How Social Isolation Is Killing Us
My patient and I both knew he was dying.
Not the long kind of dying that stretches on for months or years. He would die today. Maybe tomorrow. And if not tomorrow, the next day. Was there someone I should call? Someone he wanted to see?
Not a one, he told me. No immediate family. No close friends. He had a niece down South, maybe, but they hadn’t spoken in years.
For me, the sadness of his death was surpassed only by the sadness of his solitude.
Every day I see variations at both the beginning and end of life: a young man abandoned by friends as he struggles with opioid addiction; an older woman getting by on tea and toast, no longer able to clean her cluttered apartment. In these moments, it seems the only thing worse than suffering a serious illness is suffering it alone.
Social isolation is a growing epidemic — one that’s increasingly recognized as having dire physical, mental and emotional consequences. Since the 1980s, the percentage of American adults who say they’re lonely has doubled from 20 percent to 40 percent.
About one-third of Americans older than 65 live alone; half of those over 85 do. People in poor health — especially those with mood disorders like anxiety and depression — are likelier to feel lonely. Those without a college education are the least likely to have someone they can talk to about important personal matters.
A wave of new research suggests social separation is bad for us. People with less social connection have disrupted sleep patterns, altered immune systems, more inflammation and higher levels of stress hormones. One recent study found that isolation increases the risk of heart disease by 29 percent and stroke by 32 percent.
Another analysis that pooled data from 70 studies and 3.4 million people found that socially isolated individuals had a 30 percent higher risk of dying in the next seven years, an effect largest in middle age.
Loneliness can accelerate cognitive decline in older adults, and isolated individuals are twice as likely to die prematurely as those with more robust social interactions. These effects start early: Socially isolated children have significantly poorer health 20 years later, even after controlling for other factors. All told, loneliness is as important a risk factor for early death as obesity and smoking.
The evidence on social isolation is clear. What to do about it is less so.
Loneliness is especially tricky because accepting and declaring our loneliness carries profound stigma. Admitting we’re lonely can feel as if we’re admitting we’ve failed in life’s most fundamental domains: belonging, love, attachment. It attacks our basic instincts to save face, and makes it hard to ask for help.
I see this most acutely during the holidays when I care for hospitalized patients, some connected to IV poles in rooms devoid of family or friends — their aloneness amplified by cheerful Christmas movies playing on wall-mounted televisions. And hospitalized or not, many people report feeling lonelier, more depressed and less satisfied with life during the holiday season.
New research suggests that loneliness is not necessarily the result of poor social skills or lack of social support, but can be caused in part by unusual sensitivity to social cues. Lonely people are more likely to perceive ambiguous social cues negatively, and enter a self-preservation mindset — worsening the problem. In this way, loneliness can be contagious: When one person becomes lonely, he withdraws from his social circle and causes others to do the same.
Dr. John Cacioppo, a psychology professor at the University of Chicago, has tested various approaches to treat loneliness. His work has found that the most effective interventions focus on addressing “maladaptive social cognition” — that is, helping people re-examine how they interact with others and perceive social cues. He is collaborating with the U.S. military to explore how social cognition training can help soldiers feel less isolated while deployed and after returning home.
芝加哥大学(University of Chicago)心理学教授约翰·卡奇奥波(John Cacioppo)博士对各种应对孤独的方法进行了测试。他经研究发现，最有效的干预以应对“非适应性社会认知”为重点——意即帮助人们重新审视他们与人互动和感知社交线索的方式。他正与美国军方合作，研究社会认知培训如何能够有助于减少士兵在服役期间和退役后的孤立感。
The loneliness of older adults has different roots — often resulting from family members moving away and close friends passing away.
Ideally, experts say, neighborhoods and communities would keep an eye out for such older people and take steps to reduce social isolation. Ensuring they have easy access to transportation, through discounted bus passes or special transport services, can help maintain social connections.
Religious older people should be encouraged to continue regular attendance at services. Those capable of caring for an animal might enjoy the companionship of a pet. And loved ones living far away from a parent or grandparent could ask a neighbor to check in periodically.
But more structured programs are arising, too. For example, Dr. Paul Tang of the Palo Alto Medical Foundation started a program called linkAges, a cross-generational service exchange inspired by the idea that everyone has something to offer.
但更加有组织的项目也在涌现。例如，帕洛·奥尔图医疗基金会(Palo Alto Medical Foundation)的保罗·唐(Paul Tang)博士受人人都能有所贡献这一理念启发，创建了一个跨越代际的服务交换项目，名为linkAges。
The program works by allowing members to post online something they want help with: guitar lessons, a Scrabble partner, a ride to the doctor’s office. Others can then volunteer their time and skills to fill these needs and “bank” hours for when they need something themselves.
“In America, you almost need an excuse for knocking on a neighbor’s door,” Tang told me. “We want to break down those barriers.”
The program now has hundreds of members in California and plans to expand to other areas of the country with a recent grant from the Robert Wood Johnson Foundation.
该项目目前在加利福尼亚州有数百名成员，最近收到了来自罗伯特·伍德·约翰逊基金会(Robert Wood Johnson Foundation)的一笔资助，打算向美国其他地区拓展。
“We in the medical community have to ask ourselves: Are we controlling blood pressure or improving health and well-being?” Tang said. “I think you have to do the latter to do the former.”
Increasingly, research confirms our deepest intuition: Human connection lies at the heart of human well-being. It’s up to all of us to maintain bonds where they’re fading, and create ones where they haven’t existed.