Karaoke Highs, Celine Dion Vibes, and Exploring How Feeling (vs. Being) Alone, Might Influence Health/Well-Being (Part III)

A Confession

Okay, deep breath – it's confession time. I'm a card-carrying member of the Celine Dion fan club. Ok, I don’t literally have a card - they’re still in the process of issuing those, I suppose, but I am a big fan. I might not fit the mold of a typical fan, but I have very eclectic tastes. It's a legacy, really. Picture this: a car, my mom at the wheel, blissfully tuning into Celine's power ballads, setting the soundtrack for a casual 5-10% of my childhood car rides. Through osmosis, I developed a deep, almost mystical appreciation, for Celine’s sky-high notes and dramatic crescendos. And then came her 1997 Grammy show appearance, which I watched with my family when I was a kid, and it was a revelation. Seeing her perform live, beyond the confines of our car's CD player, was like watching a virtuoso in her element. I was mesmerized, truly understanding for the first time the sheer force of her talent.

Scaling Vocal Everest at Karaoke Night

Now, let’s talk 'All By Myself,' a Celine Dion magnum opus, where in karaoke rooms across the world brave souls attempt to climb the Everest of high notes, often leaving the audience half amazed, and half concerned for their vocal cords. It’s like a musical emotional rollercoaster. You start off calm, collected, a bit nervous with anticipation. And by the end, you're channeling your inner Celine, hitting notes that could get you a noise complaint from neighbors. As you reach those vocal peaks, you start questioning your life choices – specifically, why you ever thought picking this song was a good idea. Because Celine's voice is like that of a high-flying eagle soaring in the blue sky with poise and purpose. And let's be honest, most of our voices are more like that of an enthusiastic NYC pigeon, cooing along, and getting lost in that city's labirynth of a subway system (I'm from New York, by the way). But that's the true charm of karaoke, isn't it? It's like that time you decided to cut your own hair after watching one too many DIY videos during the COVID-19 lockdowns, or when you volunteered to cook all of Thanksgiving dinner for the family without ever having roasted a turkey before. None of these adventures were nearly as easy as they first seemed.

DJ Subconscious: Dropping Celine Dion Beats

In acts of rebellion, when I’m doing research on the topic of loneliness/social isolation (or any research, really), my brain sometimes starts wandering into random territories. On lucky days it veers into the realm of scientific ideas that shed new light on the topic at hand, other times it thinks about relevant images I saw throughout life, sometimes it autoplays the chorus from Celine Dion’s 'All By Myself.' It's like my subconscious is a DJ with a flair for irony. Let me tell you about some of this research we’ve been doing, but first there’s an important distinction to make between loneliness and social isolation.

Solo Boating at Celine's Ocean Concert: Riding the Waves of Social Isolation and Loneliness

Before we dive in, let’s untangle the spaghetti of terms because there are both objective and subjective aspects to social (dis)connectedness, and they aren’t the same thing.

Social isolation is the objective lack of social interactions (e.g., smaller social network). Imagine this: Celine Dion is giving the performance of a lifetime in the middle of the ocean, belting 'My Heart Will Go On' with Titanic-level passion. There you are, alone in a boat, bobbing to the rhythm, while everyone else is having a mesmerizing time with their friends on other boats, clinking glasses and swaying together. You can hear the music, and see the distant lights, but your social GPS led you to the solo spectator section of this nautical concert. This scene also evokes the solitary figure in Hopper’s 'Nighthawks,' sitting alone at the counter, surrounded by the city but isolated in his own silent world (its the painting at the start of this post, one that I started with but totally forgot about until the very end - so I'm trying to weave it in here again). Also, when thinking about this painting again, I imagined this lone soul in the modern era - with a smartphone in hand of course. So instead of contemplating the quiet of the night, and perhaps beginning to introspect, in today's day and age he might be lost in the endless scroll of social media. Sipping coffee with one hand and swiping through a parade of videos, memes, and sensational news headlines with the other. So his isolation is broken not by the company of others, but by the relentless pings of virtual distractions, offering quick dopamine hits and a mirage of social connection that can be as transient as city lights.

Loneliness, on the other hand, is the subjective perception of feeling socially disconnected. It’s like finding yourself in an alternate universe, where you’re still at an epic Celine Dion ocean concert. However, this time you’re in the midst of all your friends on a big boat. Everyone else is lost in a 'Power of Love' trance. And you? Amidst a sea of friends, you feel like your emotional radio is somehow tuned into EDM instead of power ballads. You're physically in the midst of friends, but emotionally, you’re miles away from the heart-thumping action. This mirrors the couple in 'Nighthawks' who, despite their physical closeness, seem engulfed in their own bubbles of loneliness, disconnected from each other as much as from the outside world. Or at least, that's one of several interepretations I had when observing the painting in Chicago. I never finished the series, but the couple reminded me of Don and Betty Draper from the early seasons of "Mad Men" - often trying to embody the facade of a perfect couple, while harboring deep emotional disconnect.

Both these objective (social isolation) and the subjective (loneliness) aspects of social connectedness are important. And both are influenced by, and also shape, our health and well-being.

The Hidden Costs of Loneliness and Isolation

Joking aside, growing research shows that loneliness and social isolation are each associated with an elevated risk of: psychological distress (e.g., depression), dysregulated biologic functioning (e.g., allostatic load), chronic conditions (e.g., cardiovascular disease), and premature mortality. Further, the economic burden of weaker social ties is substantial and rising. In response, governments, businesses, and community groups are trying to tackle loneliness and social isolation in various innovative ways. They're thinking up interventions and policies, like using cognitive behavioral therapy to combat loneliness and creating programs to boost social interaction for those who are isolated – at scale. The goal? To make positive waves and ripple effects across communities. But here’s the catch: it's tricky to figure out whether to focus on loneliness, social isolation, or both. Getting this right could be crucial for making these efforts effective.

Decoding Loneliness and Social Isolation Research: A Tango More Complex Than Flamingo Dance Moves

Some studies have looked at the loneliness vs social isolation saga. But very few have been able to look at how changes in loneliness and social isolation are associated with a range of health and well-being outcomes. Further, its often very difficult to compare findings across studies. It’s something like trying to compare apples with, well, lets just say flamingos. Every study is often doing its own flamingo dance – different populations (e.g., Chilean Flamingos, American Flamingos, etc.), different analytic methods, different covariates, different follow-up periods, different ways of assessing loneliness and social isolation, etc.

Twinning with Data

Therefore, we tried standardizing everything. Same population, same analytic method, same covariates, same time period, same assessments, same everything – kind of like dressing baby fraternal twins (in our case loneliness and social isolation) in identical outfits. This approach of standardizing our research methods allowed us to draw direct comparisons between loneliness and social isolation.

In our paper that was recently published in Social Science and Medicine–Population Health, we analyzed data from about 13,752 people in the Health and Retirement Study. A nationally representative dataset of people aged >50. We assessed loneliness and social isolation at baseline, and evaluated how changes in these factors were associated with changes in over 30 health and well-being outcomes. We used various methods to try and provide evidence for causal inference and those methods have been described elsewhere (for more info, see a fascinating paper that Tyler VanderWeele wrote called “Can Sophisticated Study Designs With Regression Analyses of Observational Data Provide Causal Inferences?” in JAMA Psychiatry).

Loneliness vs. Social Isolation: The Health/Well-Being Impacts

What did we find? A sea of interesting null results, 12 null results for loneliness, and 17 null results for social isolation. We also observed that both loneliness and social isolation were associated with several physical health outcomes and health behaviors. Further, both loneliness and social isolation were associated with several psychological factors including decreased life satisfaction, positive emotions, optimism, purpose in life, and increased depression.

Intriguingly, social isolation emerged as a more substantial predictor of increased physical health problems (e.g., increased risk of physical functioning problems) and mortality risk, while loneliness demonstrated a more pronounced influence on psychological well-being outcomes. Overall, the results suggest that loneliness and social isolation, while related, exert equally critical, but distinct imprints across diverse aspects of health and well-being.

Therefore, it appears both social isolation and loneliness influence these outcomes, but their degree of influence varies depending on the outcome. We also controlled for social isolation and loneliness in all of our main analyses. And we observed that each had unique effects that were independent of one another.?

Wait, Am I Lonely?

Great question! Now, this loneliness quiz below won’t be as amusing as Buzzfeeds 'What Type of Potato Matches Your Personality' or a 'Which Cheese Are You?'* But buckle up, because we're about to go from the snack aisle to the self-discovery aisle.

*Astonishingly, and for reasons unknown to science, I finally uncovered my true identity – I’m a Scalloped Potato and a Swiss Cheese – what a relief!

These 5 questions below from the National Institutes of Health (NIH) are the result of, much, much more serious and rigorous research. And it can help assess your level of loneliness. While this isn't your typical light-hearted quiz, recognizing and assessing your own feelings of loneliness is an important step towards nurturing mental health and strengthening your social connections. It’s like choosing a documentary over a sitcom – less entertaining perhaps, but sometimes just the dose of reality needed. Also, I chose not to include specific scoring thresholds here, to emphasize personal reflection over quantitative categorization. So please take a minute or two, and try this scale out below.

Are you feeling lonely? You’re not alone. A recent survey from Gallup, Global State of Connections Survey, shows that loneliness is a global issue, with almost 25% reporting feeling fairly or very lonely (Gallup, 2022).

By the way, there are other excellent loneliness and social isolation scales out there, but most have copyrights, and this one above from NIH is intended for public use.

Lonely Like a Cave(wo)man: The Evolutionary Theory of Why We Crave Company

Pioneers of loneliness research – the Cacioppo’s from the University of Chicago – said this about loneliness: “Hunger, thirst, and pain, for instance, have evolved to prompt an organism to change its behavior in a way that protects the individual and promotes the likelihood his or her genes will make their way into the gene pool. We have proposed that the awareness of loneliness evolved to serve as a signal that one’s connections to others are frayed or broken and to motivate the repair and maintenance of the connections to others that are needed for our health and well being as well as for the survival of our genes.” This theory suggests that loneliness isn't just an arbitrary burden. It acts as a critical alert, much like hunger or thirst, nudging us to start/preserve/repair vital social bonds. And this in turn enhances our overall health, and even survival. Therefore, experiencing loneliness should be viewed not with stigma, but as an important and natural signal for action – just like hunger and thirst are.

So, What Can be Done?

This post is already getting too long. However, in the next post I will discuss the 3 C’s (Confidence, Connection, Community), which is a framework (one of many) that can be used to reduce loneliness and enhance friendships. It was created for the healthcare system, but is also broadly applicable. It’s a framework that we created after brainstorming with leaders and veterans at AARP (largest older adult advocacy group in the U.S.), UnitedHealthcare (largest U.S. health insurance company with deep expertise in healthcare delivery, benefit design, financing, operations, and marketplace incentives), Mercer (#1 human resources consulting firm that shapes employee wellness program throughout U.S.).

Here’s a preview below:

Behind the Laughter: The Serious Side of Studying Loneliness and Social Isolation

While I may sprinkle humor in these posts, the essence of this research is anything but light-hearted. It touches on a painful universal human experience, one that many of us have navigated at one time or another. As we move through our busy lives, let's not forget the real faces behind these statistics – our neighbors, coworkers, loved ones, and even that stranger we pass by. They all have their stories of solitude, just like us. It's a reminder to stay connected, empathetic, and aware that beneath the surface, we're all seeking that same sense of belonging. Remember, reaching out for support or connection is a sign of strength, not weakness. Whether it's joining a community group, talking to a therapist, or simply sharing your feelings with a friend, (almost) every step towards connection is a positive one, fostering a path toward understanding and camaraderie. If you want to understand why I say "(almost)," please read my prior post. More next time.

*As you reach the end of this article, imagine - Celine Dion's 'Because You Loved Me' is gently playing, and fading into the background. Because nothing says 'conclusion' quite like a power ballad. Also, I think this song can be about anyone, not just a partner*

References:

-Cacioppo, J. T., Cacioppo, S., & Boomsma, D. I. (2014). Evolutionary mechanisms for loneliness. Cognition & emotion, 28(1), 3-21.

-Gallup. (2022). The Global State of Social Connections.

- Hong, J. H., Nakamura, J. S., Berkman, L. F., Chen, F. S., Shiba, K., Chen, Y., ... & VanderWeele, T. J. (2023). Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach. SSM-Population Health, 23, 101459.

#socialconnections?#loneliness