Wednesday, July 3, 2013

The Psychology of Mental Health Disorders - Isolation and Loneliness

Update, October, 2014

I've done considerably more research into the relation between isolation and stigmatization and psychiatric disorders since first writing this piece, especially in terms of understanding isolation stress and the tangled effects of isolation in the mind. Not many researchers look into this but I am very good at connecting my own dots from studying the neuroscience of stress and case studies of those with certain forms of bipolar, schizophrenia and other mental health conditions. And everything I've found has left no doubt in my mind that not only is isolation stress a major trigger for psychiatric episodes, it is a major factor in the long term outcome for those disorders. 

There is a great deal more for me to write about regarding isolation stress and emotional pain and how they're processed in the brain and how this both triggers and contributes to mental health struggles of all kinds (from depression to psychosis to manic episodes to paranoid schizophrenia and others) but I have far too much on my plate for that now. For now then, this will have to continue to serve as an introduction to the affects of isolation on mental health. 


In talking about isolation and bipolar, I will include schizophrenia as well. I've actually researched schizophrenia more than bipolar even. Indeed the two conditions can be confused for each other and can co-exist as well (well, according to the docs anyway). In discussing how psychological factors can affect the outcome and course of an mental health disorder, isolation may top the list.

One of the greatest blessings that helped me turn things around at the very end of last year was being given access to free therapy through a program sponsored by the psychology department at UBC in which psychologists in training would serve a sort of internship. My therapist, "B", turned out to be a perfect fit for me. Without getting into too much detail of our hours of sessions, feelings of loneliness and isolation was one of the things that B helped unearth for me. The more we talked about it, the more I could see this when I looked back on my own suffering; the more alone I felt, the more I suffered. 

As well, though B and I only touched lightly on this, among other things that I battled and was effected by, acute sensations of being rejected was one of them. (and speaking of if only, if only I'd been able to keep up the appointments with B. That would have greatly aided me in getting through some of the more recent darkness. But my free sessions ended with the end of the UBC university term. I'm able to continue them but not until a new session opens in September and then with a new therapist). 

The nature of this sense of rejection is a whole other thing to explore but I believe it's something akin to Borderline Personality Disorder which, according to Psychology Today's Taming Bipolar, is often "comorbid" with bipolar disorder (and in an interview I conducted for my book with another bipolar sufferer, this came up and we both felt many of the same things, things that are described as symptoms of BPD). In any case, these acute feelings of rejection, whether or not the feeling was justified, would also greatly contribute to feelings of isolation and worsening of the condition and I could trace this back for years, even the years before the current Struggles.

So being as highly interested and motivated as I was at the time (earlier this year) to learn everything about mental health disorders, I turned more of my attention to the role of loneliness and isolation. I had a very strong feeling that I was not alone and that isolated feelings greatly contributed to negative outcomes in mental health disorders. As I read through cases of bipolar, major depressive disorder, schizophrenia and especially suicide, isolation, loneliness and worse, ostracizing from others, showed up time and time again.

Loneliness, isolation and ostracizing are three variations on a similar theme. All three set one apart from others but stem from different situations. Loneliness is the feeling of having no one in your life. Isolation is closer to a feeling of being rejected by others. Loneliness is a passive situation while isolation is an active situation, or in other words, loneliness could be a natural course of events whereas isolation is an active rejection by others. Ostracizing is of course a whole different beast. Like rejection, it's active but with strong malicious intent. I include forms of ridicule as ostracizing as well. How these are experienced very much varies with each individual and how they're feeling at any one point. One may be stronger than others in the face of these things or one may feel stronger one day and more vulnerable the next. All, I felt, would have an accumulative effect over time.

In Sylvia Nasar's superbly written and researched biography of John Nash, A Beautiful Mind (which is not to  be confused with the movie of the same name. While I loved the movie, and it is based on the story of Nash as well, it bears little resemblance to the actual story), she does not specifically mention the effects of loneliness, isolation and ostracizing on Nash's illness (which was paranoid schizophrenia) but I could see these three things running like a thread through his life from his childhood to during the worst episodes of his illness. It may or not been any one instance of rejection and isolation but, based on my own feelings and intuition, I could well imagine all the loneliness, isolation and ostracizing he experienced over his life building up and both perhaps playing a role in triggering his episodes and worsening and prolonging them (this becomes a strong self re-enforcing cycle as well as we'll examine).

I really felt I was on to something so it was with some satisfaction that I ran across a piece in the online edition of The New Republic called Loneliness - how isolation can kill you. "Bam", I thought, "this is just what I was looking for".

In it we are introduced to Frieda Fromm-Reichman, a fifties era therapist made famous for her role in successfully treating a severely disturbed schizophrenic young woman named Joanne Greenberg, the subject of the well known autobiography I Never Promised You a Rose Garden (and pop song of the same name). From the article,
Her 1959 essay, “On Loneliness,” is considered a founding document in a fast-growing area of scientific research you might call loneliness studies. Over the past half-century, academic psychologists have largely abandoned psychoanalysis and made themselves over as biologists. And as they delve deeper into the workings of cells and nerves, they are confirming that loneliness is as monstrous as Fromm-Reichmann said it was. It has now been linked with a wide array of bodily ailments as well as the old mental ones.
And further,

 Psychobiologists can now show that loneliness sends misleading hormonal signals, rejiggers the molecules on genes that govern behavior, and wrenches a slew of other systems out of whack. They have proved that long-lasting loneliness not only makes you sick; it can kill you. Emotional isolation is ranked as high a risk factor for mortality as smoking. A partial list of the physical diseases thought to be caused or exacerbated by loneliness would include Alzheimer’s, obesity, diabetes, high blood pressure, heart disease, neurodegenerative diseases, and even cancer—tumors can metastasize faster in lonely people.

 So it would appear that beyond the purely psychological effects of loneliness and isolation, there are organic components as well, components that certainly wouldn't help one who's already battling a tough mental illness. But the thing with loneliness, and this is something I've observed and understood myself for a long time, is that one can be surrounded by people, or at least not be physically "alone", yet still feel incredible loneliness and disconnect inside. And this would appear to be born out,

Today’s psychologists accept Fromm-Reichmann’s inventory of all the things that loneliness isn’t and add a wrinkle she would surely have approved of. They insist that loneliness must be seen as an interior, subjective experience, not an external, objective condition. Loneliness “is not synonymous with being alone, nor does being with others guarantee protection from feelings of loneliness,” writes John Cacioppo, the leading psychologist on the subject. Cacioppo privileges the emotion over the social fact because—remarkably—he’s sure that it’s the feeling that wreaks havoc on the body and brain.
Mental health patients face a large enigma when it comes to their conditions. They could be suffering horribly on the inside but appear perfectly normal on the outside. Others in their lives often can't accept that there is anything wrong and/or be unable to offer compassion, understanding and support, something that is enormously frustrating. Further complicating this, the term "mental illness" and the (false) belief that mental illnesses are due to a chemical imbalance paradoxically does nothing to improve this, in fact appearing to have the opposite effect. Instead of eliciting empathy and understanding, studies show that
...the dissemination of this false belief has not led to a lessening of societal stigma toward people with psychiatric diagnoses. If anything, it has increased it. In their survey, Pescosolido and the other researchers asked a number of questions to flesh out attitudes toward the mentally ill, and in 2006, there was "no significant decrease in any indicator of stigma" compared to 1996. Moreover, "significantly more respondents in the 2006 survey than in the 1996 survey reported an unwillingness to have someone with schizophrenia as a neighbor."
Equally revealing was this: In both the 1996 and 2006 surveys, those who believed in a "neurobiological conception of mental illness" -- i.e., the chemical imbalance story -- were more likely to have a negative attitude toward those with mental disorders than those who did not. [my bold - BGE. And again, excuse the weird formatting issues]
While this study does not tell the whole story, it does give a pretty good indication of the attitudes of the general public towards those with mental illnesses. I can tell you from my own experience and from reading dozens of case studies, that this sort of stigmatization and prejudice absolutely does exist and cannot but help contribute to the loneliness and isolation those with mental health disorders experience. I've experienced that even with people who outwardly express empathy, they'll slowly edge you out of their social circle or work opportunities thus ultimately contributing to the cycles of loneliness and isolation and their damaging affects on brain and body health and thus the course of the disorder.

New Update 

This is yet another angle of understanding mental health disorders that requires much more study and outlining than I've been able to get to as yet. 

At this time I can add this, however. In the four years and some months since originally writing this piece, I have had the opportunity to listen to or observe or read the stories of dozens of people with various disorders. These may be diagnosed or undiagnosed. I look into their life backgrounds and ongoing life circumstances. Meanwhile, I have done considerably more study into available literature on isolation and the brain and the effects of becoming disconnected from understanding, support and caring and loving connection. There are, I believe, very distinct effects on the mind, thinking processes and the very reality the brain creates when one prone to psychiatric disorders experiences certain types of acute or ongoing isolation (this is not to say those without risk for more severe psychiatric disorders are not affected - I think the evidence is strong that almost all humans would be affected - but the effects manifest themselves differently in those prone to psychiatric disorders such as schizophrenia, bipolar disorder, major depressive and/or anxiety disorders along with several others).

There is, I have observed, a hideous and very difficult to arrest or reverse cycle that takes place - the more one is isolated, the less able they are able to connect with and trust others. The less able they are able to connect with and trust others, the more isolated they become. The more isolated they become the more their minds turn inward giving rise to many symptoms and disordered thinking associated with psychiatric disorders. The more and stronger the symptoms and disordered thinking the less able they are to connect with and trust others and so on and so on. 

Complicating this is the brain's own ability or inability to be self-aware of or understanding of any of these symptoms and resultant behaviours. Various types of delusions and/or denial will be present. Intervention is a very difficult task for family members or friends (if indeed any are present and involved at all). Society at present is not at all equipped to deal with individuals struggling with this cycle.

Clinically speaking it becomes a near impossible tangle to sort out and treat. I have to emphasize once again that while treatments with pharmaceutical drugs may appear to help in the short term, the evidence and track record for long term efficacy is weak and is complicated by potentially very serious side effects from long term use of psychotropic drugs. Helping any individual struggling with this cycle requires much, much more than a simple drug therapy routine, I'm afraid.

All of which I know sounds darkly lacking in hope. And it's true, I must say, after four and a half years of researching and study into the world of mental health and the brain, the big picture does not look at all promising. Many will be lost. 

Yet I do remain brightly optimistic and hopeful on individual levels. It absolutely is possible to overcome this for many and I work daily on ways to see and work on the positive possibilities for any one individual.  

So if you are reading along and all of this strikes a chord for yourself or someone you know and care for who is struggling with this, I can only leave you this - there is hope, there are positive possibilities. We just need to get you there. 

BGE - September 30, 2017

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