Susan J. Noonan - Reconnecting after Isolation: Coping with Anxiety, Depression, Grief, PTSD, and More

after Isolation

Coping with Anxiety, Depression, Grief, PTSD, and More

Susan J. Noonan, MD, MPH

JOHNS HOPKINS UNIVERSITY PRESS

Baltimore

Note to the reader: This book is not meant to substitute for medical care of people who have depression or other mental disorders, and treatment should not be based solely on its contents. Instead, treatment must be developed in a dialogue between the individual and their physician. My book has been written to help with that dialogue.

2022 Johns Hopkins University Press

All rights reserved. Published 2022

Printed in the United States of America on acid-free paper

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Library of Congress Cataloging-in-Publication Data

Names: Noonan, Susan J., 1953 author.

Title: Reconnecting after isolation : coping with anxiety, depression, grief, PTSD, and more / Susan J. Noonan, MD, MPH.

Description: Baltimore : Johns Hopkins University Press, [2022] | Series: A Johns Hopkins Press health book | Includes bibliographical references and index.

Identifiers: LCCN 2021046919 | ISBN 9781421444222 (hardcover ; alk. paper) | ISBN 9781421444239 (paperback ; alk. paper) | ISBN 9781421444246 (ebook)

Subjects: LCSH: Social isolationPsychological aspects. | Loneliness. | Interpersonal relations. | Social interaction.

Classification: LCC BF575.L7 N66 2022 | DDC 302.5/45dc23

LC record available at https://lccn.loc.gov/2021046919

A catalog record for this book is available from the British Library.

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A [mental] health charity called the Bearded Fishermen has begun a nightly suicide-prevention patrol in and around Gainsborough, [England,]... looking for people in crisis due to the coronavirus pandemic. Founded by two men who have firsthand experience with depression, anxiety, and suicide attempts, they are part of Night Watch, an initiative to monitor known suicide hot spots in the area, working with emergency responders and the community. There has been a measurable increase in calls for support and their crisis services as the community struggles through the coronavirus pandemic.

The situation in the Gainsborough area reflects the larger mental health strain across Britain [and the world]... Research has shown a rise in reports of loneliness, a particular concern for young people, difficulties for those with pre-existing mental health issues and an increase in reports of suicidal ideation. The impact of the pandemic and its effectlockdowns, an economic downturn and social isolationon mental health... could be felt for years to come.

Megan Specia, New York Times, December 6, 2020

I was greatly honored when asked to write this book on the mental health consequences of social isolation using our collective experience of the COVID-19 pandemic as an example. Digging down deep and writing about such a sensitive topic would not have been possible without the support of those in my life who keep me afloat. I continue to owe limitless thanks and appreciation to Drs. Andrew Nierenberg, Jonathan Alpert, and Timothy Petersen and to the close friends and family who have sustained me throughout.

No book is published alone. I want to acknowledge the openness, perception, and unique contributions of Drs. Thea Gallagher, Wendy Silverman, Douglas Katz, and Sheila Rauchtheir real-time clinical input has greatly enhanced this manuscript.

Most important, the insightful staff of Johns Hopkins University Press have rightfully earned my profound gratitude and praise, including Joe Rusko, Juliana McCarthy, Melanie Mallon, and others. They guided me in addressing this topic in a uniquely perceptive, meticulous, and thoughtful manner.

Reconnecting after Isolation

Weve all been there at one time or anothercaught in the sense of being alone and far apart from others, leaving us feeling lost, anxious, or depressed. This is commonly known as social isolationphysical separation and removal from the friends and family who know us, and on whom we can rely and trust, causing us great emotional distress. If any of this strikes a familiar note, this book is for you.

We werent meant to live this way, in isolation. We were designed to be social beings, wired to seek out relationships with others and rely on them for communal protection and self-preservation, as Dr. Vivek Murthy reviews for us in his book Together: The Healing Power of Human Connection in a Sometimes Lonely World (2020). He reminds us that our earliest ancestors learned to recognize who around them is safe and trustworthy and who is a threat to be avoided. Ancient tribes and villages banded together and were there for one another in obtaining food, shelter, support, and protection, as well as in providing a community to help raise children and care for seniors. Forming relationships is a fundamental human need, an inborn matter of well-being and survival, and its essence continues to this day.

You can imagine that not having essential personal and social connections can feel devastating to a person. Social isolation puts us on guard, looking for constant threat; increases our vigilance; and affects our sense of safety, belonging, vulnerability, and anxiety. Its an unfamiliar and unpleasant experience that may result in physical and mental illness such as heart disease, stroke, obesity, sleep disorders, premature mortality, depression, anxiety, post-traumatic stress disorder (PTSD), cognitive decline, and other conditions.

Many factors can contribute to social isolation and loneliness. For example, in modern life we have drifted away from living in villages and small towns where the entire community looks out for and nurtures each other, and that has resulted in rising levels of seclusion and loneliness in our society. Many of us now live in big cities and may be far away from family, cautiously leaning on a few new, untested friends for support. In addition, our lives are affected by life transitions and disruptions; general medical events; race, ethnicity, and cultural issues; as well as preexisting mental health conditionsall of which can contribute to a feeling of isolation.

One example of events causing isolation in our current era has been the recent COVID-19 pandemic (caused by severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2). COVID-19 has caused a worldwide health crisis that began in December 2019 and rapidly spread, with a major impact on us personally, medically, emotionally, socially, and economically. The threat of infection with this potentially lethal virus has caused us to change the way we live, significantly disrupting the lives and daily routines of all persons, whether or not infected. Its a cause of monumental stress, newfound fear, and anxiety in many. In response, most of us have dutifully remained at home, worked remotely when possible, homeschooled our children, wore face masks, followed handwashing guidelines, kept a physical distance from others, and limited the number of people who gather in any one place. In other wordswe intentionally