A Cure for Loneliness
By: Clarke Southwick
Tags: Healthcare, Community, Medical, Health, Doctors

The following is adapted from The Community Cure by James Maskell.

As a first year resident in 1996, Dr. Jeffrey Geller began to feel like there had to be more to health than just the nuts and bolts of diagnostics and drug-based treatments. His medical career started like most others: with a deep-seated passion for helping people. As a resident, he noticed that patients received the same standard of care, but their outcomes varied significantly. Some patients would arrive with a stubbed toe, for instance, and feel as though they were completely disabled, with their world crashing down around them. Other patients with the same stubbed toe would continue on with their days happily and healthily, as if it were a minor disruption or inconvenience.

Dr. Geller started to wonder why some people portrayed resilience in the face of a medical issue while others completely fell apart.

With each interaction, it became more obvious that the difference between the two groups stemmed from their support systems. People who had support felt engaged and didn’t suffer as much with their illness. Those who didn’t have support felt alone in their struggle.

Loneliness and lack of social support were some of the main determining factors of the variants in the health outcomes he witnessed.

Dr. Geller conducted award-winning research to back up his observations: people who are lonely visit health centers four to six times more often than those who are not, and visit emergency rooms two to three times more.

According to a study from the AARP Public Policy Institute and Stanford University’s Center on the Demography and Economics of Health and Aging, people who were lonely were more likely to have extended hospital stays, more expensive treatments, and need the support of skilled nursing facilities in lieu of support systems to aid in at-home rehabilitation. The participants in the study who were socially isolated had a 50 percent higher risk of death: 35.3 percent of isolated individuals died within six years of the initial interview, whereas 24 percent of those who were connected and 22.3 percent of those who were well connected. Overall, the study found that socially isolated individuals had a 31 percent higher risk of death than those who were not socially isolated.

It’s not just mortality, loneliness and isolation is linked to lowered immunity and increased risks for common killers — specifically a 29 percent higher risk for heart disease, 32 percent for stroke, 25 percent for cancer, and 40 percent for Alzheimer’s. Another paper on “Loneliness and Social Isolation as Risk Factors for Mortality” found a 26 percent increased likelihood of premature mortality.

The data is unfortunately not surprising, nor is it unknown by practitioners. When Dr. Geller shared his observations from the late 90s, and even when I talk about it now, practitioners are generally in agreement: loneliness is bad for you and significantly impacts health outcomes.

Yet the usual follow-up response is that loneliness doesn’t have a billing code. Yes, we acknowledge it’s a problem, but if we can’t bill for it we can’t treat it within the current system. This is true for psychologists, mental health professionals, and medical professionals alike. All parties are on board, but haven’t determined a fiscally — and logistically — sound solution to the epidemic of loneliness.

As is typical for a first-year intern, Dr. Geller was swamped with work and severely lacking in sleep. Though he didn’t have a lot of free time on his hands, one of his patients, Eduvijes, convinced him to meet her at the library, where she and a group of friends met to discuss their health issues. They were mostly uninsured and intentionally formed this group to support one another. They called it Si Tú Puedes, which is Spanish for “yes, you can.”

Dr. Geller taught the group about health, and they in turn taught him a bit of Spanish. After some time, he said, “it became clear to me that the relationship with people was so much more important than the actual information I was giving them.” The format of Si Tú Puedes became the model for the initial group visits.

The first group Dr. Geller started in 1997 and 1998 was ostensibly formed to treat diabetes. He really wanted to cure loneliness, but he knew that wasn’t something he could advertise. “If I were to say, ‘I’m starting a group for loneliness,’ people wouldn’t come.” Knowing a group founded on loneliness isn’t most people’s idea of a good time, he needed to find another way to get people in the room. It had to be based on a health issue that they wanted to improve and wouldn’t be ashamed to discuss in a group setting.

He secured funding through the CDC and approval from an institutional review board at the University of Massachusetts, which would allow him to research how group visits impacted the health outcomes of patients with diabetes. He didn’t bill for the visits. Quickly, and not surprisingly, he witnessed how loneliness was quickly cured when people gathered together. But what about diabetes or other chronic diseases?

For three years, the group met regularly, surmounting a few challenges along the way. Located in an economically disadvantaged community, most of the patients were immigrants who struggled not only with communication barriers, using English as a second language, but with all the other determinants of health. In one of the first meetings, Dr. Geller talked about how eating rice is bad for diabetes. As you can probably imagine, this did not go over well with the group of mostly Hispanic individuals.

Dr. Geller admits, “I didn’t quite have the right curriculum off the bat,” but people kept coming because they liked each other and the group dynamic.

After three years, participants enjoyed it so much they asked to bring their families. They felt empowered, and went from being participants to being leaders.

Since the guidelines of the CDC study couldn’t accommodate it, Dr. Geller allowed them to organize a second meeting to take place in the same space. They didn’t have a budget for Tai Chi lessons or cooking classes, so Dr. Geller asked what they wanted to do with that time. The participants said salsa dancing. “I can’t teach you that,” Dr. Geller said. “That’s okay,” the group told him, “we can teach you.”

And their health outcomes? “People’s loneliness improved, people’s depression improved, they lost weight. […] Blood pressure reduced by 5–10 points, and hemoglobin A1C also reduced, which is a measure of blood sugar and diabetes.”

Dr. Geller was able to take the idea that treating loneliness positively impacts health outcomes and turn it into actual medical care that could produce better results than most medications on the market.