Health Challenges of Social Distancing

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Excerpted from the Dana Foundation, March 30, 2020.)

We are social creatures by nature, wired to connect with friends, family, and with other people within their communities (See In Sync: How Humans are Wired for Social Relationships). Yet, according to the U.S. Resources and Services Administration (HRSA), a large number of Americans report feeling lonely or socially isolated from others – so much so that many experts are calling it a “loneliness epidemic.” In response to the COVID-19 pandemic, many communities are facing work and school closures and shelter-in-place orders, which may be further isolating vulnerable populations from the social interactions that are so vital to mental health and well-being.

Here, Myrna Weissman, Ph.D., the Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry at Columbia University’s College of Physicians and Surgeons, discusses the impact of loneliness on mental health, as well as ways to stay connected when circumstances dictate you must stay at home.

What do we know about the effect of social isolation on mental health?

Human attachments are a basic need. That’s why we live in families and communities where we can be connected to other people. It’s just part of the human condition. There is vast data to document that when these kind of attachments are disrupted in early life, like when a mother suffers from post-partum depression, which often disrupts the mother-infant bond, it can have long-term health consequences, ranging from low-birth weight to increased risk of depression, anxiety, substance abuse, or suicidal behavior later in life. Unfortunately, the studies also show that poor bonds early in life can also lead to more social isolation when you are older, as well as feelings of extreme loneliness.

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We understand that attachments to others are very important. In fact, a lot of talk therapy focuses on dealing with disruptions to those attachments. You don’t need a lot of friends, but you need to have some people in your life that you can talk to and share your life with.

One of the things psychiatrists were seeing long before the COVID-19 pandemic is that loneliness and social isolation are huge factors in depression. Sometimes, a person has depression and they will avoid other people and become more isolated as their symptoms worsen. Other times, people are depressed because they are isolated from others and they don’t have people they can rely on. Maybe they are lonely because something has changed in their lives. Maybe something bad has happened and they’ve lost someone special. Maybe they don’t get along with their families or the people who should be closest to them. There are, unfortunately, many paths to loneliness....

Does it influence only depression?

No, it influences everything – including chronic medical illnesses like hypertension and diabetes. It’s also now been linked to dementia. People don’t just wake up one day with dementia, unless they’ve had a stroke. Rather, the lack of social interaction, the ability to talk and cooperate with others, leads to a graduate mental decline over time. These social interactions are an important part to health in general.

That said, some people have the opposite experience. They are living with people with whom they don’t get along. Being stuck at home makes things even more stressful as they no longer can do the activities that take them out during the day that can compensate for the underlying discord in the family. That’s of concern.

Then there are the people who live alone. They may be more used to a lowered level of social contact in general. But, on the other hand, many people who live alone have a large number of friends and family members who they see on a regular basis to compensate for that alone time. They could be made more vulnerable by what’s going on, too.

How can people best cope with this sort of forced isolation?

The good news is that human beings, in general, are very flexible and adaptable. There’s good evidence that when you can find ways to connect, it helps to reduce symptoms associated with isolation. Anecdotally, I’ve seen some very creative solutions over the past few weeks....

How can people recognize when the isolation may be becoming too much?

It may not always be easy to recognize it in yourself. It may be easier to see in others. From my experience over the past 10 days, I’d say to watch out for the following situations. First, if there’s someone in your life that you are never hearing from – you send an email or call them and they don’t answer, that’s worrisome. That may be the kind of person who requires more attention during this time. Keep reaching out. Make sure they are okay.

The other kind of situation that may be of concern is a friend or family member who are hyper-focused on the disasters. They are on social media or sending out emails about the number of people who are dying, who are in the hospitals, or the lack of respirators. They are dwelling on the bad things. There, too, it is worthwhile to reach out to them and try to help them focus on something else, to help them see the positives in the situation.

Is there anything we can learn from this period of isolation that can help our mental health and well-being once the isolation from COVID-19 lifts so we can better connect with others in the future?

I’ve been thinking a lot about how the world might change after this is all over. What you take away from this experience will largely depend on your circumstances. Hopefully, you’ll learn something new about yourself. You’ll take stock of what is most vital to your wellbeing during this extraordinary period – both the things you need to be at your best and the things you need to avoid. My hope is that it will help people to reorder their priorities, examine what is important, and discover new ways to foster connections with others.

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Beyond a Hangover: Alcohol and the Brain

Effects on the brain

You’re chatting with friends at a party and a waitress comes around with glasses of champagne. You drink one, then another, maybe even a few more. 

Before you realize it, you are laughing more loudly than usual and swaying as you walk. By the end of the evening, you are too slow to move out of the way of a waiter with a dessert tray and have trouble speaking clearly. The next morning, you wake up feeling dizzy and your head hurts. You may have a hard time remembering everything you did the night before.

Learn about your amazing brain.

These reactions illustrate how quickly and dramatically alcohol affects the brain. The brain is an intricate maze of connections that keeps our physical and psychological processes running smoothly. Disruption of any of these connections can affect how the brain works. Alcohol also can have longer-lasting consequences for the brain—changing the way it looks and works and resulting in a range of problems.

Most people do not realize how extensively alcohol can affect the brain. But recognizing these potential consequences will help you make better decisions about what amount of alcohol is appropriate for you.

WHAT HAPPENS INSIDE THE BRAIN?

The brain’s structure is complex. It includes multiple systems that interact to support all of your body’s functions—from thinking to breathing and moving.

These multiple brain systems communicate with each other through about a trillion tiny nerve cells called neurons. Neurons in the brain translate information into electrical and chemical signals the brain can understand. They also send messages from the brain to the rest of the body.

Chemicals called neurotransmitters carry messages between the neurons. Neurotransmitters can be very powerful. Depending on the type and the amount of neurotransmitter, these chemicals can either intensify or minimize your body’s responses, your feelings, and your mood. The brain works to balance the neurotransmitters that speed things up with the ones that slow things down to keep your body operating at the right pace.

Alcohol can slow the pace of communication between neurotransmitters in the brain.

DEFINING THE BRAIN CHANGES

Using brain imaging and psychological tests, researchers have identified the regions of the brain most vulnerable to alcohol’s effects. These include:

• CEREBELLUM – This area controls motor coordination. Damage to the cerebellum results in a loss of balance and stumbling, and also may affect cognitive functions such as memory and emotional response.
• LIMBIC SYSTEM – This complex brain system monitors a variety of tasks including memory and emotion. Damage to this area impairs each of these functions.
• CEREBRAL CORTEX – Our abilities to think, plan, behave intelligently, and interact socially stem from this brain region. In addition, this area connects the brain to the rest of the nervous system. Changes and damage to this area impair the ability to solve problems, remember, and learn.

ALCOHOL SHRINKS AND DISTURBS BRAIN TISSUE

Heavy alcohol consumption—even on a single occasion—can throw the delicate balance of neurotransmitters off course. Alcohol can cause your neurotransmitters to relay information too slowly, so you feel extremely drowsy. Alcohol-related disruptions to the neurotransmitter balance also can trigger mood and behavioral changes, including depression, agitation, memory loss, and even seizures.

Long-term, heavy drinking causes alterations in the neurons, such as reductions in the size of brain cells. As a result of these and other changes, brain mass shrinks and the brain’s inner cavity grows bigger. These changes may affect a wide range of abilities, including motor coordination; temperature regulation; sleep; mood; and various cognitive functions, including learning and memory.

One neurotransmitter particularly susceptible to even small amounts of alcohol is called glutamate. Among other things, glutamate affects memory. Researchers believe that alcohol interferes with glutamate action, and this may be what causes some people to temporarily “black out,” or forget much of what happened during a night of heavy drinking.

Alcohol also causes an increased release of serotonin, another neurotransmitter, which helps regulate emotional expression, and endorphins, which are natural substances that may spark feelings of relaxation and euphoria as intoxication sets in. Researchers now understand that the brain tries to compensate for these disruptions. 

Neurotransmitters adapt to create balance in the brain despite the presence of alcohol. But making these adaptations can have negative results, including building alcohol tolerance, developing alcohol dependence, and experiencing alcohol withdrawal symptoms.

Source: Drugabuse.gov