Home Alone
As we’ve been discussing the life of Juana of Castile this month, I couldn’t help but notice the irony of her final years. Although Juana was generally stable, her family portrayed her as “mad” so that they could lock her away and rule in her place. But the isolation that Juana was subjected to ended up taking a toll on her mental health. She began to attack her guards and after her daughter left to get married, she entered into a deep depression, refusing to eat. While these are behaviors she had engaged in before, they intensified in her isolation.
There is an abundance of scientific literature focused on the biological effects of social isolation, which has been examined with renewed interest this year as the coronavirus pandemic forced people to stay at home and away from friends and family. What did Juana experience at the biological level from her years spent behind castle walls? I will resist my desire to write about how the 1990 cinematic treasure “Home Alone” is an artistic portrayal of the psychological effect of social isolation and instead answer this pressing question.
Lonely Eyes
Before we dive into the research, let’s define the terms. Generally, I want to focus on social isolation, which is when you have a lack of interaction with others. Loneliness, in contrast, is an emotional experience of an individual, based on a real or perceived lack of social interactions. Social isolation is easier to quantify and study because it is more objective, and therefore will be our focus for today. However, there is research showing that self-reported loneliness has similar effects as verified social isolation.
There is abundant data showing that social isolation is associated with poor health outcomes, but it can be hard to interpret. There are a variety of reasons why having a good social network is associated with better health, and you can’t look at any one factor in isolation (pun intended). Social people are more likely to be physically active, have people take care of them if they’re sick, and keep their minds engaged by conversing with others. In turn, they are less likely to have cardiovascular disease, dementia, or experience the deleterious psychological effects associated with isolation. In sum, you end up with a higher risk of mortality in socially isolated individuals. So unfortunately for all the introverts, while the mechanisms might not yet be fully elucidated, it’s clear that building and maintaining a solid group of friends and family is good for your overall health. A party/coffee date/meeting a day keeps the doctor away.
Iso Potential
As I alluded to with Juana, social isolation has particularly potent effects on mental health. An extreme example of this is the effect of solitary confinement on prison inmates, who can develop aggression, anxiety, depression, and impulse control issues after isolation, which some psychiatrists argue is a syndrome similar to post-traumatic stress disorder (PTSD). There have been recent pushes to characterize the effects of solitary confinement scientifically to support its eradication. In the meantime, there is plenty of literature detailing the neurological effects of more common social isolation. Together, the evidence demonstrates that social deprivation affects the brain at the molecular, functional, and structural levels.
Molecularly, social isolation acts as an environmental stressor that disturbs our good old friend the endocrine system and alters levels of neurotransmitter that the brain needs to send signals. These molecular changes lead to an immune response in the brain, and the hormonal, neurotransmitter, and inflammatory changes can impair neuronal signaling, and therefore brain function. Finally, chronic social isolation in both humans and animal models is associated with atrophy in key brain areas involved in memory, such as the hippocampus, and emotional regulation, like the amygdala. In adults, this means neurons are degenerating, which can contribute to cognitive decline. In children, isolation can impair the organization of these brain regions and become the trigger for neurodevelopmental disorders, like schizophrenia, highlighting that isolation has distinct effects depending on the age of the individual and the duration during which they are isolated. Overall, the multi-level effects of isolation on the brain are consistent with data showing that social deprivation increases the risk of developing depression, anxiety, addiction, and a host of other mental illnesses.
One of the reasons that social isolation is linked to an increased risk of death is that social isolation is a major cause of suicide. A 2019 study that looked at over 200,000 men who had been released from North Carolina prisons found that those who had experienced solitary confinement were 78% more likely to commit suicide. Suicide is also extremely prevalent in the elderly, a population that is particularly vulnerable to social isolation. Men over the age of 65 are the most likely to take their own lives of any group in the US, and 18% of suicides are committed by people over the age of 65. These numbers are shocking, and highlight the fact that social isolation is a public health issue; an issue that is rooted in a complex neurobiology but that we all have the ability to alleviate in our day-to-day lives.
Free Solo
The profound effects of social bonds on health reveal a beautiful truth about human nature: we are made for communion with others. Just as our bodies require food and water, they need relationships to function properly. What does that mean for people who are living alone during the pandemic? Admittedly, most research suggests that in-person socialization is preferable to digital communication. For example, a study of veterans suffering from PTSD found that face-to-face communication had a positive effect on symptoms, while social media use did not. However, understanding the effects of virtual forms of communication on mental health is a growing area of research. If you’re using Zoom and FaceTime these days to mix and mingle, don’t lose hope! There is research showing that subjective reports of loneliness in young people with serious mental illnesses were improved by using social media. In addition, another study showed that online interaction can translate into real-world community involvement. So whether it’s IRL or on the TL this week, make time for friends and family, and for your health in turn.
If you or someone you know is struggling with depression or suicidal ideation, call the Suicide Prevention Lifeline at 1-800-273-8255.
References
Axelrod, J., Balaban, S., & Simon, S. (2019, July 27). Isolated And Struggling, Many Seniors Are Turning To Suicide. Retrieved from https://www.npr.org/2019/07/27/745017374/isolated-and-struggling-many-seniors-are-turning-to-suicide
Brinkley-Rubinstein, L., Sivaraman, J., Rosen, D. L., Cloud, D. H., Junker, G., Proescholdbell, S., . . . Ranapurwala, S. I. (2019). Association of Restrictive Housing During Incarceration With Mortality After Release. JAMA Network Open,2(10). doi:10.1001/jamanetworkopen.2019.12516
Keim, B. (2013, July 10). The Horrible Psychology of Solitary Confinement. Retrieved from https://www.wired.com/2013/07/solitary-confinement-2/
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health,152, 157-171. doi:10.1016/j.puhe.2017.07.035
Mumtaz, F., Khan, M. I., Zubair, M., & Dehpour, A. R. (2018). Neurobiology and consequences of social isolation stress in animal model—A comprehensive review. Biomedicine & Pharmacotherapy,105, 1205-1222. doi:10.1016/j.biopha.2018.05.086
Naslund, J. A., Bondre, A., Torous, J., & Aschbrenner, K. A. (2020). Social Media and Mental Health: Benefits, Risks, and Opportunities for Research and Practice. Journal of Technology in Behavioral Science,5(3), 245-257. doi:10.1007/s41347-020-00134-x
Offord, C. (2020, July 13). How Social Isolation Affects the Brain. Retrieved from https://www.the-scientist.com/features/how-social-isolation-affects-the-brain-67701
Teo, A. R., Chan, B. K., Saha, S., & Nicolaidis, C. (2019). Frequency of social contact in-person vs. on Facebook: An examination of associations with psychiatric symptoms in military veterans. Journal of Affective Disorders,243, 375-380. doi:10.1016/j.jad.2018.09.043
Uneasy Lies the Crown 
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