal stories help to dispel perceived isolation. 

Loneliness Defined

The most widely-accepted definition of loneliness is “a unique condition in which individuals perceive themselves to be socially isolated even when among other people.” Social isolation is different from loneliness — it is defined as the “absence of social interactions, contacts, and relationships with family and friends, with neighbors on an individual level, and with ‘society at large’ on a broader level”. While these two terms are different, they are not mutually exclusive. Loneliness is the perception of social isolation; therefore, it is categorically influenced by actual social isolation and the disparity between expectation and reality. 

Before the COVID-19 pandemic, 1 in 5 Americans reported feeling lonely or socially isolated, which is partially why experts use the term “loneliness epidemic” to describe the prevalence of this condition. The prevalence of loneliness is as concerning as the magnitude of its effects. The feeling of loneliness is not only uncomfortable and deemed undesirable by society; it can also affect health outcomes, with one study putting individuals with loneliness at a higher risk for premature mortality. 

Loneliness is also associated with depression, generalized anxiety and suicidal ideation, in addition to an increased risk of late-life dementia. Dr. Carla Perissinotto, associate professor in the Geriatrics Division at the Department of Medicine at UCSF, described the relationship between loneliness and mental health as “bidirectional” in an interview with the HPR. In other words, loneliness can lead to or contribute to psychiatric disorders, and vice versa. Literature on the “disease” of loneliness indicates that, like opioid use disorder or obesity, it is an epidemic and therefore should be treated as such. While there is no current biomarker for loneliness, there is an association between the neurological basis for loneliness and Alzheimer’s disease, as Dr. Nancy Donovan, the Chief of the Division of Geriatric Psychiatry at Brigham and Women’s Hospital, told the HPR.

Beyond the neurological and individual bases for loneliness, societal and cultural shifts have also shaped social isolation and loneliness. In the past few decades alone, single-person households have become increasingly popular; while this increase is not necessarily indicative of social isolation or loneliness, it is possible that it represents a cultural or societal shift toward more isolated lifestyles. On the flip side, loneliness, given its status as a feeling tangential to and interwoven with mental health, faces similar stigma as mental health. In just a decade, antidepressant use has skyrocketed, with over 61 million prescriptions in 2015, for a variety of reasons. Most importantly, however, depression is not going undertreated now in the same way that it was just a couple of decades ago. Still, stigma is a challenge to recognition and treatment of depression and loneliness. There is a paradoxical relationship between the way our society moves toward a future of virtual individuality while simultaneously viewing loneliness as an undesirable character flaw.

Beyond the household, communities are one of the most important contributors to social fulfillment and interconnectedness; many find their communities through religion or other organized groups. Indeed, women who frequently attend religious services are five-fold less likely to die by suicide. However, the COVID-19 pandemic has severely limited these group gatherings and opportunities for social interaction, which may contribute to increased feelings of loneliness. While this does not mean that reports of loneliness will increase proportionately, it does imply that loneliness, as a function of perceived social isolation, may increase with increased social isolation. 

For instance, suicide increases during COVID-19, while not necessarily a cause of loneliness or isolation, may be related to the enforced measures related to social isolation. Suicidal thoughts are associated with loneliness and social isolation, and the almost complete loss of social and community-based interaction driven by the pandemic more specifically may exacerbate the risk of suicide.

Combating the Epidemic

Loneliness seems to be a stable trait, but that does not mean there are not potential avenues for addressing and dispelling it. Indeed, there are many creative and effective ways to address and reduce loneliness, and there have been many campaigns in the US and abroad to decrease the subjective feeling of loneliness among the populations that experience it. 

One of these campaigns is the UnLonely Project, led by Dr. Jeremy Nobel. In an interview with the HPR, Nobel detailed the aim and inspiration that drives the UnLonely Project, which includes sharing personal experiences in a way that lets you “tolerate the discomfort of disclosure.” Through sessions constituted of creative expression, mindfulness and reflection, the UnLonely Project aims to dispel feelings of loneliness and leave participants feeling socially connected and understood. These “creativity circles” can take on many different forms; they can be individual or multiple sessions, they can be in-person or online, and they can serve essentially any age or demographic that experiences loneliness. Ultimately, they serve the purpose of encouraging people to share and create meaningful social interaction to reduce loneliness, and by consequence, associated conditions. 

Of course, there are also many unconventional forms of combating loneliness, in particular during the COVID-19 pandemic. In one Reddit thread from 2018, some claimed that weighted blankets mimic the hug of another human and reduce loneliness-induced anxiety. During the COVID-19 pandemic, many different dating apps and relationship-related solutions surged, with the Dutch government making headlines for providing advice and guidelines for having sex while adhering to COVID-19 distancing mandates. At Harvard, the Datamatch team created Quarantine Datamatch, an algorithm for college students from all over the country to be randomly “matched” with another student based on answers to a jovial and quirky survey. The need for social connectedness and interaction is evident when use of dating apps and social media for meeting and talking to others is surging. 

By way of the aforementioned apps and websites (and many more), technology plays a big role in pandemic-adapted social connectedness. Perissinotto claims it “enhances” rather than replaces actual social interaction; nontechnological interactions are still necessary for building meaningful connections. During this pandemic, however, platforms such as Zoom and FaceTime allow family, friends and social networks to keep in touch with each other. In an interview with the HPR, UnLonely Project representative Bradley Riew ‘18 also mentioned how technology has its limitations in dispelling loneliness, noting the different outcomes between passively (e.g. mindlessly scrolling) and actively (e.g. messaging and engaging) using social media. Whereas passive active use of social media is associated with depressive symptoms, active use is not, pointing to a broader role in reducing loneliness than previously thought. 

However, technology cannot entirely solve this mental health crisis. Donovan underscores the importance of physical presence in social interactions, with a “sensory experience” being necessary for meaningful connections. While there are many temporary, and perhaps ineffective, solutions to loneliness and social isolation, it seems that the most sustainable are the community-based, connection-building ones, with the quintessential example being creativity circles. 

Unfortunately, though, it is almost difficult at the moment to imagine a future of more interconnectedness after the COVID-19 pandemic. At the moment, even reintegrating to society is anxiety-provoking and may need time and adjustment. Social distancing is not nearly the same as prison, but lessons can be learned from the U.S. prison system’s harmful reduction of social interconnectedness, furthering the point that social interaction and community support are essential to reducing the feelings of isolation and loneliness that drive certain actions and behaviors. Until communities begin to address this need for connection across all of their populations, loneliness will continue to be an epidemic.

Image Credit: “Loneliness” by Nikolay Gromin is licensed under CC BY 2.0

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