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Is growing loneliness, a serious health hazard?

Dr. Rahul Bansal*

A very interesting and thought provoking study was reported in ‘Science Vol. 208, 27 June 1980’.The essence of this fascinating animal experiment was that when rabbits kept in different cages were fed 2% cholesterol diet to study its effect on the diet induced atherosclerosis, the ones that were patted, held, talked to, and played with on regular basis, showed a 60% reduction in the percentage of arterial surface area exhibiting sudanophilic lesions, even though the serum cholesterol levels, heart rate, and blood pressure were comparable.

The experiment (which initially was done by chance) was repeated twice and the results were reproducible i.e. somehow the love shown to the rabbits protected them from the hazardous effect of cholesterol!
This famous study raises a million dollar question – can social relations & intimacy have protective effect against the risk of Coronary heart disease (in this case, a high cholesterol diet) and conversely, can social isolation and lack of intimacy have a negative effect on our health?

Epidemiological researches, seems to suggest strongly that loneliness indeed can have a very negative impact on the health of human beings. In fact ‘WHO’ has rated loneliness as a higher risk to health than smoking and as great a risk as obesity (Times of India, 2nd Feb, 2011).

Another research finding (Times of India, 9th Feb. 2011) says that chronically lonely people may be at a higher risk for certain types of inflammatory diseases because their social isolation triggers the activity of pro-inflammatory immune cells. 

A well known study know as Alameda county study, done on a random sample of 6928 adults in Alameda county, California, showed that people who lacked social & community ties were more likely to die in the follow up period (RR 2.3 from men, and 2.8 for women, between most isolated and most socially committed). This association was independent of self reported physical health status, socio economic status, smoking, alcohol consumption, obesity, physical activity and utilization of preventive health services. (‘Social Networks, host resistance, and mortality: Nine-year follow-up study of Alameda county residents’ ,written by Lisa F. Berkman & S. Leonard Sym in American Journal of Epidemiology, Vol. 109, No 2, Page 186-204). The authors of this study have suggested three possible pathways to explain this association

The first one, is that socially isolated people have poor health practices, the second being – socially isolated people have poor physiological responses to isolation leading to depression or changed coping & appraisal process predisposing them to suicidal or risk taking behavior; the third one is that through nervous, immunological & hormonal control systems the socially isolated become more susceptible to different types of diseases (due to the physiological changes).
There are many such interesting studies quoted in a well written book Love & Survival – The scientific basis for the Healing Power of Intimacy by the world famous author Dr. Dean Ornish, of ‘Reversing Health Disease’ fame. In this book, Dean Ornish has very successfully argued that love & intimacy have a definite role in healthy ageing. To support this point of view he has cited evidence for both situations – regarding the health damaging role of lack of intimacy and social connectedness as well as regarding the salutary effect of having intimate relationships on health and well being. Let us briefly look at some of these studies: Dr. David McClelland and his colleagues conducted a series of studies showing the effect of a good relationship on immunity. They asked students to watch a documentary movie about Mother Teresa’s service to the sick and dying poor of Calcutta’s slums. On an average those who watched the movie about Mother Teresa’s service showed a significant increase in protective antibodies while those who watched a neutral movie did not show a similar effect. (‘The effect of motivational arousal through films on salivary immunoglobulin A’, written by McClelland, D.C, and C Kirshnot in Psychology & Health 1988, 2:31-52).     

Dr. Sheldon Cohen and his colleagues exposed a group of healthy 276 volunteers aged 18 to 55 years to nasal drops containing rhinovirus. They studied the association of social relationships with getting clinical disease (common cold). The number of social relationships played a powerful role in protecting people (who were exposed to the virus) from developing a symptom. In other words social support increased the resistance of volunteers to developing a cold even when they were infected with a virus that causes it. (‘Social ties and susceptibility to the common cold’ by Cohen S, WT Doyle, D.P. Skoner et al in Journal of the American medical Association  1997, 277: 1940- 44).

Besides citing many such studies on the role of social connectedness & health, Dr. Dean Ornish has personally interviewed many world famous scientists related to this field in his book. He concludes “I am not aware of any other factor in medicine – not diet, not smoking, not exercise, not stress, not genetics not drugs, not surgery – that has as great an impact on our quality of life, incidence of illness, and premature death from all causes”(as does loneliness).

In another ground breaking book Loneliness- human nature and the Need for Social Connection’ by John T. Cacioppo and William Patrick, they take a solid scientific look at the connection between loneliness and human health. They have referred more than 100 studies published in reputed journals to bring home the point that human connection is one of the most profound needs in human beings and the lack of it can be a major risk factor for various diseases.

In the words of the author – “This finding (that roughly 20% of individuals .i.e. around 60 million people in US alone feel isolated) becomes even more compelling when we consider, that social isolation has an impact on health comparable to the effect of high blood pressure, lack of exercise, obesity or smoking”. Our research in the past decade also demonstrates that culprit behind these dire statistics is not usually being literally alone, but the subjective experience know as ‘loneliness’ ……… feeling of isolation can drive a cascade of physiological events that actually accelerates the ageing process, loneliness not only alters behaviors but shows up in measurements of stress hormones, immune function and cardiovascular function. Over time these changes in physiology are compounded in ways that may be hastening millions of people to an early grave”.

It has been a common observation, that those communities which have close social ties have lower rates of cardiovascular diseases and higher longevity; a classical example being people living in Japan. When the people from these close knit communities migrate to individualistic societies like U.S.A, they start suffering from higher rates of non communicable diseases almost like the native inhabitants of that country.
Various mechanisms have been suggested to explain the negative influence of loneliness on health, one of them being that loneliness decreases immunity thus increasing the vulnerability of the host to various diseases and there are some good   studies supporting this hypothesis.

Given the strong evidence coming from the various sources about the link between loneliness & disease one is forced to ponder upon certain questions:-

  1. Is there a link between the crumbling joint family system, emerging nuclear family system, increasing individualistic behavior and the rising rates of non communicable diseases – especially cardiovascular diseases in Indian cities? 
  2. In the hospitals and clinics while taking the history of the patients should we include inquiry about social connectedness of patients and should it also be considered while planning management of chronic diseases?
  3. Should we sensitize our undergraduate and postgraduate medical students about the importance of social connectedness in preventing disease and promoting health?

I strongly feel that the time has come to consider these ideas, test them in our society through epidemiological studies and make use of this knowledge in imparting holistic health care to the millions of people of this country.

“Friends can be good medicine”- Sobel, D.S
Suggested reading:

  1. ‘Loneliness- Human nature and the need for social connection’ by John T. Cacioppo and William Patrick (W.W Norton & Company, New York London)
  2. ‘Love and survival- The scientific basis for the healing power of intimacy’ by Dr Dean Ornish (Vermilion, London)
  3. ‘Who gets sick- Thinking and health’ by Blair Justice (Peak press, Houston)
  4. ‘Learned optimism- How to change your mind and your life’ by Martin E. P. Selgman, Ph.D. (Vintage Books, A division of random house, Inc., New York)
‘The status syndrome- How social standing affects our health and longevity’ by Michael Marmot (Henry Holt and Company, New York).      

*Dr. Rahul Bansal is presently Professor and Head, Department of Community Medicine, Subharati Medical College, Meerut. He had served as Associate Professor at Kasturba Medical College, Manipal and Professor, Himalaya Institute of Medical Sciences. He has also received Best Teacher award in 1999 at Himalayan Institute of Medical Sciences. His areas of special interest are Geriatrics, Health Education, Holistic Healthcare, Spiritual Dimensions of Health, Health of School Going Children, Adolescent Health Capre and Medical Education. He is also Founder Secretary of AGE- Mangalore and Founder of Holistic Health Foundation, Meerut.