September 30, 2021

Relationships are just like muscle tissue, the more they are engaged the stronger and more valuable they become.Ted Rubin

Imagine a place where all the worst criminals, and offenders to societal norms were placed in an establishment to be separated from the rest of the population.  This is likely not hard to imagine as there are countless prisons throughout every state and city of our country.  Now imagine how “punishment” for bad behavior and the breaking of rules within these facilities are handled.  How do you punish those who have already been punished and in some cases serving maximum sentences for their crimes?

Solitary confinement.  Otherwise known as social isolation.

According to Abraham Maslow’s Hierarchy of Needs, all human beings require physiological needs (air, food, water, sex), safety needs (family, police, schools), love and belongingness (friendship and intimacy), and lastly self-esteem (dignity and status) needs.  The common thread among these needs is that they all share a common social component.

While we are always quick to label stress in our lives when it comes to money, education, or work, a surplus of social relationships, but more commonly a deficit in these connections often results in a host of illnesses and co-morbidities to us as human beings.  A deficit in social relationships, or being isolated either voluntarily or involuntarily, has been linked to depression, shorter life expectancy and higher rates of cancer.   A key driver for determining negative health outcomes?  If people truly feel lonely, versus actually feeling alone.

A feeling of being lonely may usually be passing or fleeting or last for a short duration of time, whereas a feeling of being alone in the world can often result in the loss of hope and as previously described, much worse.  The perception of being alone also results in altered immune and inflammatory responses.  Now look at the world as we know it since 2020.  Has it been easy for us to maintain social relationships?  For some, due to technology, wealth and large family support systems they have, but for many of us throughout the world ZOOM and FaceTime calls were poor substitutes for human interaction.

It will be interesting to look back on the world’s handling of the COVID-19 pandemic and wonder if we will regret isolating the people who needed us the most.  Creating an additional layer of fear, worry and anxiety on top of an already significant disease.  It will also be interesting to see if acknowledging the growing data and importance of social relationships and interactions on health, if we would handle things differently in the future.  Typically a feeling of being alone drives us to seek connection, but when many of us were not allowed or too worried to leave our homes, this innate evolutionary drive failed to kick in.

As we may be aware, “homeostasis” for our bodies is a theme commonly discussed in medicine, yet when we think of homeostasis we usually think of temperature control, pH balance, inflammation, or even feelings such as hunger that motivate us to seek food.  Little discussion revolves around social homeostasis and the tremendous importance of maintaining our relationships as well as our “outer world” for the maintenance of health.

For most of us, we were used to a “normal” set point of social contact and interaction.  A set point that was suddenly and dramatically taken away from us without an ability to restore it.  Acute social isolation, may be good for us – as usual bouts of acute stress tend to be, however chronic social isolation tends to lead to aggression, further avoidance, and increase anxiety in human and animal studies.  

This continued imbalance will lead to altered stress response and higher allostatic load.  Allostatic load is a direct determinant of resiliency.  As such, in an allostatic model with each encounter or experience with stress, we should learn, adapt and become more capable at handling such stress in the future, however with chronic social isolation that is not the case.  This altered stress and coping response becomes coupled with an increased perception of “loneliness” and activation of the brain’s default mode network – typically resulting in loss of creativity, focus and self identity.  The declining trends in mental health were already alarming prior to the COVID-19 pandemic and there is no doubt that as more data emerges trends in depression, anxiety, and stress related illness are likely to continue to rise.

How can we improve our social bonding, relationships and perception of loneliness?  Lean on family, spouses and community whenever possible – ask for help when you need it and ask them to check in on you in a positive way.  Hold hands.  Exercise, outside and in groups.  Connect with others based on culture, values, and spirituality as opposed to flags, diets, gender or professions.  Practice gratitude, if someone is important to you, let them know, and most importantly why that is so.

        Ask your clients about their social support systems and circles.  They are and always will be much more than their diagnosis or painful symptoms yet these are the things that are much easier for our medical community to focus on because it is “comfortable”.  It is time to acknowledge perhaps the most important factor for our health – each other.

Until next week, see you on the fringe.

References:

Lee, C. Et al “The Neural Circuitry of Social Homeostasis: Consequences of Acute versus Chronic Social Isolation” Cell (184) 1500-1516. (2021)

Gross, E. Et al “Cognitive Processes Unfold in a Social Context: A Review and Extension of Social Baseline Theory” Frontiers in Psychology (11) Article 378. (2020)

Joe LaVacca is a Physical Therapist based out of New York City where he owns his own private practice; Strength in Motion Physical Therapy. Joe’s focus on communication, emotion, and education are the 3 primary tools he uses to build empowerment while teaching and with his patients. Joe is the lead educator for Fringe Inc, a company focused on building a community for human beings to support one another, while promoting and celebrating the very things that make us who we are.