By Grace Chiang
Solitude vilifies, isolation kills.
——Joseph Roux
Social isolation and loneliness are growing realities with devastating physical, mental, and emotional consequences, but they are distinct concepts. The terms are neither synonymous nor equivalent. Social isolation is an objective state, whereas loneliness is a subjective experience.
The current theory is that social isolation triggers a primordial response (essentially, flight or fight) that leads to chronic inflammation if prolonged. Chronic inflammation then leads to a variety of negative health outcomes.
In the midst of plenty
Social isolation can be triggered by long-term illness, disability, lack of transportation, unemployment, or economic hardship. Isolation can mean being home-bound for a lengthy period, having no access to services or community involvement, and with little or no communication with other people. Particular attention should be paid during transitional moments — around the time of retirement, loss of loved ones, or changes in physical abilities.
Community-based interventions such as the village movement are new models aimed at decreasing social isolation. Ageing residents form an organization to provide access to services. These services, such as daily-life assistance, health programs, social events and means of transportation, are determined by members. This model enables older adults to make new social connections.
Technology is a double-edged sword. Technology can enhance engagement and reduce social isolation, but it can also increase social isolation. Monitoring and compensation technologies can replace human caregivers and allow individuals to live in their home despite significant functional impairment. Not unexpectedly, this might exacerbate social isolation.
Individuals, families, and communities need to work together to create and to maintain bonds.
Commentary
The drawing shows a listless-looking middle-aged man whose eyes are the focal point. Vertical black and white stripes depicting prison bars are drawn in lieu of normal eyes. If one looks closely at the right eye, a faded man can be seen tightly gripping the bars, his eyes squeezed shut; he looks like he is trying his hardest to escape. Is this a reflection of this man’s circumstances? Is he trapped in his failing body? Instead of handcuffs or ropes, he is tied down by nasal prongs.
This man is drawn in black and white, whilst his surroundings are vibrantly coloured. Bright orange, yellow, and blue coils are drawn around his head. These brightly coloured coils may be symbols of his ever-changing environment, while he himself remains stagnant. The world continues growing and brimming with life, as depicted by the trees and music symbols.
The words Not all prisoners are locked up behind METAL BARS are boldly emblazoned across his chest. METAL BARS are written in bright red. Is this symbolic of the scarlet letter of shame? Is this man ashamed that he has become a prisoner, confined and impotent? He is alone and trapped in his circumstances. His attention is turned inward. His outlook is marked by feelings of loneliness and inadequacy as he becomes increasingly isolated from life as it passes him by.
Dr Grace Chiang is a family physician with a background in public health, who is currently practicing in a community hospital. Her research and clinical interests include population health, ageing in place, and frailty.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by Assoc Prof Cheong Pak Yean. Senior Family Physicians subsequently shared vignettes and commentaries based on the pictures.
