COVID-19 and Loneliness

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No single state lasts forever. How will you react when things change and you feel threatened? People are creatures of habit, and in 2020 a form of coronavirus has unexpectedly risen to rapidly infect over 300,000 humans while disturbing our daily routines on a global scale. We are geared towards survival, and things that appear to threaten our survival often disturb us.

Our reaction to the virus may demonstrate our desire for predictability more than our frustrations with widespread death and disease. A person often seems less disturbed when that person thinks a disease has the potential to hurt many others. A person seems more disturbed when a disease has the potential to hurt that person or people who feel closer to that person. The speed and urgency with which this virus is spreading is another factor that produces a sense of dread.

If you want to explore this further, take some time to compare the statistics on coronavirus with the statistics on other causes of death such as heart disease, cancer, diabetes, stroke, chronic lower respiratory disease, kidney disease, Alzheimer disease and other dementias, unintentional injuries (e.g. road accidents), and suicide (Center for Disease Control, 2020; CDC, 2017). The reproduction rate of coronavirus is disturbing, but other infectious diseases such as diarrhoeal diseases, influenza and pneumonia, HIV, tuberculosis, and mosquito-borne illnesses have killed many, many more people while remaining commonplace (World Health Organization, 2019). It may be that commonplace feeling combined with the privileges of age-group, socioeconomic status, and environmental advantages (e.g. geographic location, economic & technological development, community immunity, etc.) that allow our fears to be stilled in the midst of these other pervasive problems.

Diet, exercise, sleep, and social health habits impact our lives over long periods of time. A motor vehicle accident (MVA) or suicide only requires a few mistakes or a moment of ignorance. These problems can seem more insidious : “developing so gradually as to be well established before becoming apparent” (e.g. heart disease, cancer, chronic lower respiratory diseases, stroke, etc.) or “awaiting a chance to entrap” (e.g. unintentional accidents such as MVA’s, intentional self-harm, etc.) (Mish et al., 2014).

While it is important to realize that everything develops over time (e.g. even MVA and self-harm risk factors can be identified and addressed), these more insidious causes of death may be less disturbing to us due to their familiarity, slow onset, and rapid culmination. Atherosclerosis (“artery hardening” “…marked by cholesterol-lipid-calcium deposits in the walls of arteries that may restrict blood flow”), accumulation of radiation exposure (e.g. tobacco smoke, ultraviolet light, etc.), chronic sleep deprivation, social isolation, and obesity can all take years or decades to accumulate/develop before resulting in dramatic lifestyle changes over the course of a few months (Chabner, 2015; Venes et al., 2005). Feeling lonely is only a small aspect of one factor of many, many variables that accumulate to influence our health over time.

Coronavirus has spread at an unprecedented rate, and this fact alone is enough to awaken our instinctual fears. This is the time to be listening to local authorities and adhering to recommended precautions, not gathering together in groups. Cases of COVID-19 continue to rise in the United States, and the longer people ignore social distancing and travel restrictions, the worse this pandemic is likely to be. We need to take this seriously while still caring for each other. See the World Health Organization’s updates on COVID-19, and adhere to their and the Center for Disease Control’s advice concerning this coronavirus (World Health Organization, 2019-2020; CDC, 2020). My goal with this post is to highlight a little of what I have been learning about another problem (loneliness) that could be exacerbated by the quarantine-like measures in place to slow the spread of COVID-19.

Loneliness is a common human condition to experience, especially in response to perceived threats (e.g. isolation and coronavirus). Lonely is commonly defined in many ways: “being without company” (i.e. lone), “cut off from others” (i.e. solitary), “not frequented by human beings” (i.e. desolate), “sad from being alone” (i.e. lonesome), and “producing a feeling of bleakness or desolation” (i.e. loneliness) (Mish et al., 2014). The last two definitions more closely resemble the way John Cacioppo portrayed loneliness in his 2008 book, Loneliness, co-authored by William Patrick.

When we have feelings of loneliness (i.e. “the anxious, depressed, or dysphoric mood that occurs as a result of physical or psychic isolation”), we need to react to them in a healthy way to prevent those feelings from accumulating over time (Venes et al., 2005). John Cacioppo and William Patrick describe loneliness as “…a stimulus to get humans to pay more attention to their social connections, and to reach out toward others, to renew frayed or broken bonds.” By comparing loneliness to hunger or thirst, Cacioppo is suggesting the feeling is an “…alarm signal…” that “…serves a survival function…”. The authors state, “…chronic feelings of isolation can drive a cascade of physiological events that actually accelerates the aging process.” Cacioppo and Patrick (2008) go on to describe the health implications of loneliness in detail, but the most functional takeaway from the book may be how Cacioppo encourages us to respond to loneliness.

“Whereas kind and generous behavior leads to social acceptance and the healthful feeling of connection, selfish antisocial behavior leads to physical decline and the disruptive pain of social isolation.” (Cacioppo & Patrick, 2009).

The authors are encouraging their readers to engage and invest in their communities in a healthy way. Instead of fearing society, we are encouraged to move towards others with whom we can establish mutually encouraging relationships that foster more kind, deep, and meaningful connections. I came to similar but much simpler and more rudimentary conclusion when I wrote a reflection on loneliness a year or two ago. We are all original and unique people, and the answers we find in life often look at least slightly different. My answers for loneliness often come from the values and people I have encountered throughout my past. You will need to find your own way to healthily respond to loneliness, but in this time of increased physical isolation here are a few suggestions to remain socially engaged…

  • Call or video chat with a kind friend/family member with whom you have a deep, mutually-encouraging relationship
  • Call someone who you want to encourage while expecting to be content regardless of how your encouragement is received (e.g. your friends, siblings, parents, grandparents, or other relatives)
  • Write some thank you notes or emails
  • Volunteer your time or resources to safely support others during this time
  • Hold virtual gatherings around meals or other events (e.g. a movie, a birthday, a spiritual or religious gathering, a book study, etc.)
  • Educate yourself about things that other people are going through or feeling during this time and how you can be helpful to them
  • Practice your artistic talents (e.g. music, crafts, sports, etc.) and practical skills (e.g. cooking, coding, handiwork, etc.) with the goal of being better able to use those skills to personally care for others in the future (e.g. I’m coping with my subjective feelings, expanding my knowledge, and reaching out to others through writing this blog post)
  • If your area is allowing person-to-person interactions in public spaces (the fewer the better at this point), casually screen you friend(s) for recent symptoms (cough, fever, shortness of breath) and meet in locations where social distancing (i.e. maintaining a distance of 6 feet at all times) is fairly easy (e.g. going for a walk in a local park or trail)

If you are curious about the potential consequences and severity of loneliness, talk to your doctor and/or ask for a referral for counseling or behavioral health. You can also consider taking the UCLA Loneliness Scale and reading Loneliness by Cacioppo and Patrick. The book ends with practical ways to “EASE Your Way to Social Connection” (Extend yourself, Action plan, Selection, Expect the best) (Cacioppo & Patrick, 2009). If you want to know the details of and reasons for those strategies, you’ll have to read the book.

“The best ideas are those that benefit the individual, the family, the tribe, and ultimately the species.” (Cacioppo & Patrick, 2009)

If there is something good that is coming out of this pandemic, it is the undeniable interconnectedness of our species and of life on earth. In spite of our best efforts, we cannot yet escape each other. Each of our actions influences this little island paradise and the life upon it in some minuscule or small way. Only those who can decipher the butterfly effect will know the extent of the impact of those actions. We are lucky, blessed, and privileged to be living out our unique life-journeys on this oasis of a planet. If we draw larger and larger circles around ourselves while gladly holding ourselves accountable to our individual and social responsibilities, we will come out of this stronger together.

 

“…the hallmark of a successful, long-lived civilization may be the ability to achieve a lasting peace among the several brain components.” – Carl Sagan, The Dragons of Eden

 

“I recommend that the Statue of Liberty on the East Coast be supplemented by a Statue of Responsibility on the West Coast.” – Viktor E. Frankl as quoted by William J. Winslade in the Afterward to Man’s Search for Meaning

 

“Any ideology that needs to attack the thing that least threatens it is an ideology that will not outlive its own generation. Inclusion not exclusion, gentlemen, is the key to survival.” – St. John, fictional character, The Power of One (1992)

 

 

Citations

Cacioppo, J. T. & Patrick, W. (2009). Loneliness: human nature and the need for social connection. New York: W. W. Norton and Company.

CDC (2020, March 13). Coronavirus Disease 2019 (COVID-19). Retrieved March 22, 2020, from https://www.cdc.gov/coronavirus/2019-nCoV/index.html

CDC (2017, May 3). FastStats – Deaths and Mortality. Retrieved March 22, 2020, from https://www.cdc.gov/nchs/fastats/deaths.htm

Center for Disease Control (2020, March 19). World Map. Retrieved March 22, 2020, from https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/world-map.html

Chabner, D.-E. (2015). Medical terminology: a short course (6th ed.). St. Louis, MO: Elsevier Inc.

Mish, Frederick C., et al. (2014). The Merriam-Webster’s Collegiate Dictionary (11th ed.). Springfield, MA: Merriam-Webster.

Venes, D., M.D. et al. (2005). Tabers cyclopedic medical dictionary (21st ed.). Philadelphia: F.A. Davis.

World Health Organization (2019, May 6). Top 10 causes of death. Retrieved March 22, 2020, from https://www.who.int/gho/mortality_burden_disease/causes_death/top_10/en/

World Health Organization (2019-2020). Novel Coronavirus situation reports. (n.d.). Retrieved March 22, 2020, from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

 

The Laws of Medicine

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In The Laws of Medicine Siddhartha Mukherjee uses his skills in writing and storytelling to elaborate on medical realities learned from invaluable education and experience. Mukherjee sets out to describe principles of medical practice, pointing out that practicing medicine is about knowing the strengths and weaknesses of knowledge gleaned from patients, tests, experiments, and one’s self, then making the best decision with that information. Mukherjee much more eloquently elaborates on that point, emphasizing his three “laws” or principles of medicine.

  • Before Mukherjee describes the three principles of his book, he sets them up in a forward. He wonders if medical jargon is partly subconsciously employed to escape unknowns. He briefly discusses the modern history of medicine from the cure-all treatments of the 1800’s to a more careful observance of the Hippocratic oath in the 1900’s. Mukherjee pays homage to William Osler (commonly referred to as the “Father of Modern Medicine”), and Lewis Thomas’s The Youngest Science: Notes of a Medicine Watcher. Mukherjee is careful to differentiate the “laws” he is about to expose from more pure scientific laws such as those in Physics, Chemistry, and Biology.
  • Mukherjee explains that assessing a patient involves raising or lowering the probability of a diagnosis through interpreting test results in context. Mukherjee uses Thomas Bayes, an 18th century Philosopher and Clergyman, to illuminate the imperfect nature of tests.
  • Mukherjee continues his excellence use of relevant storytelling to explain how the unexplained abnormal results of tests or experiments are keys to better understanding. Hearkening back to history once more, Mukherjee uses Karl Popper’s The Logic of Scientific Discovery to point out that medical knowledge is scientific only when it carries a stipulation that can disprove it by new information or discovery.
  • Mukherjee adapts Heisenburg’s uncertainty principle to medicine to question how generalizable experiments are. He mentions that Paul de Kruif’s Microbe Hunters may have been apt in the early 20th century, but in the 21st century, bias is the prey of physicians. Mukherjee reflects on the role of physicians to hunt bias, including their own bias, while using imperfect information to help patients make better decisions about their health.

In The Laws of Medicine, Mukherjee impresses a sense of understanding upon the reader through taking complex issues and breaking them down into manageable pieces of information. He doesn’t need to explain the science behind his examples to give the reader a little understanding of the big picture. Furthermore, bleeding through the pages are rich examples of medical history that incite an appreciation for great minds that have come before Mukherjee’s imparting knowledge for him to build upon.

Another theme of Mukherjee’s book is the uncertainty within medicine. His comments on medical jargon and the imperfections of tests are humbling. Still a relatively young science, medicine continues to experience a boom in information and technology. These advancements may clarify some things while opening up new areas vast with questions.

Studies, companies, and patients all have opinions on medicine, and it seems correlations are often unexplained while being sold as causation to the public. Statistics, anatomy, physiology, epidemiology, pathology, advanced mathematics, history, etc. are each worthy of in-depth study. Combine all of those subjects while adding many others and you will begin to understand the challenges of medicine. It’s edifying to see an author acknowledging the difficulties of his field while simplifying the principles within it.

With all the avenues with which information and opinion is accessed in today’s world, it is difficult to focus on what matters most. Focus is what Mukherjee encourages with his three laws of medicine. Sifting through a myriad of information to find relevance seems an ever-increasing challenge among today’s youth, whether or not they are interested in practicing medicine. With the precision of a great writer, Mukherjee illuminates invaluable principles learned through a wealth of experience. These principles help thin the overwhelming fog of information to be processed, and if put to use are likely to improve the work of those practicing medicine.

Mukherjee’s The Laws of Medicine is a short and worthy read for anyone interested in the practice of medicine. At less than 100 pages, The Laws of Medicine seems to be Mukherjee’s most concise and easy read. Mukherjee’s other books, The Gene and The Emperor of All Maladies: A Biography of Cancer, are both over 500 pages. The Emperor of All Maladies: A Biography of Cancer was awarded the Pulitzer Prize for General Nonfiction in 2011, and Mukherjee has also written for NEJM, Cell, Nature, and The New York Times.

 

On Truth

OnTruth

On Truth, written by Harry G. Frankfurt who was a professor of Philosophy at Princeton University, is a book defending and elaborating on the concept of truth. The first thing Frankfurt does is dispose of the fallacy that truth does not exist as disproving  itself (i.e. saying truth does not exist would be an absolute truth). The second thing Frankfurt does is emphasize that he is not writing about what is true and what is not true, but about the vital concept of truth itself.

Frankfurt then examines the importance of truth within modern society and some of the ideologies surrounding the idea of truth. Frankfurt indirectly invites the reader to consider if a person’s idea of truth is determined by her or his experiences and environment. The author emphasizes the importance of truth in regards to being honest about one’s self and in regards to a healthily functioning society. He discusses Baruch Spinoza’s idea that people who love themselves and their lives tend to love truth because of the role truth plays in life.

In the second half of “On Truth”, Frankfurt seems to continue his consequentialist approach to truth as he describes the importance of a person accepting reality for what it is regardless of whether or not she or he agrees with it. Though he continues to elaborate on the necessity of truth in living a fulfilled life, Frankfurt’s dialogue illuminates some fundamental questions. Is it better to utilize truth for one’s own gain, for the gain of a group, or for the gain of society as a whole? Is it better to exercise delayed gratification or immediate gratification?

For example:

The issue of the growing national debt of the United States government is discussed with every election cycle, and this topic must influence decision making on the part of U.S. citizens. Is it better to allow the debt to continue increasing to bolster the U.S. economy now or should the U.S. government make severe budget cuts now to avoid long-term consequences? One could argue that both approaches can be motivated by a consequentialist perspective (i.e. one seeks to benefit people in the present and the other seeks to benefit people in the future), but which approach provides the most benefit for the greatest number of people?

When considering a consequentialist approach an important distinction must be made between what benefits the individual (or the individual’s group) and between what benefits the greatest number of people in society. Though these discussions will likely make decisions much more complicated, they can serve to make decisions more intentional in regards to the beneficence of results. We tend to live in a world that is not black and white in nature but is instead a reality of many shades of gray. Conflicting information and opinion calls for deliberate reasoning based on evidence-based principles and truth. But, humanity often succumbs to impulsive, black and white decision-making based on preset preferences and pre-selected sources of information.

Frankfurt’s realization of the innate variation and grayness of life is refreshing. At one point Frankfurt implies that a lie may have consequential utility in one situation while being a burden to society in another situation.

For example:

Comedians lie frequently about their experiences to create a more humorous punch line. This is one example of how manipulating the reality of a situation may be of benefit to a great number of people. Often jokes are dependent upon realizing the untrue nature of a statement, and such sarcasm may serve to mock a falsity and admire a truth.

If the example of comedians seems like a weak defense of the utility of a lie, the genocidal examples of a German lying to the Gestapo about the location of Jews or of a Rwandan lying about her or his ethnicity to avoid being a victim of mass slaughter should serve as a more potent example. Frankfurt makes his points effectively without use of such examples, and he goes on to illuminate why lies can be so uncomfortable, even when they have some consequential utility.

Lies keep the hearer from some reality. The full truth of a situation is shrouded. That aspect of a lie is always negative, regardless of the lie’s consequential utility. The nature of a lie is entertaining a thought or an idea that is false, and this serves to explain why lies should be naturally less popular than truths (i.e. the nature of reality causes lies to be self-defeating).

“On Truth” is a short, reflective read that provides a good defense of the overall utility and vital nature of absolute truth while acknowledging the existence of various situations in which complete, raw honesty about truth is unknown, undesirable, or not of the most immediate beneficence. Truth has a self-evident nature which always makes falsity somewhat undesirable even if an untruth is useful. Frankfurt’s approach entertains the complex nature of truth while upholding truth’s integrity, and when discussing and deliberating what is likely the most important concept in life, such a balanced and rational approach is a good thing.