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Risk of anxiety and depression increases in loneliness and Isolation

This is a story of the U.S Surgeon General Vivek H Murthy. His first stint as the U.S Surgeon General had just ended. During his 1st tenure, he had been disconnected with his colleagues, convincing himself that he had to focus on work, and he could not do both. Even when he was physically with the people he loved, he was not present. He was often checking the news and responding to messages in his inbox. After his job ended, he felt ashamed to reach out to friends he had ignored. He found himself increasingly lonely and isolated and it felt as he was the only one who felt that way.

Loneliness, like depression with which it can be associated, can chip away at your self-esteem and erode your sense who are you. That is what happened to him. He says that at any moment, about one out of every two Americans is experiencing immeasurable level of loneliness. This includes introvert and extroverts, rich and poor, young and old Americans. Sometimes loneliness is set off by the loss of a loved one or a job, a move to a new city, health, financial difficulties or once-a-century pandemic. In the recent pandemic, it was a wide-spread problem. Americans are an individualities society, hence a wide-spread problem, other times, it is hard to know how it arose but it is simply there. Nearly everyone experiences it at some point, but its invisibility is part of it what makes it so insidious. We need to acknowledge the loneliness and isolation that millions are experiencing and the grave consequences for our mental & physical health and collective well-being.

Recently the former Surgeon General proposed a national framework to rebuild social connection and community in America. Loneliness is more than just a bad feeling, when people are socially disconnected their risk of anxiety and depression increases, as does their risk of heart disease (29%), dementia (50%) and stroke (32%). The increased risk of pre-mature death associated with social disconnection can be compared to smoking daily, and may be even greater than the risk associated with obesity. This shows that mental factors may be more adversive than the physical one. That is a cogent reason to teach and practice medicine physical and mental health together i.e., psychiatry, psychology and sociology along with the physical factors as recommended by WHO. This is being practiced in many countries in Africa like Ghana, Ethiopia, Niger etc. and many advanced countries in Asia, Europe etc.

To go on saying that there are only 500 psychiatrists in Pakistan for the population of 241 million is all non-sense. As an example, in UK, a GP treats common conditions like anxiety, depression, PTSD etc. and refers to consultant for advice on problem cases who sends back to the GP after offering advice with integrated teaching of medicine. This has fully integrated physical and mental health practice and teaching. It is also cost effective.

Loneliness and isolation hurt whole communities. Social disconnection is associated with reduced productivity in the workplace worse performance in school and diminished civic engagement. When we are less invested in one another, we are more susceptible to polarization and less able to pull together to face the challenges that we cannot solve alone, from climate change and violence, terrorism to economic inequality and future pandemics. As it has built for decades, the epidemic of loneliness and isolation has fueled other problems that are killing.

Given these extraordinary costs, rebuilding social connection must be a top public health priority of our own nation. It will require reorienting ourselves, our communities and our institutions, to prioritize human connections and healthy relationships. The good news is we know how to do this.

First, we must strengthen social infrastructure, the programs, policies and structures that aid the development of healthy relationship, workplace design that foster social connection and community programs that bring people together. Secondly, we have to renegotiate our relationship with technology, creating space in our lives without our devices so we can be more present with one another. That also means choosing not to take part in online dialogues that amplify judgement and hate instead of understanding.

Finally, we have to take steps in our personal lives to rebuild connections with one-another, as small steps can make a big difference. This is a medicine hiding in plain sights. Evidence shows that connection is linked to better heart health, brain health and immunity, resulting in longer, healthy and productive life. It could be by spending 15 minutes each day to reach out to people we care about, introducing ourselves to our neighbors, checking on coworkers who may be having a hard time, sitting down with people with different views to get to know and understand them and seek opportunities to serve others recognizing that helping people is one of the most powerful antidotes to loneliness. If loneliness and isolation have left you struggling with distressing feelings, reach out to someone supportive or your healthcare provider. And if you go through significant social changes, be open with your healthcare provider about them in order for them to understand and manage potential health effects.

For me, it took more than one year of struggling with pain and shame of loneliness. Eventually, I found my footing, which was not on my own. My mother Myeteraie, father Hallagree and sister Rashmi, called me every day to remind me that they loved me for who I am. My wife Alice reminded me that the light she had seen in me when we first met was still there, even if I could not see at times and my friends, Sunny and Dave, committed to video conferencing once a month and texting, talking weekly about the issues that weighed on our hearts and minds.

During one of my lowest lows, the people in my life patched me with their acts of love and connection. It is still a work in progress, but years later, in my second tenure in public service, I am making much bigger efforts to build and maintain relationships. I am a better father, husband, friend and Surgeon General as a result.

Every generation is called to take in challenges that threaten the underpinnings of society. Addressing the crisis of loneliness and isolation is one of our generation’s greatest challenges. By building more connected lives and more connected communities, we can strengthen the foundation of individual and collective well-being and can be better poised to respond to the threats we are facing as a nation. This work will take all of us; schools, workplaces, community organizations, governments, health workers, public health professionals, individuals, families and more, working together. It will be worth it because our need of human connection is like our need for water and food, essential for our survival. The joy I felt on being reconnected with my friends and family is possible for everyone.

In UK, there is a Ministry for happiness to deal with this problem. The Ministry of Health arranges caregiving nurses to visit the old peoples’ residences to help in bathing, physical therapies, providing medicine and healthcare etc. The United Arab Republic also has a Ministry for Happiness. The Scandinavian and many other countries having universal healthcare system provide help to lonely / isolated people. USA is a capitalist country where millions of people live on the streets, while it has billionaires holding the highest level of wealth in the world.

In Pakistan’s rural areas, communities provide help to the downtrodden people. That is the reason that in spite of terrible prevalent poverty, Pakistan is placed well above many countries in the SAARC in happiness index. Bhutan is the happiest country in Asia, while Finland is at the top of the happiness index of the world.


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