Originally posted at Beacon Lens The holidays are upon us, and the irony they bring is the potential for isolation and loneliness. Holidays’ essential identity is getting together with loved ones, but some people do not feel as connected as they would like or expect. In 2020, add COVID-19 and its quarantining dictates, and the potential for such feelings can strengthen. The holidays, therefore, present an excellent time to discuss how we can reinforce connections during a time that requires us to be apart to protect our physical health, a requirement that paradoxically can have a damaging effect on our mental health. We can, however, take charge of improving our mental health.

Loneliness and isolation and our health

What is the difference between loneliness and isolation? “Loneliness is the feeling of being alone, regardless of the amount of social contact,” according to the Centers for Disease Control and Prevention (CDC). Social isolation, on the other hand, is a lack of social connections. Put differently, one can have many social connections but still feel lonely. The physical and mental health risks of loneliness and isolation are significant. They include but are not limited to:

• Social isolation increases the risk of premature death by 29 percent, rivalling smoking, obesity and physical inactivity.
• Social isolation is associated with increasing the risk for dementia by approximately 50 percent.
• Loneliness is connected to higher rates of depression, anxiety and suicide.

A 2020 report by the National Academies of Science, Engineering and Medicine (NASEM) states that more than one-third of adults 45 and older feel lonely, and approximately one-fourth 65 and older are socially isolated. Add the holidays and COVID-19 to an already preexisting condition, and the time is ripe for all of us to take action to protect our mental health.

Simple steps for better mental health during the holidays

Specific to the season and the times, there are common-sense tips that we all can practice to help manage loneliness. For example:

• Talk to someone about your sense of loneliness and isolation. There’s stigma around loneliness so it can be hard to do. However, you may well find that you’re not alone in those feelings, and sharing them can help lessen their effect.
• Manage your holiday/COVID-19 expectations. The holidays can fall short of expectations, but this year it may be worse. Understand that the pandemic won’t last forever, and that we’re all in this together. Indeed, many people’s holiday gatherings will likely be different this year.
• Remember to take care of yourself, now more than ever. Sleep, exercise and good nutrition — with the proper amount of holiday indulgence — go a long way in addressing mental health.
• Avoid social media, such as Facebook or Instagram, especially during the holidays. It’s easy to negatively compare one’s life to the “perfect” lives posted on social media, forgetting that people mostly post only the positive.

Loneliness and isolation as its own pandemic

The holidays don’t last forever, and we will get through the COVID-19 pandemic. However, loneliness and social isolation may persist, which presents a challenge for behavioral health providers. The recent NASEM report explores interventions that the healthcare system can take to address loneliness as a societal condition, such as engagement in support groups, cognitive behavioral therapy and mindfulness, social determinants of health, social prescribing and more. Social prescribing is arguably one of the more interesting interventions in that it puts a clinical lens on non-clinical solutions. While there is no hard-fast definition of social prescribing, it is generally accepted as a way to connect people to non-clinical sources of support, according to the NASEM. Specifically, it is a “non-medical referral, or linking service, to help people identify their social needs and develop wellbeing action plans to promote, establish or reestablish integration and support in their communities, with the aim of improving personal wellbeing.” Examples of secondary services that improve social concerns affecting health include housing and food insecurity services. While known to varying community-based organizations, social prescribing is not common among practitioners, but it’s a common-sense solution. An analysis of one pilot program from the NASEM report — albeit a small one — found that social prescribing reduced inpatient admissions by as much as 21 percent and emergency room visits by 20 percent. A modern world — without COVID-19 — is more connected than ever due to social media and other technology. However, studies have shown we are more lonely now than in any other time in recent history. It’s time to think out of the box as we realize more and more how non-physiological conditions — such as issues ranging from a public health emergency to social media — can affect our health.

From the January 2013 Monitor on Psychology by Dr. Siri Carpenter:

Excerpt: "Tempted to read just one more email before you sleep?  Don't.  New research finds that not getting enough sleep - whether because of our insatiable desire for digital media or more traditional sleep disturbances - has far-reaching effects on physical and psychological health." Read the full article.

Just read in a magazine about a new IOS app for the iPhone called Talkspace. It claims to let you text a mental health coach constantly for $32 a week. They also offer a full package, which includes four live video or audio sessions a month for $69 a week. There are serious concerns that arise with commercial tele-health enterprises that fail to adequately consider the ethical and regulatory aspects of the mental-health service they purport to provide. They offer an unsafe and potentially dangerous approach to mental health care. Todd Essig has written a series of articles for Forbes that you might enjoy reading. Be very careful when contracting with any commercial tele-health entity.

We use conversation with others to learn to converse with ourselves. So our flight from conversation can mean diminished chances to learn skills of self-reflection. These days, social media continually asks us what's "on our mind," but we have little motivation to say something truly self-reflective. Self-reflection in conversation requires trust. It's hard to do anything with 3,000 Facebook friends except connect. As we get used to being shortchanged on conversation and to getting by with less, we seem almost willing to dispense with people altogether. Serious people muse about the future of computer programs as psychiatrists. A high school sophomore confides to me that he wishes he could talk to an artificial intelligence program instead of his dad about dating; he says the A.I. would have so much more in its database. Indeed, many people tell me they hope that as Siri, the digital assistant on Apple's iPhone, becomes more advanced, "she" will be more and more like a best friend - one who will listen when others won't. During the years I have spent researching people and their relationships with technology, I have often heard "No one is listening to me." I believe this feeling helps explain why it is so appealing to have a Facebook page or a Twitter feed - each provides so many automatic listeners. And it helps explain why - against all reason - so many of us are willing to talk to machines that seem to care about us. Researchers around the world are busy inventing sociable robots, designed to be companions to the elderly, to children, to all of us. One of the most haunting experiences during my research came when I brought one of these robots, designed in the shape of a baby seal, to an elder-care facility, and an older woman began to talk to it about the loss of her child. The robot seemed to be looking into her eyes. It seemed to be following the conversation. The woman was comforted. So many people found this amazing. Like the sophomore who wants advice about dating from artificial intelligence and those who look forward to computer psychiatry, this enthusiasm speaks to how much we have confused conversation with connection and collectively seem to have embraced a new kind of delusion that accepts the simulation of compassion as sufficient unto the day. And why would we want to talk about love and loss with a machine that has no experience of the arc of human life? Have we so lost confidence that we will be there for one another? We seem increasingly drawn to technologies that provide the illusion of companionship without the demands of relationship. Always-on/always-on-you devices provide three powerful fantasies: that we will always be heard; that we can put our attention wherever we want it to be; and that we never have to be alone. When people are alone, even for a few moments, they fidget and reach for a device. Here connection works like a symptom, not a cure, and our constant, reflexive impulse to connect shapes a new way of being. Think of it as "I share, therefore I am." We use technology to define ourselves by sharing our thoughts and feelings as we're having them. We used to think, "I have a feeling; I want to make a call." Now our impulse is, "I want to have a feeling; I need to send a text." So, in order to feel more, and to feel more like ourselves, we connect. But in our rush to connect, we flee from solitude, our ability to be separate and gather ourselves. Lacking the capacity for solitude, we turn to other people but don't experience them as they are. It is as though we use them, need them as spare parts to support our increasingly fragile selves. We think constant connection will make us feel less lonely. The opposite is true. If we are unable to be alone, we are far more likely to be lonely. If we don't teach our children to be alone, they will know only how to be lonely. To make room for conversation, we can create sacred spaces in the kitchen or dining room. We can make our cars "device-free zones." We can demonstrate conversation to our children. And we can do the same thing at work where we are so busy communicating that we often don't have time to talk to one another about what really matters. Employees asked for casual Fridays; perhaps managers should introduce conversational Thursdays. Most of all, we need to remember - in between texts and e-mails and Facebook posts - to listen to one another, even to the boring bits, because it is often in unedited moments, moments in which we hesitate and stutter and go silent, that we reveal ourselves to one another. I spend the summers at a cottage on Cape Cod, and for decades I walked the same dunes that Thoreau once walked, looking at the water, the sky, the sand and at one another talking. Now they often walk with their heads down, typing. Even when they are with friends, partners, children, everyone is on their own devices. So I say, look up, look at one another, and let's start the conversation.

We live in a technological universe in which we are always communicating. And yet we have sacrificed conversation for mere connection. At home, families sit together, texting and reading e-mail. At work executives text during board meetings. We text (and shop and go on Facebook) during classes and when we're on dates. My students tell me about an important new skill: it involves maintaining eye contact with someone while you text someone else; it's hard, but it can be done. Over the past 15 years, I've studied technologies of mobile connection and talked to hundreds of people of all ages and circumstances about their plugged-in lives. I've learned that the little devices most of us carry around are so powerful that they change not only what we do, but also who we are. We've become accustomed to a new way of being "alone together." Technology-enabled, we are able to be with one another, and also elsewhere, connected to wherever we want to be. We want to customize our lives. We want to move in and out of where we are because the thing we value most is control over where we focus our attention. We have gotten used to the idea of being in a tribe of one, loyal to our own party. Our colleagues want to go to that board meeting but pay attention only to what interests them. To some this seems like a good idea, but we can end up hiding from one another, even as we are constantly connected to one another. A businessman laments that he no longer has colleagues at work. He doesn't stop by to talk; he doesn't call. He says that he doesn't want to interrupt them. He says they're "too busy on their e-mail." But then he pauses and corrects himself. "I'm not telling the truth. I'm the one who doesn't want to be interrupted. I think I should. But I'd rather just do things on my BlackBerry." A 16-year-old boy who relies on texting for almost everything says almost wistfully, "Someday, someday, but certainly not now, I'd like to learn how to have a conversation." In today�s workplace, young people who have grown up fearing conversation show up on the job wearing earphones. Walking through a college library or the campus of a high-tech start-up, one sees the same thing: we are together, but each of us is in our own bubble, furiously connected to keyboards and tiny ouch screens. A senior partner at a Boston law firm describes a scene in his office. Young associates lay out their suite of technologies: laptops, iPods and multiple phones. And then they put their earphones on. "Big ones. Like pilots. They turn their desks into cockpits." With the young lawyers in their cockpits, the office is quiet, a quiet that does not ask to be broken. In the silence of connection, people are comforted by being in touch with a lot of people - carefully kept at bay. We can't get enough of one another if we can use technology to keep one another at distances we can control: not too close, not too far, just right. I think of it as a Goldilocks effect.
Texting and e-mail and posting let us present the self we want to be. This means we can edit. And if we wish to, we can delete. Or retouch: the voice, the flesh, the face, the body. Not too much, not too little - just right. Human relationships are rich; they're messy and demanding. We have learned the habit of cleaning them up with technology. And the move from conversation to connection is part of this. But it's a process in which we shortchange ourselves. Worse, it seems that over time we stop caring, we forget that there is a difference. We are tempted to think that our little "sips" of online connection add up to a big gulp of real conversation. But they don't. E-mail, Twitter, Facebook, all of these have their places - in politics, commerce, romance and friendship. But no matter how valuable, they do not substitute for conversation. Connecting in sips may work for gathering discrete bits of information or for saying, "I am thinking about you." Or even for saying, "I love you." But connecting in sips doesn't work as well when it comes to understanding and knowing one another. In conversation we tend to one another. (The word itself is kinetic; it's derived from words that mean to move, together.) We can attend to tone and nuance. In conversation, we are called upon to see things from another's point of view. FACE-TO-FACE conversation unfolds slowly. It teaches patience. When we communicate on our digital devices, we learn different habits. As we ramp up the volume and velocity of online connections, we start to expect faster answers. To get these, we ask one another simpler questions; we dumb down our communications, even on the most important matters. It is as though we have all put ourselves on cable news. Shakespeare might have said, "We are consumed with that which we were nourished by."