Social networks are key to good health. That has some doctors seeking strategies to cure loneliness
Knowing a patient's social connections called as important as knowing their vital signs
At one point, Elaine Dawe's sense of loneliness enveloped her life.
"I was sad all the time. I was lonely. I didn't want to get dressed. I went for a week in my nightgown, didn't wash my hair sometimes for a week-and-a-half," said the 76-year-old Toronto woman.
Dawe is a human face of what the World Health Organization (WHO) recently declared a "global public health concern," in which loneliness has been linked to an increased risk of obesity, dementia, cardiovascular disease and stroke.
In November, WHO launched an international commission to tackle the problem. It is headed by U.S. surgeon general Dr. Vivek Murthy, who cited research that compared loneliness to the equivalent of smoking 15 cigarettes a day.
According to a recent poll of people in more than 140 countries, almost a quarter of the world's population — or about one billion people — feel lonely. The survey wasn't asked in China, meaning the number of people affected is likely even higher.
Loneliness knows no age. Once thought to be a problem of the elderly, a Statistics Canada survey from 2021 found that one in 10 Canadians over the age of 15 identified as being always or often lonely.
Nor does loneliness know boundaries. A recent survey by the Toronto Foundation found the city to be one of the loneliest in Canada, with residents withdrawing and interacting less with each other.
What loneliness looks like in the brain
Many psychologists agree that the pandemic exacerbated our sense of loneliness. However the problem has been building for decades as people moved away from friends, family, and community.
"Many people are no longer reporting that they are belonging to groups," said Julianne Holt-Lunstad, a psychology and neuroscience professor and director of the Social Connection and Health Lab at Brigham Young University in Utah.
She said these include faith-based communities as well as civic engagement or groups that come together to explore hobbies.
Advancements in technology, from online banking to social media, have also made it easier to be alone, she said.
But Holt-Lunstad believes all this disconnectedness flies in the face of how humans are hard-wired.
"Social connection is crucial, and has been crucial, to human survival. When we feel loneliness, that is really our biology really signalling ... much like hunger and thirst."
It also literally changes our physiology.
Before beginning her master's thesis in neuroscience, Kimia Shafighi was part of the McGill University team that in 2020 mapped out what loneliness looks like in the brain.
Using MRI data from 40,000 volunteers of the UK Biobank — a database of genetic and lifestyle samples from 500,000 people in Britain — they contrasted the brain scans of people who considered themselves lonely with people who didn't.
What they discovered was that lonely people showed more brain activity in what's called the default network, a region of the brain known that is involved in reminiscing, ruminating or daydreaming.
According to Shafighi, people who identified as being lonely had the biggest variations in this region of their brain.
"Lonely people might spend a lot more time imagining events from the past and thinking about future social events," said Shafighi.
"This sort of daydreaming, imaginative realm that they create is to compensate for that lack of social interaction."
A stubborn optimist
It took a nasty fall and a trip to the hospital for Elaine Dawe to emerge from her sense of loneliness.
She ended up at Toronto's Mount Sinai Hospital and as part of the intake, identified as someone who was lonely. Dawe agreed to be part of a study that was started by Dr. Jacques Lee, who is the inaugural Schwartz-Reisman Emergency Medicine Institute Research Chair in Geriatric Emergency Medicine.
As a doctor, Lee said he was never taught a single thing about loneliness. He now realizes it's as critical as any other vital sign.
"I've got all of their important biological information, their blood pressure, et cetera, but how are they connected? Who are they with? That's a really important thing that we have to start being curious about."
Lee, who considers himself a stubborn optimist, created two separate studies, the results of which are still being gathered.
The first involved Dawe and a group of others who identified themselves as feeling lonely. Through a program called "Making Art/Making Change," they were each given a box with art supplies. Over 12 weeks, Dawe and the others met by Zoom to show their work and share their stories.
Lee's second study involved volunteers at Mount Sinai who did one-on-one coaching and mentoring of patients. For an hour each week over three months, volunteers like Andrew Taylor used his iPad to connect with someone who didn't have friends, family or activities. Through shared interests, Taylor tried to coax them out of their loneliness.
"I guess I'd like to think that because they agreed to take on this program and agreed to accept an iPad that was loaned to them and to be linked with a stranger, that they're encouraged," he said.
Experts say people can't simply snap out of solitude. They often feel it's their fault, that something is wrong with them — and taking that first step can be a barrier.
But Holt-Lunstad says it can start with small interactions, such as at a checkout counter or coffee shop.
"These kinds of casual encounters with others in our community seem to also be linked to better well-being, a greater sense of community."
Lee agrees, noting there's "a huge long list of things that can work.
"What it is, is coming up with something that's easy to start, that's cost-effective and that's scalable."
For Dawe, who had never before picked up a paintbrush, the program was transformative. The woman who had once travelled the world was finding her way to reconnect with others.
"It felt like I lost hope and I got it back. I was able to pull myself out of it with the coaching and camaraderie of the group of people," she said.
Dawe even reached out to an old friend who she hadn't spoken to in 50 years. The two went out for coffee, spoke for hours and are making plans to get together again soon.
"I still slip back," Dawe said. "It's not a total resurrection but my cup is no longer half-empty or half-full. It's full."
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With files from CBC's Christine Birak