Bipolar 2 From Inside and Out

Posts tagged ‘loneliness’

Global Wins for Mental Health

Most of us know quite a bit about the U.S. mental health system, if it can be called that. We know about its successes and its failures, its help and its harm, and its practitioners and patients. But what about other countries? What large and small actions do they take to help people with psychiatric symptoms or disorders in their countries?

First, we know that approximately 78 countries around the world have socialized medicine or some form of universal health care that includes psychiatric services. Some have reported long wait times to get help, but others are easier to access. Most psychiatric drugs are subsidized. And the societies function in ways that foster mental health. Let’s look at a couple of programs that seem to be working.

Denmark

Denmark has a program designed to fight the stigma that accompanies mental disorders. It’s called One of Us.

Giuseppe Parlatore, who lives with paranoid schizophrenia, felt the stigma himself when a former teacher assumed—and said to him—that he must be either self-harming or violent and dangerous to others. He felt shame.

Parlatore, who was diagnosed in 2009, has worked hard to cope with his symptoms and carve out a life for himself. Now he is a leading mental health advocate, working with officials to lessen the stigma of mental disorders.

One of Us works with people called ambassadors, who have mental illnesses, to work with schools, police, and hospitals, sharing their stories and focusing on recovery. The emphasis on hospitals and police, they feel, is necessitated by the fact that personnel mainly see mental patients when they are in crisis rather than when they are coping better with their illnesses.

The Danish Health Authority also has a department of prevention and inequity. Anti-stigma campaigns are a part of the Ministry of Health. They hope to see lasting effects among the population, rather than just short-term upticks in awareness. The Danes see social contacts as more likely to change opinions than education alone.

Still, the battle against stigma requires persistence. Parlatore says that for him, it’s a “generational project.”

Japan

In Japan, there is a thing called kodokushi or “the lonely death.” The population of Japan is aging, and many older adults have little to no social contact. They can die alone and not be discovered for a long time. Social isolation leads to stress and loneliness. But a program designed to encourage physical health is having an effect on the elderly people’s mental health as well.

The “yogurt ladies” started as a way to promote health by selling yogurt to households. They were easily identifiable by their blue uniforms and bicycles. They succeeded very well in making people aware of gut health.

But gut health is also related to stress and chronic loneliness, two factors affecting mental health. Social isolation is, in turn, involved with gut microbiome diversity.

Loneliness is taken seriously in Japan. The government even includes a Ministry of Loneliness, as well as a task force on social isolation. The yogurt ladies provide weekly check-ins, a friendly face, and a chance to interact with someone. They see themselves as people who look out for others. Their services are a practical factor in maintaining gut health, but they perform an important function in reducing social isolation and preventing the “lonely deaths.” The lift they provide weekly is an important factor in maintaining mental health for the aging population of Japan.

Why don’t we have programs like this in the U.S.? I think you know the answer.

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Mental Health

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Loneliness Reigns

For some of us, those with bipolar disorder, depression, agoraphobia, and anxiety, it’s like the COVID restrictions were never lifted. We remain at home as if we were still sheltering in place. We’ve lost touch with many of the people in our lives. The thin threads of social media aren’t enough to provide solid connections, though we’ve had practice during the pandemic.

There’s also the “reaching out” problem. We’re perpetually advised to reach out to others when we’re lonely or having difficulties. But of course, reaching out is too much to expect for many. Often, we’re not even able to make a connection when someone reaches in. Whether it’s a matter of not believing that we’re really worth someone else’s time or being submerged in misery, the loneliness of depression or anxiety does not allow us to respond.

Lately, though, there have been a lot of headlines and articles saying that America in general is experiencing an epidemic of loneliness. I don’t know about you, but for me, loneliness is nothing new. Depression does that to a person, even if loneliness is not one of the diagnostic criteria in the DSM.

Of course, the articles point out that the loneliness epidemic coincided with the COVID epidemic. People were sheltering in place, many working from home. We couldn’t get out and see our friends or go to school, church, or family gatherings. We missed weddings, birthdays, reunions, funerals. We missed seeing coworkers and friends. We even missed chatting with the people we encountered in our daily lives—nail technicians, servers, sales clerks, plumbers, and all the other people you don’t even think about missing until you miss them. Even our doctors and therapists took care of us online instead of in person.

But that’s largely over. What’s driving widespread loneliness now? Apparently, it’s a chicken-and-egg dilemma. Does loneliness come first? Do psychiatric illnesses? Recent research “suggests a correlation between loneliness and depressive symptoms, with one potentially leading to the other, although the causal direction remains unclear.”

The Journal of Clinical and Diagnostic Research has published a study that says there are three kinds of loneliness: situational, developmental, and internal. Situational loneliness involves environmental factors such as interpersonal conflicts, accidents, and disasters. Developmental loneliness appears with conditions including physical and psychological disabilities. Internal loneliness is associated with “personality factors, locus of control, mental distress, low self-esteem, guilt feeling, and poor coping strategies with situations.” Two other kinds of loneliness have been reported as well: emotional and social loneliness. It seems to me that those are the two that are behind the “loneliness epidemic” that headlines tout. Among the psychiatric and other disorders they say are associated with loneliness are depression, suicidal ideation, personality disorders as well as bereavement, Alzheimer’s, and physical illnesses.

The research is all well and good, but what’s to be done? The usual remedies don’t work very well. The report cited above recommends developing social skills, recognizing maladaptive social cognition, giving social support, and developing opportunities for social interaction. Not much help there. The last two rely on other people to provide intervention, which is obviously uncontrollable by the person experiencing loneliness. And the first two require therapy of one sort or another.

At any rate, the continued advice of the general public remains, “Cheer up,” “Get out more,” and variations on “Get over it,” as if the loneliness were the sufferer’s fault. Antidepressants may help but they don’t attack the root cause of social isolation. There are still social media, which help me a lot. But I interact with various people and groups, which not everyone is able to do. My husband gets me out of the house at times, usually with the lure of a restaurant meal. And that primarily connects me with the person I’m already most in contact with. He’s my social support. I have a high school reunion coming up, with a number of different events scheduled, but so far I’ve only talked myself into the most casual one.

Am I lonely? At times I am. But my loneliness is not the overwhelming sort that attacks many people. There are some ways to ameliorate the condition, but most of them require getting out of the house, which many lonely people are simply unable to do; having good friends who reach in (assuming that we have the wherewithal to reach back; and the long, slow slog of antidepressants and therapy, which may or may not “cure” the problem. Advertisements are beginning to address the problem of loneliness with advice to reach in and talk to friends and acquaintances who aren’t doing well, those these are minimal compared to all the ads for the latest drugs.

Obviously, there are other aspects of brain illnesses that the experts are working on more vigorously. But I, for one, hope that more research and interventions can be devoted to solving the problem, not just defining it.

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Mental Health

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