The Psychology of Social Isolation (ep. 119)

September 17, 2020
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As many Americans stare down the end of their sixth month of social distancing, we are re-running a conversation we recorded back in April, that still has relevance to our lives today. 

For some people, the advent of social isolation came long before the coronavirus. At the ACLU, we work with many communities who deal with the long term impacts of social isolation. People living with disabilities who often experience accessibility issues, people held in detention, and people imprisoned in solitary confinement, just to name a few. We'll hear from folks impacted by chronic isolation as well as professor of psychology and neuroscience at Brigham Young University, Dr. Julie Holt-Lunstad.

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KENDALL CIESEMIER
From the ACLU, this is At Liberty. I’m Kendall Ciesemier, the producer of this podcast and your host for this episode

KENDALL
[00:06:27] As many Americans stare down the end of their sixth month of social distancing, we are re-running a conversation we recorded back in April, that unfortunately still has relevance to our lives today. Visiting it again, I can’t help but think both that we were maybe a little naive in the spring AND that what we are going through is only a sliver of the social isolation many people face in our country. I hope it brings you the fresh perspective it has brought me. Enjoy.

For some people, the advent of social isolation came long before the coronavirus. At the ACLU, we work with many communities who deal with the long term impacts of social isolation. People living with disabilities who often experience accessibility issues, people held in detention, and people imprisoned in solitary confinement, just to name a few.

Joining us today is Dr. Julianne Holt-Lunstad, a professor of psychology and neuroscience at Brigham Young University who understands the impacts of isolation and how we can mitigate them for both ourselves and others. But first, we spoke with a few people who know a thing or two about social distancing. Their circumstances have made them familiar with isolation long before COVID-19.

ANNA LANDRE
[00:01:53] I’m a wheelchair user and I’ve had periods of my life where I had to stay isolated due to being injured or sick, so this definitely isn’t my first experience living like this, and I think that’s true of a lot of disabled people.

KENDALL
[00:02:06] This Anna Landre, a student at Georgetown University. For Anna, COVID-19 quarantine may not feel as difficult as it does to other people. In some ways, it’s actually leveling the social playing field for her.

ANNA
[00:02:21] On a regular basis I even have to turn down invitations to outings or parties at school because people choose to have them at inaccessible locations where I just literally can’t get into the front door. And that’s really upsetting, it happens almost every week. But this situation now is slightly different because suddenly I’m not the only one stuck at home. We’re all stuck at home. And I think that’s made it easier for me to stay in touch with people and still feel like I’m a part of a community even if we’re physically separated.

KENDALL
[00:02:55] TreShaun Pate, a member of the trans community and an advocate with the ACLU of Texas, believes that the problems that isolate his community have only been made worse by the pandemic.

TRESHAUN PATE
[00:03:05] COVID-19 is particularly hard to navigate for trans people. Some people are sheltering in place with people who are not supportive of them, if they even have the privilege to live in a home in the first place. Some people have never had proper healthcare and they’re being turned away from doctors offices or hospitals due to new protocols that are in place for COVID. During these times it's just like really important to make sure that you’re checking in on your trans friends and family members. Just let us know you haven’t forgotten about us.

JASON HERNANDEZ
[00:03:39] Hello, my name is Jason Hernandez. I was formerly incarcerated. I did 18 years on a life sentence without parole until President Barack Obama commuted my sentence and I was released in 2015.

[00:03:54] You know, obviously I have experience with how would you say social distancing and isolation because of my incarceration. And even before people started going to grocery stores and places like that and stocking up on toilet paper. I think there's something in me. Right? Whether it is just like maybe some type of PTSD where I immediately went to the grocery store and got those bare necessities that I would have in prison. In prison is similar to the behavior. What I've seen out here is similar to that in prison, too, where when we go on a 24 hour lockdown and you know that it's about to happen, you get toilet paper. Toilet paper is like the first thing that everybody gets.

[00:04:48] When I was in my cell, my 8 by 10 cell by myself, and there were times where I was in an 8 by 10 cell with two other prisoners for months on end. And it's extremely difficult to do stuff that in that situation, but you still make do.

[00:05:02] I do say that there is that uncertainty for me as when is it gonna be over? When is it gonna be over? How long is it gonna go? And when you were in prison and you're serving a life sentence like I was, that's a question that you ask yourself constantly even though your release date says you don't get out until you die. You still question and you had that question in your head like is it's gonna be over one day. It has to be right and you don't want to give up hope.

KENDALL
[00:05:29] And finally, here’s a reflection from Claire Goldberg, a member of our At Liberty production team.

CLAIRE GOLDBERG
[00:05:36] I’ve struggled with depression for many years, and when it gets really bad, if I go without my meds, I won’t want to leave my room, I won’t want to get out of my bed, so self isolation doesn’t feel new to me. Depression has definitely made me feel isolated before. And I think the weird part is that I’m taking my meds right now and I’m feeling relatively good but I’m practicing the same habits I would if I were at my worst. It’s a strange feeling to be in the same pattern of habits like not going out and not leaving the house when my depression is mostly in check.

[00:06:18] Isolation certainly does not help my condition. But I’ve also been better at remembering to take my meds and being able to do all these things I’ve been wanting to do has been helping my mood generally.

KENDALL
[00:06:32] Hearing Anna, TreShaun, Jason and Claire reflect on their own experiences of social isolation and what this time is like for them gives us some perspective on this challenging time.

Next, I spoke with Dr. Holt-Lundstad to better understand just how detrimental social isolation can be to our wellbeing, and what we can all do to help each other during this time and beyond.

[00:06:58] So there's a lot to discuss here around social isolation. But just to orient our audience around some basic terminology, how would you as a psychologist define social isolation, and how would you define loneliness? And are they different?

DR. HOLT-LUNSTAD
[00:07:12] Yeah. So these are terms that are often used interchangeably. They are related but distinct concepts. And so isolation is typically thought of as being more objective, as loneliness being subjective. So isolation, often referring to having few social relationships or infrequent social contact and loneliness is really thought to be much more subjective. The discrepancy between one's actual level of social connection and one's desired level of social connection. And so of course, being objectively alone can make you feel lonely or feel alone. But these don't always go hand in hand. And so someone could be objectively isolated but not feel lonely. They might actually take great pleasure or solitude in that time alone. And conversely, if someone may not be isolated but still feel lonely, the term lonely in a crowd I think captures this sense of how you can still feel profoundly lonely despite being surrounded by others. And so while these can co-occur, they don't always. So it's important to help make those fine distinctions.

KENDALL
[00:08:40] And as far as loneliness goes, I mean, I understand that it's you could feel lonely. But isn't that also potentially our body telling us something?

DR. HOLT-LUNSTAD
[00:08:51] Yes. You know, across scientific disciplines, it's argued that humans are social beings, social creatures, and that throughout human history we have needed to rely upon others for our actual survival. And so because of this our brains have adapted to expect others around us. And so there's even some scientific evidence to support that that loneliness is like a biological drive that motivates us to reconnect. And so much like hunger is a biological drive that motivates us to seek out food and thirst motivates us to seek out water. That loneliness motivates us to seek out others.

KENDALL
[00:09:42] So who in society mostly experiences this kind of social isolation and then is that different than who in society typically experiences loneliness or where do we see the overlaps as far as communities or kinds of people who might experience these things?

DR. HOLT-LUNSTAD
[00:10:02] Yeah. There have been a variety of surveys that have looked at prevalence rates. And so one thing I should clarify is that despite the relative differences in prevalence rates, that loneliness and social isolation doesn't seem to be confined to any one particular group, meaning any one of us at any age could could potentially be lonely.

[00:10:29] So, for instance, some surveys suggest that loneliness is highest among Gen Z and Millennials as well as older adults. Those with mental and physical health conditions are at greater risk, those with mobility and communication impairments are at greater risk, as well as those that are members of stigmatized groups, are also at increased risk.

KENDALL
[00:11:02] And for people who are experiencing social isolation and I guess loneliness, too, is it a sliding scale of the impact it could have on our health holistically?

DR. HOLT-LUNSTAD
[00:11:17] Yeah, actually, there was a really fantastic paper that was published in 2016 that included data from four nationally representative samples and it included measures of not only the structural aspects of relationships. So to the extent to which the size of people's social networks varied, as well as the functions that these relationships serve and the quality of those relationships. And what they found was a dose response effect, meaning that for every increase in social connection, there was a decrease in risk for biomarkers linked to health, including things like blood pressure, BMI and inflammation. And what was incredible about this was that it was also seen across each phase of life including from adolescence all the way to older adulthood. And so what this suggests is that this is something that can affect people’s physiology and physical health across the lifespan, and that we’re all somewhere on this continuum. So this is an issue that affects us all.

KENDALL
[00:12:43] Yeah. And so I'm looking specifically at something like someone's psychological status, their mental health. What does isolation do to that? What does loneliness due to that?

DR. HOLT-LUNSTAD
[00:12:57] Yeah, so some neuroscientists have looked at the sorts of things that go on in our brains, and what some research has shown is that our brain expects proximity to others. And so when we are alone or we are not with trusted others, that this signals of a state of heightened alertness. So we have to be much more vigilant to threats in our environment. The idea that we kind of have to do everything on our own right. And so that takes more effort. And this, of course, signals other areas of the body that increase this state of alertness, which when experienced more chronically can lead to other kinds of longer term effects. But this can affect not only just our emotional state, our feelings of stress or anxiety, but also can affect our physiology as well.

KENDALL
[00:14:00] And so for people who are listening at home and perhaps in this Coronavirus time, they're feeling kind of more isolated or more lonely from other people and potentially are experiencing some kind of psychological impact from that loneliness. What would you advise as far as how to mitigate some of those things?

DR. HOLT-LUNSTAD
[00:14:23] Right. Well, first of all, I think it's important to acknowledge that those feelings are normal. And so if you're feeling distressed, if you're feeling lonely, again that's normal. That's your body's normal response to this. But it is important to take steps to mitigate that, because we don't want that to be prolonged.

KENDALL
[00:14:48] Especially because we don't know how long this is going to be.

DR. HOLT-LUNSTAD
[00:41:51] Right. Right. But the the thing that I think is relevant here is that that research showed that our perceptions of social support mitigate the distress associated with that. What others also had found was that when people were offered support. So interestingly, they would have participants come. They'd have the standardized stressor, and half the participants were offered support. So if you need help. I'm here to help you.

[00:15:25] But importantly, none of the participants actually received any help at all. But just among those that just were offered help, this resulted in significantly lowered reactivity to stress. So. What it says is just knowing that there is support available to you if needed, that that's enough to help mitigate some of those effects of stress. And so, just reaching out to your family, your friends, neighbors and offering help to them may be an important way in which you can help others. And there's other research that also suggests that providing support can have a greater benefit than receiving support. So not only are helping others, but that that can help you as well.

KENDALL
[00:16:19] That's super, super interesting. Both that being offered help helps, even if you don't receive the actual help and that providing that help or offering to provide that help helps you as well. So a lot of us are communicating through phones, through text messages, through Zoom calls, facetime, that kind of thing. Is that good enough?

DR. HOLT-LUNSTAD
[00:16:45] There's two parts to that, I think. One is we need to recognize that when we are face to face with someone, we may be engaging all five senses, or at least most of them, maybe not always all. And so we may be missing important social information when we limit that incoming information.

[00:17:08] The other point is that we have decades of research that have documented the psychological, physical and cognitive health effects of social relationships and social connections. But most of that research is based on face to face kinds of interaction and so we really don’t have as much evidence when it comes to these kinds of tools. We shouldn't rely on them so much that they become the new norm once this crisis is over, and when when the threat is lifted, that we're able to reconnect in other ways, that includes things like touch, and we can go give someone a hug. And you know, that right now feels like a long way off. And that's something that we don't have a good substitute for right now. But we can offer emotional kinds of support through these tools. And so using them where we can in positive ways is really what we're going to have to do until this crisis is over.

KENDALL
[00:18:23] You know, in talking about all of this, we obviously don't know how long our social isolation will last.

[00:18:30] I think that there are a lot of communities of people who experience this in a long term setting. And I appreciated, you know, understanding a little bit more about how we all might experience some psychological distress. But I'm wondering how severe those things get for people who might be in situations like solitary confinement, where there is just such an extreme version of social isolation.

DR. HOLT-LUNSTAD
[00:19:00] So my research doesn't specifically look at solitary confinement or in incarceration type settings, but certainly research has suggested that some of the extreme detrimental effects of this. But what's interesting is even in less extreme forms, we see quite profound negative effects. So people who experience isolation and loneliness chronically are at increased risk for earlier death. So, for instance, my research, I have data from over 3.4 million participants and this it comes from the available data worldwide. And what this data showed was that among those who were chronically lonely, that this increases risk for earlier deaths by 26 percent. Social isolation by 29 percent. And living alone by 32 percent. And so we already are aware of these fairly robust important factors that are occurring naturally. And so while I can't speak specifically to solitary confinement, I suspect that that effect would be even larger.

KENDALL
[00:20:27] Yeah. And so as far as, you know, the physiological impacts and you noted a few in your research. I'm wondering how do the physiological impacts compare with other potential physical illnesses? How does this compare to someone who might have cancer or other kinds of chronic diseases? Is loneliness as detrimental to us?

DR. HOLT-LUNSTAD
[00:20:53] So when I first did these studies, I knew that the general public may, and even the medical community may not recognize the magnitude of the effect and and just how seriously this impacts our health and longevity. And so I compared the findings to other risk factors that we take quite seriously for health. And I also did another analysis where we looked at, so, the one I just mentioned was on social isolation, loneliness of living alone. Another one looked across various indicators.

[00:21:33] And what we found in that one was that being more socially connected increases our odds of survival by 50 percent. And so when we compared these relative to these other factors that we take seriously for health. What we found was that lacking social connection was comparable to smoking up to fifteen cigarettes per day. When you look specifically at social isolation, loneliness and living alone, these exceed the effects of obesity, physical inactivity and air pollution. So these are all factors that receive significant attention and resources. And what this suggests is that we need to take this just as seriously for our health.

KENDALL
[00:22:22] Wow, that is stunning. How is that being received more broadly? Like, are people waking up to this? What are the kind of national trends that we see in people understanding and wanting to ameliorate either longer term social isolation, things like solitary confinement, or just everyday loneliness that people experience?

DR. HOLT-LUNSTAD
[00:22:49] Yeah. So I think there's some mixed reception. On the one hand, I've seen in the last few years much greater attention to this as a potential factor that's important to public health. But I also have seen some resistance, whether it be the idea that this is something very personal. You know, the government has no place or business getting involved in people's personal lives or the medical community really feeling as if this is outside, that it's not relevant clinically. What could a physician or health care professional possibly do to help with this? But we've also seen some important ways in which the medical community and potential policy can certainly play a role. Oh, one more potential pushback is that this focusing attention and resources on this issue might divert precious resources away from other important pressing issues.

KENDALL
[00:24:08] You can make that out and allow just about anything. I would imagine.

DR. HOLT-LUNSTAD
[00:24:12] Right. You know, of course, we have limited resources. But if we think about many of the pressing issues that we’re concerned about addressing this helps us address a lot of other issues. So, for instance, you know, people have argued we should be spending more time and attention around addiction. Well this may help address some underlying issues, similar with violence and other kinds of issues. So, for instance, there's evidence that suggests that untreated hearing loss puts people at increased risk for isolation and loneliness. And so a bill was introduced by Senator Warren to make over the counter hearing aids more affordable. And this was signed into law by President Trump. And so here is an example of bipartisan cooperation around an issue. And so, of course, we still have to see whether this helps reduce that risk. But it's an example of how government can potentially play a role in reducing social isolation and loneliness that doesn't necessarily impede people's privacy or personal choices.

KENDALL
[00:25:35] That's really interesting. So I think when we talk about the idea of this impacting all of us during this period of time when we're all quarantining and may impact, you know, whether or not the government decides to get involved in some kind of policy. I've heard something referred to as this concern that we're going to be experiencing after this period of quarantine. Something called a social recession. That is, you know, this continued pattern of distancing ourselves socially beyond what this kind of immediate time calls for. And I I'm wondering if you've ever heard of that term and if you're worried about that happening. And and if so, how could we potentially prevent that?

DR. HOLT-LUNSTAD
[00:26:21] Yes, I have heard that. And I think it's a real concern. I think all of us would love for us to somehow one day get notification of OK. All clear, and, you know, we can all run outside and hug our neighbors and resume life as normal. But that is highly unlikely.

[00:26:46] What I suspect is that it will be a gradual process as rates decline, that there may be loosening of restrictions, but there will still be that concern of some lingering threat. And so for many, this may result in continued patterns of isolation and distancing oneself from others. And in fact, for instance, in cases where a city or a municipality, the public water becomes unsafe to drink, it was contaminated. And even after the problem is solved, oftentimes residents don't feel safe drinking the water after that. That trust has been compromised. And so I worry that people will continue to try to distance themselves from others. But I'm a bit of an optimist. And so I always try to look or for the good and the hope in a situation.

[00:27:53] And one of the things that I really hope will come from this crisis is a recognition of just how important our relationships are and how important it is to look out for each other. And one thing that I'm observing is greater attention to to those in our communities that might be at greater risk. And so I hope that this sensitivity to those who might be most vulnerable will be an eye opener. And I think that this situation has really underscored that we're in this together and that there's a degree of solidarity around this. And I hope that it brings out the best in humanity and that we can grow from this and become better from this.

KENDALL
[00:28:44] I agree. I hope so, too.

Anna also sees an opportunity in this time, but she’s clear that we must not forget this experience of isolation when the world opens back up because it won’t open back up equally.

ANNA
[00:28:59] If anything good can come of this crisis, it will be that maybe people will start to understand and empathize with those of us who face marginalization in our daily lives, because for us, this isolation and exclusion and oppression isn't going to end when Coronavirus does. The structures that harm us will still be there. So we need to make sure, I think, that the ways we're coming together to understand each other during this crisis also exist afterwards. And then we have to continue to pursue change because our work certainly isn't done.

KENDALL
[00:29:36] To us at the ACLU, that work looks like dismantling systems that separate us—shrinking the criminal justice footprint, ending solitary confinement, mitigating detention, and creating far more inclusive spaces.

Thanks so much to Anna, TreShaun, Jason, Claire, and Dr. Holt-Lundstad for speaking with us. And thanks to you all for listening. If you enjoyed this conversation, please be sure to subscribe to At Liberty wherever you get your podcasts and rate and review the show. We really appreciate the feedback.

Until next week, stay safe everyone!

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