Category Archives: social isolation

How loneliness kills



Judith Shulevitz, in the May 13, 2013 New Republic has an interesting read “The Lethality of Loneliness.”


“Psychobiologists can now show that loneliness sends misleading hormonal signals, rejiggers the molecules on genes that govern behavior, and wrenches a slew of other systems out of whack. They have proved that long-lasting loneliness not only makes you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality as smoking. A partial list of the physical diseases thought to be caused or exacerbated by loneliness would include Alzheimer’s, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people….

“To the degree that loneliness has been treated as a matter of public concern in the past, it has generally been seen as a social problem—the product of an excessively conformist culture or of a breakdown in social norms. Nowadays, though, loneliness is a public health crisis. The standard U.S. questionnaire, the UCLA Loneliness Scale, asks 20 questions that run variations on the theme of closeness—“How often do you feel close to people?” and so on. As many as 30 percent of Americans don’t feel close to people at a given time….

“What He [God] wanted is for us not to be alone. Or rather, natural selection favored people who needed people. Humans are vastly more social than most other mammals, even most primates, and to develop what neuroscientists call our social brain, we had to be good at cooperating. To raise our children, with their slow-maturing cerebral cortexes, we needed help from the tribe. To stoke the fires that cooked the meat that gave us the protein that sustained our calorically greedy gray matter, we had to organize night watches. But compared with our predators, we were small and weak. They came after us with swift strides. We ran in a comparative waddle.

“So what would happen if one of us wandered off from her little band, or got kicked out of it because she’d slacked off or been caught stealing? She’d find herself alone on the savanna, a fine treat for a bunch of lions. She’d be exposed to attacks from marauders. If her nervous system went into overdrive at perceiving her isolation, well, that would have just sent her scurrying home. [John] Cacioppo thinks we’re hardwired to find life unpleasant outside the safety of trusted friends and family, just as we’re pre-programmed to find certain foods disgusting. “Why do you think you are ten thousand times more sensitive to foods that are bitter than to foods that are sweet?” Cacioppo asked me. “Because bitter’s dangerous!”

The article, well worth a read, discusses issues like that only about half of loneliness is hereditary, what areas of the brain light up when we are socially snubbed (the same portion that registers physical pain, i.e., the dorsal anterior cingulate cortex), what has been learned about the impact of the absence of loving parents on loneliness from the isolating experience of Russian orphans; and how Nobelist James Heckman is finding that many low SES children bear loneliness scars from poor parenting growing up (that is akin to the impact found by Steve Suomi and Harry Harlow on isolated rhesus macaques).

See other posts about the negative health effects and contagion of  loneliness and social isolation here.

Having few friends predicts early death as much as smoking or alcoholism

“Low social interaction as high a risk factor for early death as smoking 15 cigarettes daily or being an alcoholic, and twice the risk factor of obesity.”

Julianne Holt-Lunstad, a psychologist at BYU, published a recent meta-analysis with Timothy Smith and J. Bradley Layton (that culls from learning across 148 longitudinal health studies covering over 300,000 individuals). They showed that increased involvement in social networks on average reduces one’s chance of mortality over the period of any particular study by 50+%, a greater effect than either stopping smoking or eliminating one’s obesity/physical inactivity.

The study “Social Relationships and Mortality Risk: A Meta-analytic Review” appears in the journal PLoS Medicine.  They controlled for baseline health status,  and found consistent results for friendships with family, friends, neighbors and colleagues across age, gender, initial health status, cause of death, and follow-up period.

The life-protective benefits of friendship were strongest for complex measures of social integration and lowest for simple measures of residential status (e.g., living alone versus with others) .  In studies that had greater dimensions of social involvement (whether one was in a network, the kinds of social support one got, etc.), the life-protecting benefits of friendships were higher, likely corresponding to the multiple pathways through which friendships provide benefits.

Low social interaction, according to the authors, was as high a risk factor for early death as smoking 15 cigarettes a day or being an alcoholic.  Low social interaction was a higher risk factor than not exercising and twice as high a risk factor for early death as obesity.

Co-author Tim Smith noted: “We take relationships for granted as humans – we’re like fish that don’t notice the water….That constant interaction is not only beneficial psychologically but directly to our physical health.”

The longitudinal studies they analyzed tracked health outcomes and social interaction for a period of seven and a half years on average.

The 50% increased survival rate is quite likely an underestimate: these longitudinal studies don’t track relationship quality but only one’s inclusion in a social network, so they include negative relationships as well. Survival benefits of friendships are likely to be much higher if one could isolate only positive and healthy social relationships.

Holt-Lunstad speculated that the pathways of social relationships to improved longevity stem range from  “a calming touch to finding meaning in life.” She believes that those who are socially connected take greater responsibility for others’ and their own lives and take fewer risks.

Here is key Figure 6 from their study:

Unlike some other work, such as Eric Klinenberg’s Heat Wave, where shut-in elderly were especially at risk of death in Chicago’s 1995 heat wave, the findings of Holt-Lunstad are generalizable to all age groups.

Doctors prescribing social capital?

Flickr photo by carf

I wrote earlier about some insurers using social capital in making decisions of whom to insure.

That post and a story sent to me by Lew Feldstein about doctors prescribing outdoor time got me thinking about doctors and social capital.  In the same way as doctors ask questions of patients around smoking, exercise, diet, etc., why shouldn’t doctors also ask patients to fill out a short survey about social capital activities they engage in:  number of confidants, how many of their neighbors’ first names they know, how often they go to friends’ houses or entertain others in their home, etc.?

These data could be used for 3 purposes:

1) to track real changes in the patient over time:  e.g., if a patient used to report 2 confidants and now reports zero it would be a chance for the doctor to find out what had triggered this (a friend moving, serious arguments, a close friend dying, etc.) that might help identify patients at risk of being socially isolated or going through stressful times.

2) to benchmark against others of the patients’ education, race and age.  In larger practices, or if this information was aggregated anonymously by affiliated hospitals, the computer could help patients understand the degree to which they far less involved in community or other associations or less trusting than comparable others nationwide or in their area.  If one was significantly below what others were, the doctor might want to bring this to the patient’s attention:  “did you know that most others like you are far more active in their community?”  or “did you know that most others like you volunteer much more their community?”  “This is something that has clear health impacts;  would you like more information about how to get more involved?”

3) to prescribe social capital “treatments”.  We’re far more used to a doctor prescribing an antibiotic or an aspirin than recommending that a patient get actively involved in a group (on a topic he/she cares about).  And some social capital deficits are more easily treated than others — it’s hard to suddenly develop a confidant.  But doctors might note to patients that there are real health consequences of being socially isolated and being socially and civicly uninvolved: i.e., getting sick more often and recuperating more slowly.  If acquiring a confidant in the next year is not a doable goal, maybe deciding which of ones’ friends have the potential to be confidants and taking some steps to start to deepen these relationships might be doable over the next 6-12 months.   Patients might agree to certain steps they want to take and put them on a card in a sealed and addressed letter that gets sent to them in 4 months.  Nudges can also be used to help people keep promises (through ongoing social groups that hold their members accountable for their promises, checks that go to disliked groups if commitments are broken, etc.).

And as to why?  Doctors might point out that they would rather be prescribing social capital now than prescribing hypertension drugs five years down the road.

[Read related story in NY Times about prescribing outdoor time: “Head Out for a Daily Dose of Green Space” (Jane Brody, 11/30, 10]

The looming financial crisis and middle class engagement

Selling Apples (Flickr photo by SirPoseyalKnight)

Selling Apples (Flickr photo by SirPoseyalKnight)

David Brooks, in “The Formerly Middle Class” (NYT, 11/18/08) writes:

“[T]hey [the new middle class] will suffer a drop in social capital. In times of recession, people spend more time at home. But this will be the first steep recession since the revolution in household formation. Nesting amongst an extended family rich in social capital is very different from nesting in a one-person household that is isolated from family and community bonds. People in the lower middle class have much higher divorce rates and many fewer community ties. For them, cocooning is more likely to be a perilous psychological spiral.

In this recession, maybe even more than other ones, the last ones to join the middle class will be the first ones out. And it won’t only be material deprivations that bites. It will be the loss of a social identity, the loss of social networks, the loss of the little status symbols that suggest an elevated place in the social order. These reversals are bound to produce alienation and a political response. If you want to know where the next big social movements will come from, I’d say the formerly middle class.”

I agree with David Brooks’ first fear.  That said, since social networks have always been the backbone of social movements (from abolition to civil rights to women’s suffrage) it’s hard to fathom how this isolated ex-middle class constituency is going to build a movement out of vaporware.  But with time on their hand, and the Internet at their disposal, maybe this will be the test of whether Internet tools (from Meetup to Facebook to virally circulated YouTube recruiting efforts) can be put to use to engage these displaced Americans and give collective voice to their frustrations.

Train in vain

Australian designer Hamit Kanuni Kuralkan proposes a train with mini pods. The supposed benefit? Everyone gets their own personal space. But the design has a much larger social cost: no chance of building social capital on the ride with one’s train mates. Not to mention if the riders actually have to work together in the event of a crisis (someone having a heart attack, an accident, a terrorist attack,…)

Let’s hear it for progress (cue sarcastic background music!).

It does look cool, but why couldn’t he design something that would actually help society? Too much to ask?

[If you’re just into design, ignoring the social consequences, you can see other pictures of the “train to nowhere” here.]

Annoyance Tech: Zap ’em, Don’t Bother Talking to ’em

In the “If Life Gives You Lemons Make Lemonade” Department…

 Jennifer Saranow in her interesting Wall Street Journal Article “Revenge by Gadget” (Weekend Journal, 8/17/07) describes technological solutions to avoid unpleasant encounters. 

Meeting going too long? Have your cell phone fake a call to you in the middle to get out of it. 

Don’t like passengers talking on their cellphones during the ride?  Jam their cellphones with a cellphone blocker.

Get touched when you don’t want it?  Buy an electrified jacket that shocks them.

Don’t like someone’s driving?  Press a button and flash them a sign from your back window, like “Back Off” or “Idiot”.

Don’t like kids hanging around?  Buy the Kids Be Gone and emit high frequency sounds that keep them away.

In an era of increased social isolation and declining social capital (when we’re “Bowling Alone“) when it seems harder to talk with others about finding common ground,  it’s probably inevitable that we find technological solutions that promise insta-remedies.  These solutions in many cases may be penny-wise and pound-foolish, because especially for folks we are likely to encounter over time (our business colleagues, our train mates, etc.), it’s only a matter of time until word leaks out of these gadgets (what techies call “annoyance tech”).  And soon we ignite an arms-race for the most powerful gadget (does your blocker block his blocker and if not, can you buy a more powerful new version?).   These tech-wars are now doubt good for entrepeneurs who want to sell upgrades, but what about society?

In the age of high tech, it’s obvious we seek solutions that seem as instantaneous as a remote control that seemingly makes unwanted people disappear (just like undesired TV programs), but life is a bit more messy and complicated than that.  And the sooner we practice and hone our atrophying people skills, the better we’ll all be in long run.  At the risk of sounding school-marmish, we need to practice being forthright but polite.

Full “Revenge by Gadget” article available here.

Overweight friends as social contagion (II)

Yesterday, we reported about Christakis’ and Fowler’s top-rate study of how obesity spreads in social networks.

In today’s NYT, Gail Collins has a humorous Op-Ed (“Fat comes in on little cat feet“) about the ramifications of such a study.  Included are the following:

“8 p.m. — ‘Friends.’ In a much-anticipated reunion special, the gang has all bought condos in the same strangely affordable Manhattan apartment building. Tension mounts as Phoebe and Rachel notice that Monica is putting on weight. Well aware of the new study showing that obesity travels through friendship networks, they evict her. ‘The body mass of the many is more important than the survival of the one,’ says a saddened Ross. ‘Even if she is my sister.’ Later, the rest of the group reminisces about good times past with their now-shunned buddy. Nicole Richie guest stars as Chandler’s new love interest.”

Collins notes that the study found that obesity spreads through social networks and Christakis and Fowler “believe this is true even if said friend lives in Bangkok. The far-away friend has far more influence on your weight than relatives in the same house. And your neighbors can gain or lose the equivalent of several persons without it having any impact whatsoever.”

Collins doesn’t blame the researchers for their findings but notes that this is unlikely to be the “kind of information that’s going to brighten up anybody’s day. I’ve been overweight my entire life, and although I’ve had a lot of friends, I can’t think of one who got fat while hanging around with me. But if there’s anybody out there, I really do apologize. I’d have dropped you ages ago if only I’d known.”

Given the social contagion finding, Collins speculates:” Can you imagine how mean the high school mean girls are going to get if they think they have scientific evidence that ostracizing the chubby kids is a blow for physical fitness?….And now that his theory about leprosy-bearing Mexicans sneaking across the border has been completely debunked, Lou Dobbs will be hyperventilating about obese illegal immigrants ingratiating themselves and their fat into American communities.”

Christakis and Fowler are clear to indicate that they do not recommend dropping fat friends from one’s social network since friendship has many other health benefits.  A Slate magazine article (“Maybe fat people should be stigmatized“) thinks that they authors are being too PC and avoiding people taking responsibility for their decisions.    And Christakis and Fowler compare having an overweight friend to having no friend and conclude that the former confers more health benefits (even with the accompanying increased risk of obesity);  if their choice set was a fat friend or a thin friend, they would have gotten a different result since the thin friend would still confer the health benefits of friends without the obesity risk.  To this, Christakis said in a phone interview with Collins that “The network of fat-influencing relationships are so dense that in the end ‘your weight status might depend on the weight difference of your sister’s brother’s friend.’ ”   Sounds like a bit of a cop-out.  Like arguing that someone shouldn’t avoid risk factors because there are so many other risks out there.

But maybe in our days of increased social isolation, people should hang on the friends they have since so many Americans are losing their close friends.

David Lazer has an interesting post about how Christakis et al. deftly handle the issue of causality in their paper using longitudinal data.

And Ellen Goodman had an interesting post on this called Obesity Contagion (Boston Globe, 8/3/07)

The NEJM article by Christakis et al. on the spread of obesity through networks is available here.