- Loneliness and isolation are among the worst aspects of suffering from a chronic illness.
- Social isolation is both a contributing factor to anxiety and also a result of it.
- The physiological effects of isolation are devastating, with significant mental and physical consequences.
- Pushing yourself to reconnect with family, friends, and colleagues is a powerful force for healing.
It is ironic in that social isolation is such a significant contributor to poor health in this modern era. It is also dangerous. It is estimated that the effect loneliness on one’s health is equivalent to smoking 15 cigarettes/ day.1Sadly, the age group most affected is young adults— those in college and in their 20s. This stage of life has the potential to be the best of times.
Consumed by suffering
When suffering from crippling anxietyand other physical symptoms, people spend a lot of their conscious hours looking on the Internet, seeking medical care, trying different treatments, and discussing their problems with anyone who will listen. Why wouldn’t you? Your life has been consumed and you want it back. Unfortunately, in spite of your best efforts to move forward, from a brain development and physiological perspective, you are moving in the wrong direction. Here are some of the effects:
- Unpleasant circuits in your brain are reinforced.
- Pleasant circuits become less active with disuse.
- You drive people away that you used to have fun with and bond with others who are in a similar condition.
- Eventually, many people are so drained from the endless battle with their suffering that they become isolated, even in the midst of their own family.
- Oxytocin is hormone linked to social bonding and is also powerfully anti-inflammatory. Lack of connection lowers levels of oxytocin and drives your inflammatory state even higher.
The effects of social isolation are deep. They go right down to your DNA, directing the production of proteins that are the essence of life. There are approximately 20 to 30 genes that affect the production of the white blood cells called monocytes. White blood cells are at the core of fighting foreign material in your body, including cancer cells, viruses, and bacteria. There is an overactive form of them—“warrior monocytes"—that are highly aggressive and can attack your body’s own tissues, creating many diseases states and symptoms. The most powerful factor causing the creation of these cells is social isolation. The second factor is chronic stress (anxiety).2
An extensive review paper3 looking at the social influences on inflammation identifies many factors that affect inflammatory markers. The top four factors singled out as lowering inflammation are:
- A sense of control
- Hope/ optimism
- Positive affect/ attitude
- Social connection.
Humans evolved by having language and being able to cooperate through social connection. It is the reason we are so tribal; unfortunately, we haven’t evolved enough as a species to view every person as part of the human tribe. We exclude groups of people, as we compete for resources. That said, social connection remains a deep need, and it is expressed in our physiological state.
Another paper, reflecting research done at UCLA, reports on a study in which volunteers were placed in a functional MRI (fMRI) scanner, which highlights area of increased brain activity during specific tasks. Volunteers played a computer-based video game of three-way catch, programmed at a certain point to exclude the volunteer. The volunteers did not know the two other "players" were simply the computer. Even though it was just a computer game and the volunteers could not physically see the other players, the centers of the brain that lit up are active in processing chronic physical pain. In other words, emotional pain is processed in a similar manner as physical pain.
The catch-22 of social isolation
Becoming socially isolated and feeling lonely was one of the worst aspects of my 15 years of suffering. The only word that slightly described the feeling was “crushing.” I began to experience deep self-deprecating thoughts that revolved around, “why would anyone want to hang around with me?” and “I don’t have anything interesting to say.” These thought patterns played endlessly in my head, despite me generally being a very social person. Loneliness felt like an abyss and was paralyzing with regards to re-engaging. I really could not see an end to it.
As an orthopedic surgeon, I noticed very early on that my patients would check off, “re-engaging with family and friends” as part of their healing. Social interactions are tricky in that they sometimes involve rejection, giving rise to social anxiety, which is greatly magnified when you are already experiencing chronic mental and/or physical pain. Not only do you not have the energy to reach out to others, feeling inadequate may compound the isolation. Here are some suggestions.
- Be kind to yourself. You are doing the best you can.
- People who you used to be friends with may not have as much in common with you and you may be rejected.
- Others you have bonded with through your pain may also reject you as you heal. You are no longer validating their suffering, and as you heal, they are confronted with their own inability or unwillingness to pursue the same journey.
- So, the first step in returning to a normal life is to be prepared for these kinds of interactions.
Then just move forward in any way that you can:
- Call old friends or family members. Many of them are in the same condition you are. It is remarkable how common it is to be trapped by anxiety and pain. However, as mentioned, many times, conversations around these topics are counterproductive for all parties.
- Re-engage with old skills and interests such as art, music, and hobbies.
- Read interesting books or watch inspiring movies. They are great topics for conversation.
- Join a club. You don’t need to be an expert. There are numerous choices such as bird watching; Scrabble; ping pong; book, movie, and history clubs; walking with friends; and music.
- Find ways to give back; there are endless options. One of my successful patients was “trapped” in a nursing home and spiraling back down into the abyss. She decided to become an advocate for other patients who had dementia. Within a few weeks, her whole mood and outlook dramatically improved.
Loneliness is crushing and is both a contributing factor to chronic illness and a result of it. A significant aspect of healing is re-engaging with those around you. What makes it difficult is that, while you are suffering, you may not have the interest or energy to reach out to others. And if you are still in the mode of discussing your troubles, you will push people away who can nurture you or attract others who, also frustrated with their suffering, will pull you deeper into the abyss. Such a cycle is deadly.
That is why you must empirically make decisions to keep reaching out and connecting regardless of how you feel. You will feel awkward, especially when you have taken medical conversations and complaining off of the table as topics. The connections can be as simple as a phone call, reaching out to old friends, or joining a book club. The key is doing something—anything to reach out and break out of your patterns.
Humans evolved through language and social connection. Connection is one of the most basic of needs. Actively reaching out and giving back is a powerful move to stimulate your brain to rewire and heal. To have a good life, you must live a good life. It requires practice.