Were we meant to be alone?

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Credit: Blade Magazine

“Ha, that’s fun!” he said to himself as he looked into the camera, jovially laughing as he honked his air horn at the nonexistent mice he thought may be living in his shelter.

Meanwhile, the audience, myself included, were simply marveling at the extent this man’s beard had grown while he spent two months entirely ALONE in the Mongolian wilderness.

If you’re not sure what I’m walking about, I’m referring to The History Channel’s amazing new show, Alone. In a nutshell, the show takes ten survival experts and drops them off in the remote wilderness, entirely alone. They give them a camera to film themselves and a wireless phone to call into the crew and, “tap out.” How do you win? Last the longest.

The effect of the show is remarkable; very quickly you can observe the mood fluctuations among the participants. Careful, calm experts quickly see the onset of sometimes game-ending impulsivity. Suspicion and paranoia often sets in at the later stages, not unlike the collective psychosis shared by the cast of “Lost.”

It’s impossible to watch the show and not wonder, were we meant to be alone?

The effects of loneliness on the human mind are well documented. Loneliness can both contribute to and perpetuate a depressive episode, and loneliness is one of the number one risk factors for suicide. In Borderline Personality Disorder, one of the key features is an inability to be alone. This manifests as a fear of abandonment/intense interpersonal relationships, difficulties defining your own individual identity, and impulsivity.

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Photo by Serkan Göktay on Pexels.com

The effects of loneliness on dementia risk is one of the most astonishing revelations as we reflect on the effect of isolation on the human brain. Studies have shown that elders who endorsed feeling lonely had a 1.64 higher likelihood (that’s 164%!) of developing dementia than their non-lonely peers. Sadly, millions of older seniors in the developed world interact with absolutely nobody up to six days a week. How does loneliness affect the elderly brain? You can read my article on sleep hygiene and brain functioning here – the punchline is that our brain needs to be used to stay healthy. “If you don’t use it, you lose it.” Our brains are designed to be in relative constant conversation and use, and when people become socially isolated for two long, the brain literally starts to degrade.

What may be more surprising is the effect of loneliness on our physical health. Some studies have shown that loneliness has the same effect on cardiac health as smoking fifteen cigarettes a day! Finally, the effects of loneliness on mortality has been estimated at increasing your risk of death by 29%.

The average family size two centuries ago was 20-30. It wouldn’t be uncommon for that many people to share a small residence. While I am not recommending a return to this social structure, the effects of the decreasing family size in western society cannot be ignored. In more recent times, families that often had 10-12 member (it was not uncommon to have 7-8 children per family). Today, the average household in Canada, and much of the west, is four people and change.

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Photo by Emma Bauso on Pexels.com

As our family sizes decrease, so do our supports. The increasing emphasis in western civilization on individuality and independence has caused many of our traditional social safety nets to degrade. It’s no coincidence that children apprehended by child protection do much better, on average, when there is an extended family member able to take custody of the child.

When I think about life-draining, isolating office jobs, I find myself wondering, “who the fuck doesn’t get depressed?” When I think about borderline personality disorder, and see the impulsivity, and mood fluctuations among the Alone contestants, I find myself wondering if I am simply watching the normal reaction to isolation. When I think about dementia and loneliness, I find myself disgusted, at the collective failure of our society to embrace the people who once stood before us.

I don’t think any of us were meant to be alone.

Editor’s note: Am I saying Borderline Personality doesn’t exist? No. It’s real, and can be serious. As with all psychiatric illnesses, social context matters, and people who have Borderline Personality may not necessarily find they would have had the same struggles in social functioning if our social structure was a little different!

Dr. Travis Barron is a resident physician in Toronto, Canada.

He’s biting again

“Mr. V is biting again.”

“God, what are we going to do with him?”

“I don’t know, but he’s getting too much to manage…”

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Photo by Pixabay on Pexels.com

Dementia is a debilitating disease. It creeps up slowly, crouches for attack, and seems to suddenly wipe our lives from right beneath our feet.

Many of us have had loved ones stricken by the disease, and have watched in muted horror while the person we knew vanishes, as we wonder, “if it’s this bad for us, what must it be like for them?”

I was working in an emergency department in Ontario, Canada, when a gentleman, Mr. V, was brought in from his place of residence when staff determined he was too agitated for their care. On arrival, he could not speak beyond muttering a few nonsensical words, and would randomly grab at staff as they walked by, seemingly on a completely random basis. The staff at his residence confirmed he had a history of dementia.

These sort of patients are difficult for a variety of reasons. The inability to communicate often results in subtle needs going unmet, leading to aggression. They require a high level of nursing resources to manage. And the fact is, our healthcare systems in Canada (particularly emergency rooms) are not equipped to properly care for people with dementia (in fact, in many ways they are perfectly equipped to exacerbate symptoms of aggression in dementia).

I began to work with Mr. V and I immediately noticed his age – he was in his late fifties. This is a fairly young age to develop dementia and immediately the differential changes. Could he have some rare form of genetic Alzheimer’s, which can affect people at  that age?

The second thing I noticed was has last name, changed for the purposes of this blog. The spelling on the name was immediately suspicious for someone of Sri Lankan descent. I phoned Mr. V’s emergency contact, and my suspicions were confirmed. Mr. V had a long history of alcohol abuse, and had subsequently developed a dementia. He had been various degrees of under-sheltered for the last number of years. He had immigrated to Canada some decades prior, as a refugee. Mr. V was Tamil and had been a victim of unnamed trauma during the Sri Lankan civil war.

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Credit: Alternative Press

I won’t go into details here, but the Sri Lankan civil war (1983-2009) was your typical civil war cocktail of genocide, torture, rape, and any number of unspeakable deeds. The effects of civil war and genocide on the human brain are well documented and not easily conceptualized. Obviously it has a tremendous impact on people, Mr. V being the latest example of a casualty of the war. The United Nations recently reported that one in five individuals in conflict zones suffer from a major mental illness, at any given time.

What struck me about this story was how succinct it was. The clear relationship between this man’s trauma, alcohol use, and dementia. The story isn’t always that clear. But there’s always a story. Next time you meet someone with an alcohol problem, dementia, or any other mental illness, stop and think, there’s more to the story.

 

Editor’s note: What happened to Mr. V? We uncovered an acute medical problem that was easily treated, superimposed on his dementia, and he returned to his baseline after a couple of days of treatment!

 

Dr. Travis Barron is a resident physician in the Department of Psychiatry at the University of Toronto in Toronto, Canada.