In today’s fast-paced and ongoing engagement with online information in social media and news we receive a lot of messages. Some more obvious than others. For example, we know what advertisement is trying to do: it’s trying to get us to purchase something. What is less obvious, and perhaps without any intent besides to share information and keep us knowledgeable, are highlights about new research.
For some, research that shows up in the news is simply a new color of lipstick on yet another pig. A pill for this and a pill for that. Due to the ever-increasing amount of information that we must digest each day, most of us read it, think it is interesting, then promptly dismiss it and move on with our day. There is little choice if one wants to maintain some degree of sanity. However, a newly released article in January titled “Scientists are working on a pill for loneliness”1 raised a personal and professional red flag warning. While the article appears to highlight new research, it leaves considerable room to question the media’s interpretation and framing of social problems and mental illness. In a time when mental illness is an ongoing conversation in news and media, critical thinking and questioning common knowledge is also becoming increasingly more important.
What’s The Buzz?
The first stop in considering the validity of the article was to do a quick university library search for research on loneliness. Surprisingly, there were hundreds of journal articles published about loneliness in the past year alone, and thousands of returns on a Google Scholar search. For another related topic that is often associated with loneliness, depression, there were three times as many results. For anxiety there were double the amount as that of loneliness. It became painfully obvious that this is a significant subject of interest and in rank with other serious health topics.
In the article there is reference to current research begun by the late Dr. John Cacioppo2 as currently carried on by his wife Stephanie Cacioppo3 at the Department of Psychiatry and Behavioral Neuroscience and the HPEN Laboratory, Center for Cognitive and Social Neuroscience, with the University of Chicago (references to their published work are available in the resources list4). The research explores physiological impacts of loneliness and medical interventions in order to identify some way to potentially offset and even divert those impacts. It highlights results that have demonstrated that loneliness produces medical and mental conditions that if not treated can result in significant physical changes in the brain and adversely impact health, even contributing to death. As it turns out, there is indeed much research5 to support the seriousness of this issue.
If that summary still sounds somewhat removed from a scientific aim to develop a pill to cure loneliness: you are probably correct. It does indeed leave much room for examining how the media portrays mental health research, how the general public interprets and applies that information, and what questions should be asked. While the questions could be endless, I hope to establish a foundation from which to consider a range of challenges — from the dangers of assumptions to the need for clarity in defining and operationalizing variables, to the logistics of medication in healthcare and professional ethics, to personal implications for those who are lonely.
The Hamster Wheel
After reading the article my ponderings immediately went to traditional research models that often utilize animals, as well as a troubling experience I had as a child. It began as a personal reflection about a hamster I had and a recollection of a distinct thought I had after he died. While my inattention at age seven had certainly not been intentional, like other kids my age, playing outside with friends was often a priority. Paying attention to my hamster became a pastime of watching the wheel spin under his little feet and feeding and watering him on schedule. One morning when I did decide to take him out to play, he was no longer moving. I was devastated. I couldn’t figure out what happened. I had given him the essentials: water and food. Yet even through my rumination of what I had or had not provided, there was a whisper of a question that crossed my mind: “when was the last time I played with him.” It was also the question later asked by my parents. Although I didn’t understand the significance of it at the time, the research today is crystal clear that there is an undeniable link between adverse health outcomes and loneliness. And although the exact cause of my hamster’s death was never secured, loneliness can certainly be among the top possibilities. It may also be in principle one of the reasons why there are more and more doggy daycare and pet care centers than ever before. We don’t need science to tell us that being alone excessively is unhealthy.
As I continued to consider the article, my mind wandered to a person who once was the pillar of strength in my life, my grandmother, or as I called her “Mormor” in Sweden where I grew up. When she was in her 70’s she met the man of her dreams and fell in love. Until that point, she had lived life on her terms. She had divorced earlier in life during a time when divorce was taboo. Yet she held her head high and continued on as a strong independent woman and remained single for many years. Her life revolved around enjoying her kids, grandkids, neighbors, friends, cooking, attending various community social activities, traveling, and working. Yet when this gentleman passed away only a few years after they had met, it wasn’t long before she began to die herself.
She stopped eating and sat quietly at the edge of the sofa in the living room where they had done crossword puzzles together, watched television, and napped (of course she never did admit to napping). After he died, that corner of the sofa was where she stayed and subsequently deteriorated both mentally and physically until she had to be hospitalized, developed dementia, and years later died. She never recovered from the loss. It wasn’t that those other activities to connect didn’t exist any longer, but the one that had become most meaningful to her was now gone.
As I continued contemplating the concept of a pill for loneliness, both reflecting on related research and personal experience, several questions came to mind with a bit of frustration on behalf of those who may be lonely. Everyone from pets, to widows, military veterans, moms raising kids alone, people in jobs they hate, teens who are not connecting in school, and perhaps many who are on dating sites. I was especially thinking about a good friend who after suffering a stroke at age 50 is now in long-term care in a nursing home. For many there is simply no lever they can pull to be more connected. In connecting the dots, it begs the question of how serious a social problem has to be in order to get attention. Must it be a physically related condition involving a statistically significant potential for death? As a medical and health community of providers, are we so hell-bent on keeping people physically alive that we devalue quality of life in a socio-cultural and environmental context? Isn’t a quality life more than our physical well-being and throwing a pill at it?
Square Peg In A Round Hole
The research recommendations that accompany Dr. Cacioppo’s work do include a combined treatment model of therapy and medication, not only a pill. Additionally, the passion and research to carry on Dr. Cacioppo’s work is important and his concept of self-preservation relative to loneliness is something we should also pay attention to. However, is using medication the best option when treating a social problem? It seems akin to trying to fit a square peg into a round hole. With the current state of affairs around addiction are we not trying to get away from medication overload? Is the current research taking us back into an outdated medical model? Is a pill the answer? If so, what are the right questions we need to ask, the right things to measure?
Perhaps it is the message of the “pill for loneliness” article that sheds a questionable light and lays the groundwork for alarm. Maybe the condition of loneliness speaks to a larger problem of how we don’t necessarily know how to address social issues on a larger scale? Certainly the portrayal of research on loneliness is skewed in the article. The research is in fact not directed at developing a pill as a cure but rather at exploring loneliness, its physiological impact, and solutions to symptoms and consequences thereof. As a socially rooted issue a pill is not going to solve loneliness. It could only serve as a Band-Aid. A medical model explains that well. When someone has a broken leg they don’t get a pill to fix it, the leg is put in a cast in an attempt to return it to its original state of optimal functioning. The associated symptoms of pain may be treated with medication. The measure of success is whether that pain goes away or not, but that does not necessarily indicate a healed bone. Likewise, how can we measure validity in success of treating loneliness when we are only treating the symptoms with a pill and not the root cause? In other words, the pain instead of the broken leg.
Headaches, Kidney Failure, Dry Mouth, Blindness, Death…
One might have thought that this would have ended my mind’s wanderings on the subject, but like a snowball heading downhill a stream of questions ensued. What about the marketing of this pill? The dangers of medications and pills are well known and well-advertised. We are all too familiar with the mile-long lists of “side effects” that somehow creep in to dinner conversations. Interestingly, in practice, and possibly because of how we do cost-benefit analysis in decision-making, side effects don’t seem to stop us from using the medications. It may also have something to do with the convincing reasons in how a provider explains the utility of a medication, or the lack of alternatives presented. However, beyond the side effects there are other less discussed dangers that include public interest and perceptions about treatment interventions and cures with pill advertisement. A pill, or any medication for that matter, creates dependence on something other than people, and when the issue is people a pill does not leave people empowered but rather more dependent and reaching for a substitute. To me this begs the question of what we want as a resulting impact and message for the next generation? Isn’t medication just a quick fix?
The obvious answer is yes. While that is not a bad thing, in this context it does seem to contradict current efforts and reasons why we are now in a position of having to combat an opioid epidemic. The mindset that drugs will fix it. It also seems oddly similar to something that may have started with the era of deinstitutionalization.6 If a pill for loneliness is the answer, then does the delivery of that pill involve the same level of readiness that deinstitutionalization efforts applied when no community, whatsoever, was completely ready to provide the needed support for those released? Not that we want to go back to that state of affairs, but is this pill-concept no more than encouraging people to stay in their homes and take a pill rather than get socially connected in their communities? Or for folks to reach out to those who need it? In reflection it almost seems as if we have come full circle since the 1950’s. We created pills to get people out of institutions and now a pill to potentially put them back in some form of confinement. This time in their own home alone, with a pill.
The Right Thing To Do?
With that round of questions one cannot help but consider the ethical and moral side of medicating loneliness, beyond the questionable establishment of loneliness as a medical or mental illness condition. Even if a pill could generate the same effects as physical and emotional closeness between humans, is it the right thing to do? Would a pill have saved my hamster or my grandmother? What message is it sending to say that we are trying to come up with yet one more pill to resolve something that is within our human social control? And what about social responsibility? Is it too much effort to exercise our human contact potential, or is it that we are simply looking for a faster or easier way out? Less effort exerted on a community and its members? What additional dependency are we in fact creating?
According to other bodies of research there are many alternatives, as explained in an article published last fall (and still highlighted in the mainstream press today) by a popular positive psychologist, Shawn Achor, and his wife, Michelle Gielan. For the past decade they have done extensive work and research on happiness. In their article they suggest many compelling ways in which to thwart loneliness and enrich our lives socially during stress. On that note, my questions continued around who is lonely?
Who Is Lonely?
On a more practical side of experiencing and addressing loneliness, I considered the who and what within our ways of interacting in the world. Who is lonely? Is loneliness different for various age groups? Some research points to the ages of 16-24 as taking the lead in loneliness,7 even exceeding numbers in the elderly population. This is of significant concern since the younger generation are also notably struggling with an increase in suicide rates and escalation in school violence. Instead of a pill, then, how about social engagement programs in schools and community centers? Yes, some programs already exist but do they actually change the sense of connectedness in the opinion of youth or are they just a feather in an educational system’s hat to say they did all they could? Do efforts only target the youth and not entire families to facilitate community connectedness? Are we getting involved enough or are values of independence and privacy barriers?
Access and Costs
Then there are the logistics of medication treatment in terms of access and cost. What will the good ole pharma-industry do with this one? What will the prescribing community do? Will loneliness be one of those mental illness categories where medication is claimed to be warranted rather than considering developmental challenges, environmental adversities, or trauma in youth? Where someone who is lonely at age 13 will now be prescribed a pill? In trying to recover from the devastating thought that a teen who is lonely may in the future be prescribed a pill I considered my own profession. As psychologists, counselors, social workers and other mental health providers, even those in journalism who report on the field of mental health, this is an alarming message. The portrayal and framing of this current research, perhaps also therein, warrants serious thought and consideration. The fact that this research is even having to occur should serve as a wake-up call, ethically, morally, and in terms of our social responsibility. Not with pity but with cause for questioning and reflection on who we are and how we are functioning as a global and social world.
On that train of thought also rides the concept of what has been ruled out in terms of public policy for treatment and engagement programs for the elderly. One of the things that is becoming obvious in public healthcare is that some communities, municipalities, and states are only going to do bare minimum. Checking off a list of to-do’s relative to what they are forced to do through rules, contracts, or incentives — the least amount of work that they can get away with to meet the letter of the law. In some cases employing at ridiculously high salary rates with little oversight on operations or the actual work being done; in some cases managed care incurring more costs to the system as new diagnostics evolve in order to monitor and control costs.
On that note, where are people experiencing loneliness? What about the world of work and creating healthier treatment and engagement in the workplace? If indeed there are serious health risks associated with loneliness, should that not be a consideration? How about creating more functional and comprehensive definitions of state and federal laws that are intended to protect the workforce from workplace bullying and toxic environments that isolate people? Existing guidelines are like swiss cheese with many issues slipping through in terms of accountability. For example, consider the #metoo movement. It took years for people to step out of the loneliness of secrecy. For loneliness, then, who will be the champion for resolving the epidemic on the larger scale in varied contexts like policy and collective effort? Or are we putting all our money on a pill?
What Causes Loneliness?
In the vein of causation, there are many more questions that could be asked as to why the issue of loneliness exists for some and not others — internal and external factors. This should be a central part of research methodology. Why does someone feel or not feel connected, isolated, lonely? What are the rule-outs? Is anxiety playing a role? Trauma? Lack of social skills? All of which have a number of evidence-based interventions available that are more sustainable and appropriate than a pill. Is there an inability to access those interventions? If the answer is yes, then that should be the point of focus. Why are some people uncomfortable getting involved, reaching out? There are also measures of personal preference regarding personal space and factors of personality that need to be considered. Can there be other contributing factors that would influence perceptions about loneliness subjectively and objectively? Introversion and extroversion? Is it fear-based, if so, what is that fear? Is there a difference in comorbidity of mental illness and those who have no clinical diagnosis and still are lonely? These all must be a part of the questions being explored above and beyond a pill.
In the case of categorizing loneliness as a physical and mental condition there are numerous underlying factors that should be considered, not only the fact that someone is not connected socially according to limited norms or research definitions — definitions founded on evolutionary concepts that may or may not be appropriate for all situations, especially in a presentist view such as the modern society and reflecting on human historical stages of change. What are the assumptions being made outside of brain imaging scans? Scans that only allow a confined activity response to isolated visual stimulus or personal space as noted in the current research? Relating and connecting is much more. It is an organic, personal, and interactive experience. Not simply looking at pictures. It is a give and take, a valuable and meaningful exchange of information. A friend that we value, a loved one; attention, playfulness, and freedom. How identical or strong is the brain scanning results of personal meaningful interaction with that of being in a closed environment and looking at pictures of the same, before it has occurred or in memory? Some research8 points to an increase in loneliness and not feeling connected even with engagement on social media — in other words, looking at pictures versus engaging. If that is correct, then how valid and reliable are data based on brain scans and virtual imagery as it relates to human interaction and connectedness? Is our baseline skewed?
Definitions and Assumptions
Along with the roots of causation, there is the issue of defining other variables and using appropriate definitions to understand loneliness as a term and operationalizing it. How does a person define his or her loneliness? How does the subjective experience of loneliness differ from the objective one? Maybe someone likes being alone, maybe they need a pet, or perhaps they want more likes on their posts to feel connected or rather not rejected, maybe they need their kids to call or visit more often? Trying to standardize loneliness is a dangerous goal. Making limited assumptions or generalizations about how someone defines loneliness and what people’s needs are in order to fill a connectedness and belonging gap is one of many problems with the messaging behind this new “pills for loneliness” article (and possibly even the research in my opinion). The outcome of throwing everyone in the same bucket is the reason person-centered care has become central and synonymous with quality care. Thinking a pill can meet all range of reasons for loneliness is as erroneous as the methodology that sustains treatment and stigma around mental illness to date. Even with new developments in antidepressant and antidepressant pills, cases are on the increase.9 Where is the data that shows a decrease? It’s scarce unless considering individual cases that largely pertain to an organization having to demonstrate that they met the goals and criteria of a grant or other contracted funding source. Efforts must consider the assumptions being made both as a collective body of research evolves and as society evolves. Loneliness may not be the enclosed target that research assumes it is. We must consider the human element in context. The whole person as a part of a larger world.
A New Smoke Signal
Where do we need to broaden our thinking and reflect on history as a lesson? In a world that exists partly online, as professionals in the field or individuals, we can start by thinking about how we isolate others and what it means to be inclusive and accepting, or not. In a world where comparison, competition, information, news, and misrepresentation in online content is a daily reality, what are we doing or not doing? Interestingly, the “pill for loneliness” article points the finger at technology by saying it has “sanded away the necessity and inconvenience of interacting with other human beings.” That statement alone is an indicator of a larger problem. Since when is human interaction an inconvenience? Technology is a medium of communication like television, the phone, and even smoke signals… as it has been since the human story began and we outlived the dinosaurs. Adaptation is key and making this new mode of interaction more effective, useful, and meaningful should be a part of our story and not serve as an excuse to create a pill. However, if one subscribes to the notion that human interaction is an inconvenience then maybe a pill is indeed the answer. Let’s hope that is not the thinking of most of us on the planet today. Regardless, since many are becoming more active online than in-person, considering ways to change how we engage is imperative.
In other words, what can we do to be more supportive on a daily basis? After all, value and purpose as referenced in the context of loneliness can be dormant within anyone, often waiting for someone or something to bring it out. To provide opportunity. How much effort is it for any one of us to respond with the new-age language of communication that includes a symbol of like, love, or brief comment in acknowledgment of someone else’s expression of interest or passion as presented in a post? We do not have to agree, but we can support and engage. In many cases it is only a click away, given this new world. The practical side of the new social world may still present environmental factors including transportation, geographical, or cultural elements as barriers. Variables that must then be included in loneliness analysis.
In the wake of this new research and considering the backdrop of historical research, one cannot help but to consider the Hawthorn Studies and the influence of environment on loneliness. If people who are lonely are getting more attention and interaction by participating in research, how do we know whether it is the pill or the engagement that is creating certain outcomes? No matter the extent of that engagement. What is an accurate measure of the threshold for when someone feels connected or not? Are brain scans the right measure? It would seem nearly impossible to control for relevant variables under those circumstances. With some of our human relational experiences being entirely online how do we capture that in a meaningful way and avoid a false positive?
Between the obvious concerns about the way this research was presented and the implications of a pill for people who are not able to meet the basic human need of connectedness, my list of resources and references are far from exhaustive. However, from a fundamental principle of messaging in the interest of consumers and the general public, I am simply not convinced that a pill is taking us in a healthier direction. In fact, I would question the risks and benefits of this research. In terms of ethics it may not be out of compliance with a specific ethics code nor harming participants, but what about those who are facing loneliness? Would the notion of a pill be empowering, enabling, or disabling? A pill to cure loneliness may not be considered as extreme as other types of research that has been questioned on ethical grounds, for example, cloning; it certainly takes rank with it. But then again, maybe cloning will be a solution for loneliness at some point too?
All silliness aside, the article and research must ask more questions about causes of conditions. A good example is the old medical model and standardization of terms and conditions. As it is with the medical model and the broken leg, focusing only on the pain is a temporary solution. What can we do differently in terms of early intervention, inclusion, education, and diversion? Individually, as fellow professionals, those serving in mental health, and those of us who have opportunity to be of influence at work, school, and in our community. We can certainly do better than a pill. The last thing we need is yet another tool to help us be dismissive of people’s need to connect and reduce human interaction to an “inconvenience” — to not take responsibility for our role in people’s loneliness, not recognize when it exists, or enable those struggling with loneliness to not take responsibility and reach out when they are in fact lonely.
The Real World
On a final note, I can’t help but consider the reality of loneliness in the context of choices we have and how a pill may or may not add value to life, devalue human interaction, or take us in the wrong direction through stagnation. In the movie The Matrix we are introduced to the characters of Neo played by Keanu Reeves, and Morpheus, played by Laurence Fishburne. The storyline plays on the concept of perceptions, truth, and reality. The movie prompted much debate about reality and the hidden meaning of the story. One side of the story is the quest for truth — a movement towards psychological freedom and away from restrictions of believing one thing over another. In one of its classic scenes Morpheus asks Neo to choose between two pills, one red and one blue. He says the blue pill will take Neo back to where he started. Basically, staying isolated in his apartment or whatever we choose to believe happened before the rabbit came along. On the other hand, the red pill would allow Neo to explore an alternate reality that he has now stumbled upon, which may or may not be the true reality. Morpheus claims to offer the truth either way.
For those who have not seen the movie, old as it is, I will not disclose details of outcomes. The point is that if we are going to empower people it cannot happen through a pill. Whether blue, red, or green, a pill may only continue to fuel an illusion of what potential reality there is, and thus remove people from ever connecting in the real world. We can do better. We must do better. The truth is, we cannot afford not to.
- Entis, L. (January, 2019). Scientists are working on a pill for loneliness. The Guardian. Retrieved from https://amp.theguardian.com/us-news/2019/jan/26/pill-for-loneliness-psychology-science-medicine ↩
- Cacioppo, J. (2013). The lethality of loneliness: John Cacioppo at TEDxDesMoines. (Video). Retrieved from https://www.youtube.com/watch?v=_0hxl03JoA0&list=WL&t=0s&index=22 ↩
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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.