Thursday, 22 September 2011

Is loneliness bad for your health?

A few weeks back I posted an entry on hikikomori, a 'condition' characterised by withdrawal from social life and the active pursuit of isolation for a period of 6 months or more. The gist of the post was that this phenomenon whilst having a cultural connection to places like Japan and Korea, might not necessarily be an exclusively socially-mediated condition as per the various explanations put forward for it but rather be reflective of other biological and/or psychiatric processes also involved.

This post got me thinking about lots of things, most notably what happens to the physical and mental health of those people undertaking hikikomori and whether the lack of physical contact might be detrimental to them and their overall health. The answer: probably, but its complicated. The New Scientist recently carried an interesting opinion piece about loneliness and how aside from the the psychological aspect to it, loneliness might be have some physiological effects also, at least according to John Cacioppo of the University of Chicago.

As with articles such as this one, there is always a quote which is designed to grab your attention. In the case of Prof. Cacioppo it is this one "curing loneliness is as good for your health as giving up smoking". Mighty big words indeed. But does the literature back him up and if so, what are the implications for states like hikikomori? Indeed what about the social aspects of autism spectrum conditions; are there implications to be had?

Whilst not wishing to turn this into some kind of mega-post on loneliness and physical health, there are a few studies to suggest some correlation between health and loneliness. I say suggesting some correlation, but as with many things, people don't just live in a vacuum, so it is difficult (impossible?) just to say that loneliness causes this, that or the other. Indeed, as per the paper by Shankar and colleagues highlighted above, loneliness may not directly affect health, but rather health behaviours, so things like smoking and exercise and diet. They do however make an interesting differentiation between loneliness and social isolation and note some individual correlations based on social isolation.

Cacioppo is not without some research interest in this area. As per the New Scientist article, a recent study of his indicated some interest genetic features potentially attached to loneliness in areas of stress and inflammation (inflammation is a key feature of some of his other work) suggesting some evolutionary mechanisms at work. For me the most tantalising aspect to this work is the suggestion that our behaviour, our biochemistry and our genes work in unison; so behaviour can guide our biochemistry much like the suggestion that it might guide our gut bacteria also.

As to autism spectrum conditions is there any overlap with this line of research? Well I suppose it depends on where you look. Outside of language, problems with social interaction is one of the primary features for a diagnosis of autism, although like many things, this varies from person to person. Certainly loneliness and feelings of social isolation are present for quite a few people on the autism spectrum, particularly adults, but the question of whether this is related to their autism or partly mediated by a lack of opportunities to engage in social activities like employment, social networks (not the computer variety), etc is fundamental to any question of causation.  As to the physiological correlates, well autism does have more than a passing relationship with inflammation in its various forms, but would it be too much to suggest that this is 'caused' by social isolation and loneliness outside of the myriad of other possible correlates?

Given the number of times I have used a question mark in this post, readers can perhaps see that this is an area requiring a lot more thought and research and I have very few answers to offer. What I perhaps would like to see more research on is how the social interactive side of autism links into loneliness, links into other health behaviours, links into things like depression links into inflammation. If (and it is still a very big 'if') there was some possible connection between these elements, can we intervene and would a doctor ever be able to prescribe social interaction and community as a 'cure' for loneliness? Would every person with autism necessarily want such a prescription?