One is the lonliest number

On my  Sunday morning walk with Charlie (my dog), I was listening to the podcast, Hidden Brain.




This fascinating segment on loneliness reminds us of the importance of social connection.  All the more difficult during this time of physical distancing recommendations. However, physical and social distancing can occur outside of a pandemic.  This isolation - explicit or implicit - can impose physical and psychological challenges.  This got me thinking about lepers.

Let me explain.  A few years ago, I had the wonderful experience of going on a pilgrimage to Assisi, Italy (of St. Francis fame).    In the picture to the left, the hill in the background is Assisi, while in the foreground is the former leprosaria San Rufino d'Arce. What struck me when I visited this site was the knowledge that lepers were cast out of the city walls.  They lived within the shadows of the city, yet isolated from the people and their families. While times of solitude can be restorative, marginalization, or isolation be harmful to our physical and psychological health.

Traumatic events or chronic illness can often trigger feelings of marginalization resulting in a poor quality of life.  At the root seems to be an inability or inhibition for disclosure, leading to a sense of loneliness.

Cancer survivors often report problems with physical pain, sleep, fatigue, and forgetfulness, beginning with treatment and continuing afterward. All of these symptoms contributing to poor quality of life.  While there are many treatments for these symptoms, ranging from medications to psychological support and physical activities, oftentimes these treatments are incomplete.

In research conducted by Adams and colleagues cancer-related loneliness on symptoms (pain interference, fatigue, sleep disturbance, and cognitive complaints) and social constraints. An increased sense of loneliness can have a negative impact on health behaviors and an increase in stress reactions. While one way to cope with the negative impact of loneliness is through loneliness-reduction interventions, with a  focus on maladaptive social cognitions.  As suggested above, this social isolation may not be actual isolation, but misperceptions. Lonely patients may invite more negative interactions than those who are not lonely.

This effect of loneliness seems to be present across the survivorship continuum.  Cohee and colleagues in a study of young long-term breast cancer survivors recommend that interventions should aim at decreasing social constraint and increasing open communication within couples, which may be useful in promoting more effective processing. Likewise in older adults, Liao and Brunner report that having a wide network of friends who support confiding, avoiding negative close relationships, and having a partner can have beneficial effects on the quality of life.

I enjoy my walks with Charlie, his openness to my musings, my expressions of frustration and anxieties, and his nonjudgmental and unconditional responses.  But the conversation is very onesided. How much better to walk with a friend, to share a cup of coffee with a partner, to authentically chat with a fellow human. The importance of social connection is oftentimes overlooked until it is restricted or prohibited.  Sometimes walls are built to keep others from entering, but they also can keep people from leaving.