Covid Pandemic and Loneliness – I
Posted on Jul 10, 2021 | Author DR. ARIF MAGHRIBI KHAN
Unfortunately, very little research has been done in Asia regarding the psychological impacts of this pandemic, so for now we need to learn from our counterparts in Western countries. As the world slowly loses the weight of COVID-19, psychiatrists and psychologists have an opportunity to pause and reflect on the role they are poised to play in the months and years to come. Never before has the entire modern world been subjected to such collective feelings of fear, uncertainty, anxiety and grief – and loneliness.
People around the world have been doing their part to slow the spread of COVID-19 by staying at home. Populations that were not used to being alone, such as children and adolescents, were brutally cut off from their social networks. Family members were often isolated from each other. Many people have died from COVID-19, often without families, with little comfort or human contact except for hospital staff. About 36% of Americans said they felt “severe loneliness” as a result of the pandemic, according to “Loneliness in America,” a recent Harvard University report. Of those respondents, 61% were between the ages of 18 and 25, and 43% reported an increase in loneliness since the start of the pandemic.
The effects of isolation from the pandemic have been felt in every corner of society. It may take the form of exacerbated symptoms in some patients or new signs of mental illness in others. Medically, loneliness has been linked to heart disease and stroke. It is also linked to increased rates of depression, anxiety, substance abuse, domestic violence and suicide. Psychiatry often relies on pharmaceuticals to treat mental illness; this pandemic reminds us that the best cure for loneliness can be as simple as kindness and compassion.
More than any other species, humans are dependent on others for longer periods of time. In fact, the average person spends about 80% of their waking hours in the company of other people. Loneliness is a state of mind characterized by feeling unwanted, empty, and cut off from other human beings. It is also described as a negative reaction to the gap between the relationships we want and the ones we have. Loneliness is not necessarily the result of being alone. One can easily feel alone even when surrounded by others. Because loneliness is more often a perception, feelings of isolation can trigger hyper-vigilance, in which the world comes across as a threatening place.
Single people tend to be more critical of themselves. When these negative expectations are confirmed by the behavior of others, it creates a loop of loneliness that is accompanied by feelings of hostility, stress, pessimism, anxiety, and low self-esteem. Loneliness apparently enjoys company, studies describing it as contagious. It appears to be spread through friends, rather than family members, and occurs in clusters, extending up to 3 degrees apart. Loneliness can be tackled both in a group and individually. One way to prevent loneliness is to encourage social activity. Obviously, for some people it is very difficult to be social; this is where it is important to emphasize resilience and perseverance. “In solitude, the solitary is eaten; in a crowd, many eat it, ”Friedrich Nietzsche said. Culturally, loneliness can be seen as a sign of weakness or self-pity. For example, a 1965 study of rhesus monkeys found that when a group of socially isolated monkeys were reintroduced to their colony, they were either hunted or eliminated.
In 2018, the UK’s BBC Radio 4 published the results of The Loneliness Experiment, the largest ever survey on the subject. The study included more than 55,000 participants, aged 16 to 99, from 237 countries, islands and territories. He revealed that loneliness was higher in individualistic cultures in the United States and Western Europe, which placed a high value on self-reliance, loose social networks, and chosen relationships. In contrast, cultures with strong collectivist norms, including some Asian countries, are built on interdependence, closer social networks, and stronger family ties. Some of these countries include Brazil, India, and the Philippines.
The study found that young people were the most isolated, with 40% of 16-24 year olds feeling lonely or very often, compared to 29% of 65-75 year olds. Young men in particular were more sensitive to feelings. of loneliness, and their loneliness was more intense and more lasting. Most of the research on loneliness was conducted before COVID-19, so it is too early to consider the long-term effects of the pandemic. However, recent studies have tracked the impact of social distancing and quarantine, and they have left an intriguing breadcrumb trail of predictions.
When COVID-19 hit, many experts feared suicide rates could skyrocket. A 2020 report from the Center for Disease Control and Prevention showed a 35% increase in suicide mortality in the United States from 1999 to 2018, a trend most people expected to continue. A quick review from March 2020 released 24 studies in 10 countries that looked at the psychological impact of quarantine. It included those affected by SARS, Ebola, H1N1 influenza, Middle East respiratory syndrome and equine influenza.
Common side effects of midlife included post-traumatic stress disorder (PTSD), confusion, and anger. Stressors included extended quarantines, fear of infection, frustration, boredom, insufficient supplies and information, financial loss and stigma. The review also found that healthcare workers in particular suffered from the loneliness and isolation of quarantine. They endured an increase in severe symptoms of PTSD; felt stigmatized and reported greater loss of income. Healthcare workers also reported feeling lonely, guilty, angry, helpless, isolated, nervous and sad. Many have linked their quarantine experience to alcohol abuse and symptoms of addiction. They also engaged in avoidance behavior, often by not showing up for work or avoiding direct interactions with patients.
Like all facets of society, health and mental health organizations have had to rethink how they serve their patients, especially when they cannot be treated in person. Mental health care providers have been encouraged to find alternative ways to provide services, to provide clear pathways for those considering suicide, and to offer bereavement services promptly when needed. We can rate loneliness using the revised Loneliness Scale from the University of California, Los Angeles (UCLA). One way to start the conversation is to ask patients what they do in their free time and if they have any friends or family they spend time with. Since the COVID-19 pandemic, it is likely that many more patients have reported feeling lonely.
Nurturing the doctor-patient alliance
A 2018 meta-analysis examined the relationship between 30,000 patients and their therapists. In a review of 295 independent studies published between 1978 and 2017, she found that positive clinical outcomes correlated with the strength of the therapeutic alliance between patients and their therapists. The better the relationship, the better the prognosis. The therapeutic alliance has become even more important due to the pandemic and the quarantine. As psychiatrists and psychologists, we need to strengthen our relationship with patients so that they trust us and improve. This is just as important and essential as medication management. Individuals need quality information and strategies for dealing with loneliness, in addition to helping identify and deal with self-harming thoughts. Comprehensive assessments like UCLA’s revised Loneliness Scale and access to 24-hour counseling networks could lay vital lifelines for patients suffering from loneliness.
(To be continued)
(The author can be sent by mail to [email protected])