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The Epidemic of Stress and Loneliness
PHYSICIAN HEALTH AND WELLBEING
The Epidemic of Stress and Loneliness
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Despite widespread electronic social media, many people feel isolated. WE’RE ALL IN THIS TOGETHER
By John A. Patterson MD, MSPH, FAAFP
US public health officials are alarmed by a growing mental health epidemic of stress, anxiety, depression, loneliness, substance abuse and suicide. Britain has created a Minister of Loneliness to tackle this ‘sad reality of modern life’ and its $3.5 billion annual drain on UK employers. Vivek Murthy MD is the 21st US Surgeon General. He was also the 19th Surgeon General under president Obama. He is focused on loneliness and stress as public health priorities, saying ‘loneliness is associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes
A change in culture is needed.
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a day.’ In early 2020, before the COVID pandemic, he presciently published a book titled Together- The Healing Power of Human Connection in a Sometimes Lonely World.
Authentic social connections
Despite widespread electronic social media, many people feel isolated. This was happening before the COVID pandemic and has gotten worse. Murthy says “a quarter say they do not have anyone in whom to confide about a personal problem.” Clearly, online social networks can be helpful but are not the kind of support required to combat emotional isolation and its adverse health effects. However, though in-person classes and meetings are curtailed or cancelled, technology also provides access to meaningful interpersonal support from peers and groups with which we are affiliated in ways that are meaningful and rich in purpose and values. Technology connects patients and providers, teachers and students, friends and families- as well as continuing education, culture, art, information, music, humor and endless opportunities to learn, grow, connect and serve those in need.
Managing stress
Serious psychological distress and loneliness can be caused by social isolation, fear of contracting COVID-19, financial strain, job insecurity, home schooling, uncertainty about the future, political polarization and our increasing violence and ‘bad news.’ This can lead to serious mental illness, suggesting acute distress during COVID-19 may cause longer-term psychiatric disorders. Stress and resilience are major research topics at NIH, the Veterans Administration and the Department of Defense. They are creating a research network seeking non-pharmacologic approaches to chronic pain and PTSD among active duty military and veterans. They focus on traditional military camaraderie as well as individual mind-body practices such as art, movement, faith, prayer, mindfulness and meditation.
Murthy says: “Stress is not evidence of weakness or a personal failure but a reality of life and we have to collectively figure out how to address it… Supportive relationships, exercise, sleep and meditation can benefit children, adults, workplaces, homes, schools, public health and medical providers and their patients…A change in culture is needed. Health professional training must emphasize the importance of self-care, stress management and resiliency training. We have enough research to justify this shift already and more is needed to weave emotional
Headspace App:
Screen image source www.headspace.com
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well-being into the curriculum and patient care in hospitals and clinics.” Recognizing this, the AMA now provides members a 2 year subscription to the Headspace meditation and sleep app. The Department of Homeland Security promotes mindfulness and meditation to its employees.
Importance of physical exercise
Murthy explained that regular physical exercise has been shown to relieve stress and have an anti-depressant effect for many people. Exercise-related increases in endorphins play a role in this positive emotional side-benefit of exercise. Happily, the choice of physical activity can be highly personal. Choosing an activity one enjoys increases the likelihood of regular practice and long-term commitment. Yoga, gardening, aerobics and walking illustrate the widely accessible range from which one can choose to reduce stress and promote resilience. Having a buddy with whom to exercise can help keep us motivated and combat loneliness.
Emotional well being
Murthy began his tenure as Surgeon General with a ‘listening tour,’ traveling extensively to U.S. cities and small towns and was struck by a common theme. He saw people in pain everywhere—pain from medical conditions, financial uncertainty, violence, stress of daily life and work—and the pain and grief of losing family to the opioid crisis. Regardless of geography, urban or rural residence, race, age, beliefs, background or political party, there was universal recognition that stress was overwhelming Americans’ ability to cope. Among lawmakers and citizens alike, the desire for emotional well-being was the one issue people everywhere agreed upon. He ended his tour convinced that addressing stress and emotional well-being is critical to maintaining our individual health and the health of our society.
Murthy passionately argues for a societal, public health perspective on stress and emotional well-being. “When we have stress and emotional discord that prevent us from
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– Vivek Murthy MD, the 21st US Surgeon General | 19th Surgeon General under president Obama
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coming together and talking about solutions to big problems as a country, that affects us all…We know from data that people who say they have a best friend at work are much more likely to stay in that job, be productive and not burn out… I believe we can build a country that is more compassionate and that is more kind—recognizes that our emotions, when properly cultivated, are our greatest source of strength.”
Meditation
Brown University School of Public Health recently created a Mindfulness Center to apply evidence-based behavioral approaches on an individual and population scale. Murthy encourages his staff to practice meditation together and is impressed with the support and rapport this creates. Just as the reasons for this epidemic are complex and multifactorial, our prevention and treatment approaches must also be varied and tailored to the educational, cultural, social, religious, financial and medical demographics of affected individuals and groups. Murthy touts the benefits of mindfulness and meditation, including practices that increase compassion, empathy and kindness, for ourselves and for others.
Psychotropic medications are an essential, and sometimes life-saving, treatment option. But we will not medicate our way out of this epidemic. Health professionals and patients are also concerned about the unintended dangers of polypharmacy and an over-medicated society. These dangers are more common in the elderly, who are more likely to have multiple chronic illnesses- but people of all ages are vulnerable to the medication burdens of cost, side effects, drug interactions and the sense of dependency on pills.
Meditation can be practiced alone, with a meditation buddy or a group. Dr Patterson offers a free weekly group class as well as an 8 week intensive mindfulness based stress reduction course (MBSR). Let’s help ourselves and each other manage this epidemic of stress and loneliness. In the process, we can gain confidence prescribing lifestyle recommendations for our family, friends, colleagues, patients, communities, society and planet.
Resources • Together: The healing power of human connection in a sometimes lonely world, Vivek Murthy MD, Harper Wave, New York, NY, 2020 • National Institutes of Health webinar, The Public Health
Consequences of Stress in America, NIH Director Francis
Collins MD interviews US Surgeon Vivek Murthy MD Sept 7, 2017, https://www.nccih.nih.gov/news/events/a-nationunder-pressure-the-public-health-consequences-of-stress-inamerica • Stress in America- 2017 Snapshot: Coping with Change,
American Psychological Association, 10th edition, https:// www.apa.org/news/press/releases/stress/2016/coping-withchange.pdf • American Medical Association member Headspace benefit, https://www.ama-assn.org/practice-management/physicianhealth/how-headspace-helps-physicians-medical-studentstame-stress • Brown Center for Mindfulness, https://www.brown.edu/ public-health/mindfulness/home • US Department of Homeland Security, https://www.dhs. gov/employee-resources/mindfulness • 12 Mindfulness audio sessions Dr Patterson has created at Mind Body Studio https://www.mindbodystudio. org/?page_id=1594
LMS 2022 LMS Officer Slate will be closed to further nominations at the LMS Virtual Meeting on October 12, 2021 and virtual election November 1–5, 2021.
