Let’s Wage a War on Loneliness
The condition isn’t just depressing. It can be deadly.
By Nicholas Kristof
New York Times
LONDON — We humans make a lonely crowd, and it’s killing us.
Social isolation is more lethal than smoking 15 cigarettes a day, or than obesity, according to research published by Julianne Holt-Lunstad of Brigham Young University. Since obesity is associated in the United States with 300,000 to 600,000 deaths a year, the implication is that loneliness is a huge, if silent, killer.
Loneliness increases inflammation, heart disease, dementia and death rates, researchers say — but it also simply makes us heartsick and leaves us inhabiting an Edvard Munch canvas. Public health experts in many countries are debating how to address a “loneliness epidemic” that corrodes modern life, but Britain has taken the lead: Last year it appointed a minister for loneliness.
“It touches almost every one of us at some point,” Baroness Barran, the current minister for loneliness, told me. “It can lead to very serious health consequences for the individual and leads to erosion of our society, where people become isolated and disconnected.”
I’ve become interested in loneliness while reporting on the opioid epidemic and soaring suicide rates in the United States. These have complicated roots, partly economic, but they also result from social isolation. Extended families have dissolved, and social institutions like churches, bowling leagues and neighborhood clubs have frayed. We are no longer so deeply embedded in our communities.
“I trained in internal medicine, and I expected most of my time would be spent on diabetes or heart disease or cancer,” Dr. Vivek Murthy, who was surgeon general of the United States under President Barack Obama, told me. “What I didn’t expect was that so many people I saw would be struggling with loneliness.”
More than one-fifth of adults in both the United States and Britain said in a 2018 survey that they often or always feel lonely. More than half of American adults are unmarried, and researchers have found that even among those who are married, 30 percent of relationships are severely strained. A quarter of Americans now live alone, and as the song says, one is the loneliest number.
One gauge of social isolation, or perhaps selfishness: Murthy says he saw families sometimes drop elderly family members off at a hospital for Thanksgiving or another long weekend in what sounds to me rather like the practice of a family leaving a dog at a kennel when they’re going away. At the hospital, doctors are sometimes the only ones to witness a patient’s death, with no loved ones around.
Loneliness affects physical health in two ways. First, it produces stress hormones that can lead to inflammation and other health problems. Second, people who are alone are less likely to go to doctor appointments, to take medicine or to exercise and eat a healthy diet. We may resent nagging from loved ones, but it can keep us alive.
When I met Barran I suspected that the minister of loneliness portfolio was a bit of a gimmick. In fact, I’m now persuaded that it’s a model for other countries.
The ministry started a “Let’s Talk Loneliness” campaign that sparked difficult conversations across Britain, and it is handing out small grants to local gardening clubs, bird-watching groups and others so that they can spread the word and invite more people to join. One grant of $640, for example, went to a Birmingham group to buy board games and start a game club.
It is supporting “friendly benches,” which are public benches where people are encouraged to go and chat with one another. It’s pushing to keep community spaces open and to stop public transportation from being cut in ways that leave people isolated. The government is also putting social workers in doctor’s offices for “social prescribing” — connecting lonely patients with local organizations.
One early lesson, Barran said: Because of stigma, don’t post a sign inviting lonely people to show up. Rather, have an upbeat sign inviting people to take part in a dog-walking club, a community garden or some other activity.
“We should focus on people’s gifts rather than people’s problems, because most of us would prefer to talk about our gifts,” Barran said.
I suggest that we also make it easier for people to have dogs. There is some evidence that dog owners (but not cat owners) are less lonely, although in fairness the research is mixed.
Some think that the internet has aggravated the problem, because a cursory look through Facebook or Instagram suggests that everyone else in the world is having a fabulous time and enjoys perfect relationships.
Meanwhile, the reasons to address the topic are compelling. “If we could tackle loneliness,” Barran said, “people would feel stronger, more resilient, more optimistic about the future.” Professor Holt-Lunstad has found that greater social connection is associated with a 50 percent reduced risk of early death.
Australia, Canada, Germany and New Zealand have shown interest in adopting British approaches. Maybe the United States, too, should experiment: How about a new post in the Department of Health and Human Services — an assistant secretary for loneliness?
Depression Diagnoses Up 33% (Up 47% Among Millennials): Why There Is An Upside
Bruce Y. Lee Senior Contributor
What's the bright side to the report just released by the Blue Cross Blue Shield Association. In the movie Life of Brian, Eric Idle once sang "always look on the bright side of life," followed by lots of whistling. But is there a silver lining to the report just released by the Blue Cross Blue Shield Association (BCBSA) entitled Major Depression: The Impact on Overall Health that showed steady increases in depression diagnoses from 2013 to 2016?
At first glance, there seems nothing but bad news. An analysis of insurance claims data from over 41 million Blue Cross Blue Shield commercially insured members yielded the following curves:
These look like escalators going up. As you can see at the right edge of this graph, in 2016, 6.0% of female members and 2.8% of male members (for a total of 4.4%, which is over 9 million members) had a diagnosis code for major depression. This represented a 33% increase since 2013 (hence the big red upward arrow that says 33%).
Of all the age groups, the rise was highest among teens from 12 to 17 years old (increasing by 63% from 1.6 to 2.6%) followed by Millennials (ages 18 to 34), increasing by 47% from 3.0% to 4.4%. But before you blame Millennials and younger folks for the rise in depression diagnoses, because it may seem so easy to blame Millenials for everything ("oh, it's raining today, darn Millennials"), realize that other older age groups experienced substantial rises as well (increases of 26% and 23% for those 35-49 and 50-64 years in age.)
This is one map that doesn't follow a clear "Blue States" and "Red States" pattern. As shown by the brown color, Rhode Island (6.4%), Maine (6.1%), and Utah (6.0%) had the highest overall rates. Hawaii (2.1%) in dark blue had the lowest. Both the highest Millennial (6.8%) and adolescent (4.6%) rates were highest in Utah while Hawaii had the lowest (1.8% and 1.1%, respectively).
So far, not very good news. The findings from this report add to the growing evidence that depression has been rising in the United States since at least the early 2000's, if not before then. For example, a study published in Psychological Medicine found that the prevalence of depression increased from 6.6% to 7.3% between the years 2005 and 2015 with an even greater increase (8.7% to 12.7%) among those ages 12 to 17. As BCBSA Chief Medical Officer Trent Haywood, MD, JD, explained, "Various studies and measures all suggest that there is an underlying trend that depression has been and continues to be a growing problem."
Here's more not-good-news. This isn't a simple "fix it with a song" problem. Broken and worsening systems may be contributing to this rise in depression. Haywood mentioned that "increasing social isolation, utilization of social media, competition between people, divorce rates, and other issues" may be helping fuel the upward trends. Yes, folks, it's a systems problem. A review article in the Journal of Affective Disorders also cited growing income and social inequality as contributing factors and that "modern populations are increasingly overfed, malnourished, sedentary, sunlight-deficient, sleep-deprived, and socially-isolated." In other words, people are becoming more and more like sleep-deprived potatoes that are buried in the ground and use social media to yell at each other.
So where's the sunshine on these seeming cloudy days? Well, keep in mind that this study measured the number of people who received major depression diagnoses (as indicated by insurance codes used for major depression) and not the actual number of people who had major depression. This is an important distinction. If you were suffering from major depression, you would not have been counted if you did not revealed your symptoms to a doctor or other relevant health care personnel and that person did not indicate in your insurance billing records that you had major depression. Studies, such as one published in JAMA Internal Medicine, have shown that a large percentage of people who have depression symptoms don't ever seek help and get proper treatment. Therefore, could the increase in depression diagnoses in part represent a greater percentage of people seeking medical attention for depression?
Perhaps. Recent years have seen depression become more "mainstream." Celebrities such as Beyoncé, Miley Cyrus, Lady Gaga, Kristen Bell, and The Rock have openly discussed their struggles with depression. As I mentioned recently for Forbes, NBA star DeMar DeRozan even filmed a mental health public service announcement that is airing this month during the NBA playoffs. Reports like the Blue Cross Blue Shield one may be raising awareness and could be decreasing stigma connected with depression. After all, it is saying that if you have been diagnosed with depression, you are among at least 9 million other people. As Haywood emphasized, "our findings raise awareness so that there is an opportunity to intervene."
It's also quite notable that a major insurer like BCBSA is recognizing depression as an important growing problem. Our current health care system doesn't always make it easy for depression to be detected and recognized. Nowadays doctors are often too busy and too overwhelmed to spend enough time with patients to find out how their lives are going. As I have detailed before for Forbes, fifteen minutes is barely enough time to take a "more involved" toilet visit and wash your hands properly (which you should always do after using the toilet). How can it be long enough to really talk to a patient? And here's a shocker, our health care system can be quite reactive rather than proactive, waiting for something to boil over or blow up before it is addressed. As Haywood explained, "there needs to be more active rather than passive management of lifestyles, social media, and social relationships. Sleep hygiene, nutrition, and fitness are often unrecognized issues." The BCBSA report also found that members who had a depression diagnosis also had over twice the average annual healthcare spending ($10,673) of those who did not ($4,283). So depression is costing everyone moolah. It's time for the health care system to extend more into the community and help address the systems that may be contributing to depression.
Thus, the BCBSA report is not all "this is bad, this is bad, this is bad, and it's getting badder." It could be that more people are seeking help for their depression. The report also further raises awareness and shows that a major insurer recognizes depression as an important problem and that it's worth more than just a whistle.
The following is an article from vox.com:
America has a capitalism problem
Can the mindfulness movement resist becoming a tool of self-absorption?
By Sean Illing
Capitalism has a way of co-opting a lot of our culture’s best ideas. Great concepts in fashion, music, and wellness are constantly rebranded and used to peddle consumer products. Whether it’s punk music or yoga, industry will find a way to profit from it.
Is mindfulness meditation the latest victim? This is the argument David Forbes, a professor of contemplative education at Brooklyn College, makes in his new book Mindfulness and Its Discontents.
The number of Americans who’ve tried meditation has tripled since 2012. And many are doing a specific practice with Buddhist roots called mindfulness, which involves directing your attention to your experience in the present moment with kindness and without judgment. The practice is increasingly being offered in schools, health care facilities, and prisons to improve well-being.
So how is this a bad thing?
A lightly edited transcript of my conversation with Forbes follows.
What does the mindfulness movement in America look like from your point of view, and how is it changing?
It’s a lot of different things. The mindfulness you see in Buddhist communities is not the same mindfulness being promoted in corporations and schools across the country. There are lots of people who join a mindfulness group or take an MBSR (Mindfulness-Based Stress Reduction) course, and being part of a small community like that helps a lot. And plenty of people just practice mindfulness by themselves, in isolation, at home or wherever.
At the same time, mindfulness is also becoming an industry, and lots of companies are cashing in on it. I live in New York, and there are money-making studios popping up all over the place. And mindfulness is being marketed [by them] as very much an individualistic practice, which is not healthy and even further contributes to stress and ill-health.
What sort of problems is this creating within the movement?
Well, it raises a question about the intentions of those who practice mindfulness — both those who identify as Buddhists of any kind, and those who are part of a general mindfulness movement in the US and internationally.
Buddhists seek to let go of attachment to the myth of the private, solid, unchanging self, and to promote universal compassion and end universal suffering.
But capitalist culture enforces the myth of the privatized, self-centered self. So unless mindfulness is employed in the service of making the world a better place — then practicing can and does end up serving to maintain the very self-centered, greedy, individualistic institutions and relationships that contribute to the lack of connected presence, kindness, and compassion that contribute to our unhappiness.
They help people adjust to the status quo rather than helping to transform it.
Does mindfulness, in your view, have a moral foundation?
Buddhism has ethical values and practices such as non-violence. Its deeper moral stance is that we are interconnected with all beings, to all our social relationships and institutions, and with the earth itself.
People will argue that you become kinder and more compassionate just by practicing mindfulness. But I believe people need a moral framework in addition to mindfulness, some social vision to guide them. I think [in many US contexts it has] been severed from this moral tradition. Without that, meditation can become just another tool of self-absorption.
Some people will read this and wonder why is teaching mindfulness as a coping mechanism so problematic if it does, in fact, help people?
Well, I don’t think it’s an either-or situation. I think it’s a good thing that people are getting tools to help them cope with difficult circumstances. I don’t want to dismiss that. My problem is that it ultimately doesn’t go far enough because it reinforces the sources of our unhappiness. As long as mindfulness is focused on the individual and not on our social situation, it will not help us change the conditions that are making us unhappy, namely a hyper-competitive, ultra-individualistic culture that separates and alienates us.
Are you troubled that millions of Americans are discovering mindfulness through apps like Headspace and Calm, which recently became the first mindfulness startup to reach $1 billion valuation unicorn status?
It depends on what you value. Again, I think it’s great that people are finding ways to de-stress and focus better. But as more and more people make money off of mindfulness, I think it corrupts the spirit of the tradition and practice. I think it becomes more and more a product like any other in our society, and I think it becomes more an individualistic pursuit.
But what can I say? Capitalism always finds a way to make money off of something, and mindfulness is no different.
What are examples of mindfulness being co-opted in the way you’re describing?
A lot of corporations are adopting mindfulness as part of their corporate culture. Mindfulness without any moral roots can be used as a hack for all kinds of unsavory ends.
Google, Goldman Sachs, and Aetna among others have trained many employees in mindfulness for stress reduction.
These corporations have been involved in various scandals and unethical practices that are at odds with the public good. There’s no evidence that mindfulness has made them kinder, gentler, or more socially responsible. Mindfulness is used instead to enhance employee productivity and performance by getting them to focus better [or] cut down on employer healthcare costs from stressed-out workers. All of this is aimed at improving the bottom line.
Any other examples?
There are also well-intentioned educators in schools across the country that are teaching mindfulness but lack any analysis of neoliberal reform in our education system. So they’re helping kids feel less anxiety about high-stakes tests without questioning the meaning and quality of those tests in the first place, without challenging the individualistic, competitive ethos underneath it all.
Mindfulness is also being used in inner-city schools as an anger-reduction technique, which in its own way is terrific. But at the same time, maybe we should be asking if that anger is legitimate? Maybe we should be asking why kids are angry and alienated? If we’re focused on reducing the reaction to these injustices and not focused on fixing the problems at the source of it all, how much good are we really doing?
Again, I want to be clear: I’m not opposed to teaching mindfulness to students or anyone else. But I just think we cannot ignore the moral and social dimensions of life, and I worry this is what’s happening.
What does your vision of “social mindfulness” look like? Do you think we should be meditating with other people? Do you think we need to supplement mindfulness training with a concrete political agenda?
In mindfulness, you focus on your breathing and you’re noticing your thoughts as they come and go. What I’m suggesting is that we expand on this and begin to identify where those thoughts are coming from.
How are we conditioned by certain troublesome patterns rooted in dominant society? What are the forces or structures perpetuating those patterns? In this way, we’re using our attention to really pay attention to the sources of our unhappiness and then the next step to work to overturn those sources.
My ongoing exploration into therapy related topics.