S02_E13 - Overcoming the Loneliness Epidemic, Together

Speaker 1: 0:04

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2: 0:21

Hey everybody. David Hilden here, and welcome to episode 13 of the podcast where we are gonna tackle the subject of loneliness. It affects all of us introverts, extroverts, the rich, the poor, those living in cities as well as in rural communities, the young and the old. Did you know that half of the US population is experiencing symptoms of loneliness at any given moment? This is according to Dr. Vivek Murphy . He is the Surgeon General of the United States, and he has just come out with a really fascinating in-depth look on the causes of, and the effects of being disconnected from each other. And he likens it to something as serious as smoking in terms of how bad it can be for your health. There's a risk factor for heart attacks, strokes, dementia, and that's not just an individual thing. Our communities are affected as well. So it truly is an epidemic of a healthcare nature. That's what the Surgeon General has identified. Well, today I'm gonna talk to a colleague of mine, Dr . Eduardo Colon , who is the chair of Psychiatry and Hennepin Healthcare here in downtown Minneapolis. Dr. Co Colon , welcome to the show.

Speaker 3: 1:26

Glad to be here. Thank you. I

Speaker 2: 1:28

Really appreciate you coming to talk about this topic. Does it resonate with you? Does this make sense what the surgeon talking about?

Speaker 3: 1:34

Absolutely. The Surgeon General has touched on a very important point. When we talked and looked at literature on depression in the past, we know that there's been a lot of awareness of the impact of depression and health overall. And this goes beyond that. It looks at the concept of loneliness , uh, and the epidemiologic consequences of it. And more importantly, what he does in this paper is he looks at a number of surveys and studies and he provides a number of meta-analysis. That's when you put together a number of similar articles and look at a bigger meaning. So this is a very well-founded in science, and he provides a lot of the data. He

Speaker 2: 2:10

Calls it as bad for you as smoking. That's a pretty bold statement. Exactly.

Speaker 3: 2:15

So that really tells you why he's so concerned about it as an epidemic, as a , as a concern for public health. So when you look at markers of health in the community and what things can lead to illness and or , uh, difficulties in living you , we think of a number of factors like obesity , uh, smoking, alcohol, et cetera . And a lot of the data that he produces suggests that it is as important as some of these physiologic factors as leading to medical problems.

Speaker 2: 2:41

Is it getting worse?

Speaker 3: 2:43

Uh, the survey data suggests that starting with the pandemic, this got a lot worse. So there's a lot of data prior to the pandemic, and then the surveys that have looked since then suggest that actually it has gotten worse. What we don't have right now is any sense of whether we're in the road to recovery or not.

Speaker 2: 3:00

Do you see in your practice people identifying this as a problem? Or is it, is it not on people's consciousness? Because I think people are noticing something's different, but do they identify it as I'm lonely?

Speaker 3: 3:12

I I don't think people publicly have been addressing this as much as they could. And by the time I see this, it really is in the context of people who are struggling with either depression or mental illness and their substance abuse. And certainly, you hear this a lot. I just recently saw somebody with a pretty scary suicide attempt who identified the period before starting college in, in real life. The, the period of being on Zoom and how difficult it , it was, as well as trying to then get reintegrated into the , the flow of school and feeling like a , uh, somebody who's left over and not feeling like a part of things.

Speaker 2: 3:48

We talk about introverts and extroverts and there's all these jokes flying around and there's internet memes about the pandemic was just wonderful for introverts. But it is true that all people need some kind of social interaction. What is the, what does the medical science say about the effects on us when we lack human interaction?

Speaker 3: 4:05

So I, I think what the literature has shown is that the , uh, the absence of interaction not only leads to that profound sense of loneliness, sadness, and withdrawal, it certainly has an impact on your stress response syndrome. Uh, so you have a lot of the stress hormones , uh, are altered in terms of their ability to respond at the time they should, as well as the evidence that people have more rates of inflammation, as well as all kinds of other physiologic consequences. This has been , uh, something we've recognized for a long time, but I think we think about it in extremes. You know, when somebody has profound depression, when they cannot function, and there's two ways, obviously. One is it has an impact on your body. The other part to it is that then it also leads to depression, dysphoria and or social isolation, which kind of keeps it going. So you can end up with this vicious cycle,

Speaker 2: 4:55

Right, right. Now, who is most at risk in the past? Um, I think many of us can think of some groups, seniors who are maybe living in nursing facilities and aren't getting visitors, you know, people who live alone and don't get out much. Yeah , I think we can think of that, but it seems to be many more people are at risk now.

Speaker 3: 5:12

Correct. I think the data does corroborate the , uh, vulnerability of the senior population. It also underscores, to my surprise , the high rate in young adults anywhere from adolescent up to age 20 or so. And actually the , uh, the report from the surgeon general suggests that this is a particularly affected group.

Speaker 2: 5:31

I read that , uh, I read that about teenagers. Mm-hmm . <affirmative> are feeling less connected to their peers than almost ever before, and yet they're so connected, at least electronically. Comment on that if you could. Yeah,

Speaker 3: 5:43

That's an interesting observation. So paradox, right? And he really , um, goes out of his way to try and explain this is hard to, to grab at times the notion that you might be spending more time online. And yet a lot of the interactions are not meaningful as well as the, the , uh, exposure that many youngsters are really exposed to perceived rejection or to a lot of bullying. Um, it is a lot easier for people to be mean or to dismiss you when you're online rather than when they're sitting with you in person. So it takes up a lot of time and you have a lot of flittering around with superficial awareness of data numbers or chats or games, but not any kind of fulfilling interpersonal exchange.

Speaker 2: 6:25

Do you think we're getting to a place that where kids growing up are gonna have fewer social skills because of that?

Speaker 3: 6:33

That's certainly been the concern. And I'm , I'm curious about what my colleagues and child psychiatrists say, but I think it's gonna create a big challenge. Certainly the pandemic did in , in the way that we've seen having to return to school and get used to this. I have a relative who's a school psychologist who was telling me how a lot of the children are being either tagged as having attention problems or behavioral problems. And in essence, her suggestion is that these children who are struggling need to be socialized. They need to get used to dealing with other children, not just their relatives, and begin to have time to spend on doing very basic social events that we just take for granted. And

Speaker 2: 7:10

I'm not saying that all adults have are great social skills. There's plenty of people in their older years who aren't great at social skills, but it seems particularly , um, scary, if you will, in adolescents and children growing up who might lack just the daily interactions with other people, and then can therefore feel lonely even though they're connected to people. That that's a little bit disconcerting. And , and

Speaker 3: 7:31

I believe he talks on the report on this concept that this has been going on before the pandemic. Clearly that pandemic worsened it, and certainly the social media has made it more challenging at times, but prior to that, our social structures have changed so that kids are not as embedded in neighborhoods and communities. Parents are not involved in a lot of the activities that used to bring people together to socialize and to have that kind of social exchange. So it's almost like you have to think about it, program it, and make it a part of, of what you're thinking about in terms of your kids' development.

Speaker 2: 8:03

So Eduardo , does the problem get compounded? Like once you're kind of in a little, you're a bit more socially isolated, maybe it's cuz of the pandemic or you're working from home or whatever, and, and you're not getting out as much, and then it gets harder to get out and the problem sort of just builds , uh, and , and compounds itself.

Speaker 3: 8:21

That , that certainly can be the case. So if you think about it in terms of , um, either the loss of comfort or loss of skill, and all of a sudden you're back in an environment where you're feeling uncomfortable. So again, it depends on how bad it got, what your previous capacity for engaging and what happens in the future. So you think about a lot of people not coming back to the office, and all of a sudden the interactions that we have at work, which is a big source of contact satisfaction , um, sharing a particular task or a goal, and all of a sudden you're doing that online through a distance without a lot of human contact. We need to be mindful and keep track of, to what extent does that really satisfy your need for social contact and to what extent it doesn't and how you need to deal with that.

Speaker 2: 9:07

Now, maybe I'm asking you to speculate here , um, but I read a commentary in some newspaper recently about American cities and their downtowns, how they're becoming ghost cities. We have all these buildings and they're never gonna fill up again with workers. Um, so get over it. And this particular commentary was making this out to be a very positive thing. They were saying people can be from home and they're just as productive, so get over it. The downtowns are never coming back. And that's a good thing. But is that true? Is it, what are your thoughts on our role as adults in the workplace? You know, when some folks are saying it is better that we're all at our homes and relatively isolated and others are saying we need to be back in the office. And I think there's a lot of people thinking, I don't wanna go back to my office, I'm doing just fine. How do you respond to that?

Speaker 3: 9:53

Well, I think like with everything , uh, you can find both sides, right? And it depends on your personal situation. But when you look at , uh, the Surgeon General's report on, on loneliness, the argument that even just having , um, so-called superficial or trivial exchanges with people at work provides you with a certain amount of social interaction. People get to chat, talk about their kids, talk about their families, or about what troubles them . A as well as I'm sure we'll talk about this later on, the notion that when you're in a social setting like that, people can have a sense of whether you're doing well or not. You might have the opportunity to , um, share your concerns or get some support, which may take a lot more effort if you're sitting at home and you have to pick up the phone and call somebody or let them know I'm not doing well

Speaker 2: 10:40

Completely. I've seen you in the hall, and you might say, I'm kind of joking here. You might say most of our interactions are worthless and superficial. But I think that just seeing each other in the hallways, I can tell when my colleagues are feeling a little different or even just saying, hello. Um, it was a great weekend. Uh , what'd you do this weekend? Seems to be to be valuable. Yeah .

Speaker 3: 10:59

Look at when you think about patients who come to see us and say at times, you know, just walking in the building. And that person who greeted me said, good morning. How are you doing? Uh , you look so good today. It's nice outside. Just made me grateful to be here. Very small things. And we know that from our clinic, how many times our patients talk about their interaction with our staff in the front line , how much that either makes or breaks their visit in terms of your sense of accomplishment and pleasure. And it makes you feel recognized, it makes you feel special, and, and it kind of gives you a sense of satisfaction. And we all need that.

Speaker 2: 11:32

We are gonna take a short break. We've been talking about loneliness with Dr. Eduardo Colon and about what the surgeon General of the United States has called an epidemic of loneliness that has health consequences. We are gonna talk about those health consequences and what you might do about it after this short break. We'll be right back.

Speaker 1: 11:50

You are listening to the Healthy Matters podcast with Dr . David Hilden . Got a question or comment for the doc, email us at Healthy Matters hc m e d.org or give us a call at six one two eight seven three talk. That's 6 1 2 8 7 3 8 2 5 5. And now let's get back to more healthy conversation.

Speaker 2: 12:12

And we're back talking to Dr. Eduardo Cologne about the epidemic of loneliness. Eduardo, I I wanna shift gears just a little bit and talk about specific health conditions and why might loneliness lead to worsening health conditions. So let's start out with the ones , uh, of what you're a specialist in mental health conditions. How does being lonely either exacerbate or lead to things like depression and, and even taking that further leading to risk of dying by say, suicide? Well,

Speaker 3: 12:40

I, I think that people who get depressed clearly will become a lot more lonely and distance themselves. But by the same token, we know that loneliness is a risk factor for development of depression and other psychiatric conditions. When you think about it, depression is , uh, accompanied by a significant sense of negative self-esteem, negative talk, negative cognition, which are part of what some people deal with in providing therapy. So when there isn't a reinforcement, the sense that I'm worthwhile, that I do well , uh, the repeated sense of failure are not being recognized, not being acknowledged. We all need to have a sense of attachment. That's the primary need that we all have since our birth. And when that's not present, we begin to then , uh, really kind of wilt away or become a lot more despondent.

Speaker 2: 13:28

Why do you think then loneliness can lead to heart disease or stroke?

Speaker 3: 13:33

Well, the , the most obvious and superficial way would be actually because of the impact on activity, the impact on your self care . So if I'm lonely, if I'm depressed, I'm less likely to exercise, I'm less likely to pay attention to my diet. I don't care as much if I'm gaining weight or not, and I'm more likely to engage in other high risk behaviors like smoking, drinking, and or doing things in excess or not doing enough. There's also a lot of information about the direct physiologic links between these conditions and your health. So people who are depressed, for example, don't have the same degree of heart rate variability. So your heart rate is not going at the same time constantly. It goes up and down and it measures to a certain extent the capacity of your cardiovascular system to respond to stress. Uh, we also know that, as I mentioned earlier, your flow of hormones through the course of the day gets altered so that you may have either a chronic release of stress hormones and that that happens frequently. You have a blunting of response. So I think what happens with chronic stress, where a lot of people is not that they necessarily are in high gear all the time, but their system, if I can use the metaphors exhausted and you cannot respond when you need to and slow down when you should to allow your body for recovery. It's a lot of things that happen in our body which happen acutely, and they're meant to be timed. They're meant to end shortly thereafter, and then your body gets to recover. And if you have that going on the whole time, your, your system just does not have the opportunity to do so.

Speaker 2: 15:02

That makes sense. I , is it a global phenomenon or is this something that in developed countries we're experiencing marketing ? Uh , I

Speaker 3: 15:09

Think it's, it's probably true of human beings anywhere, but the question of to what extent that happens in places where I think we become a lot more industrialized and isolated, the initial concept is that as human beings, as , uh, human animals initially, we all have the need to gather. Because if you're hunting and gathering, if you work in groups, it's a lot more efficient. You're more likely to survive. So we seem to have an inbuilt need to belong to a social structure. So whatever country, town or location where the social structure begins to get challenged , it's probably gonna have to face the same sense of isolation and, and loss of continuity. The

Speaker 2: 15:48

Surgeon General talks about three interventions, and I'd like you to comment on whether a , you think these are gonna be effective and how they're gonna affect both individuals and communities. And the first one of the surgeon general's recommendations are to strengthen our social infrastructure. I take it that means schools and workplaces. Do you think that that's an effective strategy and how might it be?

Speaker 3: 16:09

Absolutely. The question is how to get there mm-hmm . <affirmative> . So right . When you think of the basic places where people gather, the basic place where people relate to each other , uh, have people lost their sense of community? Have they lost their sense of belonging to a particular group or organization? Either places of worship where people used to gather or social structures of any other kind, clubs, classes, groups that really gather and bring people together so you don't feel alone even, you know, I see advertisements recently looking at things like gathering together to pick up garbage, getting people together to clean up the river, getting people together to do stuff. We need, we need to have a conscious return to this kind of , uh, structure. And I , and I think he's right on the money.

Speaker 2: 16:52

Yeah . So it's schools , workplaces, the communities we live, all of those things that we need to refocus on. I think that that makes perfect sense. What about the surgeon general's second recommendation, which is to what he says, renegotiate a relationship with technology. What does he mean by that?

Speaker 3: 17:10

Well, this is kind of what we're talking about, right? That technology makes it easier to be in touch with people, but if used in the correct way. So the question is , to what extent are we using technology to fill ourselves up with fear negative news commentaries, where people begin to, you know, the , the concept of going down the rabbit hole and really getting entangled up in ideologies rather that isolate people as opposed to being a way of sharing. So when people get together and have a zoom conversation with family members, it's a very positive experience. And that's different than bearing your head in the computer and reading all these positions and or fears that get promoted a lot of times in, in the media. And the same thing with relationship with children and youth. To what extent are they getting in touch of things that are more harmful and not able to talk to parents about it and or utilizing the anonymity or the protection of the technology to be nast or mean to each other and to hurt people who might already be hurting.

Speaker 2: 18:12

Do you think that leads to polarization in our society? Because I know that's not exactly the conversation of loneliness, but when you just sort of retreat into what your own bubble, if you will, and then we don't , uh, we become more polarized in society as we're all just kind of more isolated from people who maybe don't think or look like us.

Speaker 3: 18:31

Absolutely. Um, and we see it both ways. It leads to more polarization. The more polarized we get, the more isolated we become. So all of a sudden we've reached a spot where essentially you are very nervous about racing certain topics. So it is the problem when we are so polarized around whatever issue that we cannot relate to people in a comfortable, supportive fashion. And Lord, we begin to exclude a lot of the folks around us in pretty soon you find yourself pretty alone because you have this seeming companionship online, and yet it's not the companionship that's available for you when you say, let's go for a walk, or, do you know what I'm feeling today?

Speaker 2: 19:10

That leads to what , uh, you've touched on what the third recommendation from the Surgeon General is after strengthening social infrastructures and renegotiating technology, and that is just taking small steps in our personal lives to reconnect. Dr. Murth , uh, talks about just introducing yourself to more people and saying hello in just small interactions. Does that resonate with you? It ,

Speaker 3: 19:32

It does resonate with me. And this also talks about who may be more vulnerable, right? I remember growing up my, my brother was very much an extrovert and I learned that if we went anywhere, I could just rely on him.

Speaker 2: 19:44

So you're not an extrovert to

Speaker 3: 19:45

Make the

Speaker 2: 19:46

<laugh>

Speaker 3: 19:46

<laugh> ? Actually, I'm pretty shy. Um , so

Speaker 2: 19:49

Really, are you kinda shy? It

Speaker 3: 19:50

Really was something I had, I had to develop later on mm-hmm . <affirmative> , because you rely on people around you who are a lot more extroverted , uh, being able to just go out of your comfort zone and say to somebody, how are you doing? Why you're here? As opposed to the notion of mind your own business. It doesn't matter.

Speaker 2: 20:06

So let's talk about what we can do about the loneliness epidemic, both in our communal lives and individually. So I'm gonna ask your thoughts for our listeners. How does someone identify another person in your family or your social circles or in the community as being affected by loneliness? You know, what, what warning signs or , or ways can we use to, to even identify that the people that we are living among might be lonely?

Speaker 3: 20:35

I , I think if you're watchful and attentive, there's a lot of non-clear cues that you have that something is different. But in general, when people disappear, they're not present in as many of the things we're used to see them at . You don't hear from them as often, and they seem to have just kind of distance themselves. It's a good opportunity to wonder what's going on, and not necessarily to , um, intrude, but to really reach out and say, haven't seen you. What's going on? How are you doing? I think it's also clear when people are becoming less reactive to their environment. When people begin to get more withdrawn, they don't seem to have the same joy that they expressed before. Uh, irritability is a good sign for many of us, certainly , uh, for me personally, of when you've kind of reached that level where you want to just withdraw and get away and have and be quiet. And by the way, that just reminds me to make a very important distinction there . There's a big distinction to be made between solitude and loneliness. And solitude is something that I think most of us need and cherish. That is by choice. Finding yourself in a situation where you're by yourself and you can find some peace with whatever it is. Whether you just like to watch the river, whether you meditate, whether you pray, whether you just like to walk around. It's a refreshing , uh, moment of quieting down in a very positive way. And that's different from loneliness when you really feel that nobody likes you, that nobody's around you or that you're missing.

Speaker 2: 22:01

So what about self-care? How do you identify when you yourself could use a hand?

Speaker 3: 22:07

Well, you know, it takes a certain amount of, of honesty, right? And, and when you start to feel depleted is the word I like to think of. When you feel like you don't have a lot, you're tired all the time, nothing excites you , um, you don't feel like going out to things that normally would be exciting to you, I think is a , is a moment to begin to think about. And , and as we talk about loneliness, and we've talked about all the other things that can go along with loneliness, obviously one of the complications of loneliness is the spectrum from loneliness to depression, no energy, poor focus, concentration, trouble sleeping, sleeping too much negative thoughts , um, inability to respond to your environment, which is what I like to ask most of my patients is, when good things happen, how do you feel? Are you able to modulate really? Because we all have moments when you feel down, but if you bump into somebody you know and miss all a sudden you go, I'm capable of, of smiling, of enjoying their presence. And I look forward to things when people get depressed, they're no longer looking forward to anything. And if it gets to the point where people begin to either challenge their worth or think that life is too much, it's way past time to go get some help.

Speaker 2: 23:17

So do you suggest they call their doctor their friend or a hotline? What are , what are some good steps for a person to do in that situation?

Speaker 3: 23:25

And any or all of those? Right now we have hotlines where anybody can dial the number and get help. We also know that reaching out to a friend is always important. And more importantly, I think being comfortable with letting your healthcare provider know that you're struggling. We're teaching physicians, and you do this all the time to recognize signs and symptoms of depression. We give patients questionnaires to ask if they're having symptoms of depression. And the reason to do that is to try to identify it before it becomes a problem where people have retreated into themselves and get into , into significant danger. So as a friend or a colleague, then it's our opportunity to see how people's behaviors suggest that somehow they're distancing themselves. And to just offer a helping hand. I always tell this anecdote of a day when I was really particularly overwhelmed, some difficult cases, and one after another now is walking down the hallway and somebody walked by me and said, out of the blue, and who takes care of Dr. Colon ? Oh ,

Speaker 2: 24:22

To you? They said that to you? Yes , your doctor.

Speaker 3: 24:25

And it just woke me up. I'm m down the stairs going, what a kind thing for someone to do. And I realized that I was lost in my own self. Mm-hmm . <affirmative> , clearly I was not depressed or depleted, but it was a nice wake up call and more importantly, reminded me of how important just somebody reaching out and saying something kind can be for some folks.

Speaker 2: 24:48

So listeners, if you are experiencing , uh, um, pervasive symptoms of depression or you just simply need to talk to a mental health professional, please do call the national hotline. The number is easy. It's 9 88, 9 88 if you need to speak to a mental health professional 24 hours a day, seven days a week, 9 88. So Dr. Colon , this has been a great topic. It's a lot to digest and I think it really is going to resonate with all of our listeners because it's something that affects all of us from all walks of life. And so I think it's been just an incredibly important topic. Dr. Cologne , I'd like to give you the last word. What, what would you like to leave our listeners with about the topic?

Speaker 3: 25:30

I I think that the most important part is to recognize that loneliness is a significant problem. That if you , um, notice that someone around you may be experiencing loneliness or you begin to recognize it in yourself , there are things you can and you should do. You can reach out to people, you can just begin very consistently saying, hello, how was your day? And people say, that's an empty question. And it could be, but pay attention. The second part is, I , I think Dr. Murphy is very clear about suggesting that people volunteer. And it is an incredibly powerful way to get someone who is struggling with how to get into the community, how to feel a sense of productivity and or company to figure out where you can offer some volunteer work and see if that is gratifying. People also turn to , um, other groups or clubs or your , uh, your minister, your priest , your rabbi or or anybody in your faith community for support. Uh , but the important theme is be attentive. Be aware of it around you and in you. And if you notice it, begin to do something about it. It can be starting with very short stepss. We all go through lonely moments and we just need to be aware that either , uh, we're coming out of it or we're doing something to help ourselves or people around

Speaker 2: 26:45

Us. We've been talking to Dr. Eduardo Colon about loneliness. He is the chair of psychiatry at Hennepin Healthcare and a friend and a colleague of mine here in downtown Minneapolis. This has been a great topic and in like so many other large issues in healthcare , the first step is often to identify the problem. And that's what you have done for us today. Thank you so much for being with us Erra .

Speaker 3: 27:05

Thank you. My pleasure.

Speaker 2: 27:06

It's been a great show and I hope you will join us for our next episode when we will tackle the subject of autism with another one of my colleagues, Dr. Krishnan Subramanian. And in the meantime, take care of yourselves, keep an eye out for others, and be healthy and be well.

Speaker 1: 27:22

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy Matters hc m e d.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. And finally, if you enjoy the show, please leave us a review and share the show with others. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas At Highball Executive producers are Jonathan Comito and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.