Archive for May 21, 2018

Love Hunger

On August 5, 1944, my mother kissed her uniformed husband goodbye in the Navy yards of Los Angeles, watched his ship leave for Hawaii, and drove east to Phoenix, where she wrote him a letter that night. The next day she wrote him a second letter in which she described the news of the Hiroshima bomb dropping, wondering what this would mean for his expected assignment. She addressed each letter to him at the Fifth Service Depot, FMF Pacific, a military post office in San Francisco, where letters were sorted by grunts in a warehouse and routed according to the soldier’s assignment. She didn’t know it at the time, but it would be three weeks before he would read her first letter, and longer before she would read his. By then she was home in Cincinnati living with her mother and sister, watching the mailbox with a hunger that ruled the house.

Today most of us can see and talk with anyone we choose anywhere in the world at the tap of a phone screen, even in war zones, for less than the price of those stamps my mother licked for her love letters. We now make social connections with an ease that was unimaginable just a generation ago. We smart phone carriers should be well connected and socially well fed, right?

Not true, says a recent Cigna survey of loneliness in over 20,000 US adults. This study is just the most recent to underscore the paradox that in this age of hyperconnections, loneliness and social isolation remain a major public health problem. Using the UCLA Loneliness Scale to operationalize loneliness, the survey found that 27 percent of respondents reported feeling rarely or never really understood by others. Over 40 percent felt their relationships were sometimes or always not meaningful. One in five felt rarely or never close to people. The age group that reported the highest rates of loneliness was “Generation Z,” age 18-22.

The larger context for this latest survey was set by a 2015 review of 70 of the best studies of the effects of loneliness or social isolation on mortality. The wake-up call from this review is that whether you’re lonely or content to live alone, either one raises your risk of early death by 25-30%–as much as the more traditional risk factors of obesity, smoking, or physical inactivity. The effect of loneliness on mortality hits hardest not on the elderly but on those in middle age.

One of the believers in this loneliness epidemic is Vivek Murthy, MD, whom you may recognize as our former Surgeon General (2014-17). “We live in the most technologically connected age in the history of civilization,” he said recently, following his article in the Harvard Business Review, titled “Work and the Loneliness Epidemic”, “yet rates of loneliness are increasing.” According to one expert, since the 1980’s the percentage of American adults who say they’re lonely has doubled from 20 percent to 40 percent. Murthy attributes this epidemic to our increasing geographic mobility, our growing preferences for texting and email over direct conversation, and the recent shift in work efficiencies and habits that isolate workers from their colleagues.

Can we understand how such apparent progress in social networking could accompany a rise in loneliness with measurably poor consequences for our health? Evolution has not prepared us for these unprecedented levels of self-sufficiency that have come with first world rates of progress. We evolved to function best in small, tight families and tribes, but over the last half-century in developed countries we may have grown efficient and self-reliant to a fault, dispersing ourselves far from our origins. We have isolated ourselves through our houses, our cars, our access to information without talking to anyone, our work spaces, our recent dependence on screens and devices. This efficiency and comfort comes at the unintended expense of direct conversations and eye contact and handshakes and the smells of each other and the daily reminders that we belong to groups that need us.

Is loneliness a reasonable price to pay for our progress? Consider the physical effects of loneliness or social isolation. If we could swim among the undercurrents of the physiology of loneliness, what would we find? Resting heart rates generally go up when we’re alone or lonely, and over the long run high heart rates are hard on the cardiovascular system. We may find stress hormones rise and stay elevated, making us less resilient to hardships. Sleep is less restful, less efficient, meaning we don’t recover well; we lose that bounce. Inflammation levels creep up, infections too, both reflecting a struggling immune system. Self-care goes down. Why not skip that shower? Who needs to brush teeth if no one’s around? Cooking for one is no fun. More errors on the crossword puzzle, more forgetfulness. It matters less when no one else is around. Mental agility and judgment slide. Sometimes that opens the way to consider suicide, which is confined to the isolated, especially when their judgment slides. Almost no one tries to kill himself in the presence of another; the social prohibitions are too great. Pernicious combinations of these physical undercurrents of loneliness pave the pathways to heart disease and diabetes and early death.

So loneliness, like hunger and thirst, is an adaptive signal, if we learn to read it and respond. But the seductions of modern self-sufficiency are hard to resist. A substantial number of us are paying the steep price of loneliness. And yet our resources for combating the seductions of self-sufficiency also have never been greater. If we don’t get smart—smarter than our phones—about feeding our love hunger, our loneliness may do us in early. We don’t have to go to war to understand how writing daily love letters is a good way to survive.