The decline of our mental health during this pandemic
Doctors warn that every medical decision requires a careful risk/benefit assessment. There is no such thing as a totally safe, 100 percent risk-free medical choice. Aspirin can cause bleeding and may have triggered childhood deaths due to Reye’s syndrome. Exercise is generally considered good for your health, but people can hurt themselves by over-training or injure a joint.
With our nation in the midst of a viral pandemic, we must weigh the responses to COVID-19 by comparing the risks with the benefits. The choice was made to quarantine individuals from other individuals. We were mandated to a form of solitary confinement in an attempt to suppress the spread of the virus and prevent illness as well as death. Social distancing, the lockdown of businesses, and face masks are the most obvious ways to accomplish individual isolation, in essence, to quarantine 330 million Americans.
There is some evidence and much debate about the health benefits of our response to the virus. There is also considerable evidence regarding the economic cost of social distancing and lockdown. There is very little discussion about the non-economic costs, the damage to Americans’ health by separating individuals from each other as well as preventing them from engaging in normal day-to-day work and play activities.
By nature, human beings are social animals. What happens when you deny their identity by mandatory face masks? What happens when you take away a necessary element for good health–social contact with others–by required isolation or social distancing? The result is a painful, harmful, sometimes fatal sickness called loneliness. As John and Stephanie Cacioppo wrote, “Loneliness is often stigmatised, trivialised, or ignored, but …[it is a serious] public health problem.”
There is a large body of scientific evidence on the ill effects of enforced loneliness. While the signs may be less obvious than a cough, fever, and trouble breathing, harm to mental health from social isolation is nonetheless very real.
A recent CDC report provides evidence of the hazards to mental health resulting from our responses toCOVID-19. Symptoms of depression have increased 31 percent, stress-related disorders are up 26 percent, and 13 percent have started using illicit drugs or have increased their usage. Actual suicides rather than just the ideation are up as much as 70 percent in Fresno, California. Compared to CDC numbers from last year, all these adverse consequences are three to four times higher.
While the risk of direct harm from the virus is primarily in those with life-threatening comorbidities, the harmful effects of social isolation “are not attributable to some peculiarity of the character of a subset of individuals, they are a result of the condition affecting ordinary people.” Thus, while the elderly are at risk from the virus, everyone is at risk from our responses to the virus.
Furthermore, the danger to the elderly, immune-compromised persons are magnified by the combination of viral illness added to the stress of the isolation response. Family is no longer in contact and even health professionals try to keep their distance, with faces and bodies covered.
Psychologists agree that body language is at least as important in communication as what we express verbally. When your face is covered by a mask, effective communication is diminished. It is worse when the person has mask and shield, gown, and head covering: there is no body language communication. And with face masks, you often don’t know with whom you are speaking.
If a person says, “Get Out!!” with a big facial grin, the exclaiming person is surprised and happy about something that happened. The same words with a harsh tone, set jaw, and angry face are a command to leave. With a face mask, what does “Get Out!” mean?
During the cold winter months, I join a group of other bicycle racers for indoor workouts on our stationary trainers, packed together like sardines in a can. The highly structured exercises are led by instructors who calls out a specific drill, viz., three minutes pedaling in a specific gear at a specific spin rate with right leg only. The sessions last 90 to 120 minutes and though intense and exhausting, they are enjoyable because of a synergy of togetherness. At the end of each session, instructors routinely thank the group saying, “I could never have done this alone in my garage.”
There is energy gained when a group of individuals are in close physical proximity engaged in a common activity. No matter how good the exercise regimen seems when you are riding alone on a Peloton or mimicking an instructor in the Mirror, group energy is missing because you are isolated from others.
The harmful effects of social isolation are not limited to the realm of mental health. In addition to the loss of life from suicide and premature death in the elderly from isolation stress, there is decreased life expectancy in humans. While the mechanism is unclear according to Autumn Glenister, the association is confirmed. Lonely, isolated people die sooner than people in contact with others.
Choosing the best response to the COVID-19 pandemic should include detailed cost/benefit analysis. Much attention has been paid to the reputed health benefits of social isolation with little focus on possible harm to health. There are very real adverse consequences to the mental as well as physical health of Americans produced by a national isolation approach. Insufficient consideration has been given to these costs.
Deane Waldman, M.D. MBA, is Emeritus Professor of Pediatrics, Pathology, and Decision Science; former Director of Center for Healthcare Policy at Texas Public Policy Foundation; and author of multi-award-winning, Curing the Cancer in U.S. Healthcare: StatesCare and Market-Based Medicine.