Isolation and anxiety

Last September I took a job working half-time, providing companion care for a senior gentleman who lives in a full-care facility about twenty minutes' drive from where I live.  The work was easy -- mostly what he wanted to do was go for long walks -- and it helped replace a little bit of the income I lost when I retired from teaching.  It also got me out of the house, and (in my wife's words) kept me from turning into a complete recluse.

Then in November, I was furloughed because of the pandemic.

I was in the fortunate position that the financial hit of not working wasn't the dire situation it is for many.  The loss of my weekly paycheck didn't mean we would go without food or miss our mortgage payment.  What it did mean -- both for my client and me -- was that since then, we've been pretty well totally isolated.  My client still sees the nursing staff at the facility; and, to be clear about this, they are stupendous, doing their best to see not only to the physical but to the mental and emotional health of their residents.  For me, it's meant that other than occasional quick trips to the grocery store, the only person I see is my wife.

That's been the situation since the first week of November.

I honestly thought it would be easier for me to deal with isolation.  I'm an introvert by nature, and pretty shy and socially awkward at the best of times.  But the last few months have been dismal, with the fact of it being the middle of an upstate New York winter not helping matters.  I've been fighting bouts of depression and anxiety -- something I've dealt with all my life, but lately it's seemed a lot worse than my usual baseline.

A couple of weeks ago, I was contacted by the director of the facility.  Because I've been vaccinated against COVID, and the residents were also receiving their vaccines, they were reopening to non-essential visits, and my client was eager to resume our daily time together.  Yesterday was my first day back at work after being stuck at home, pretty much continuously, for four months.

This is where things get weird.  Because instead of it relieving my anxiety, it made it spike higher.  I'm talking, to nearly panic-attack levels.

In case this isn't clear enough, there is nothing rational about this reaction.  My client has some developmental disabilities, and frequently needs a lot of help and encouragement, but he's kind, funny, and a pleasure to be with.  The job itself is the opposite of stressful; the worst part of it is having to keep track of the paperwork required by the agency and the state.  Being stuck home made my anxiety worse; if anything made sense about this, you'd think being given the green light to work again would assuage it.

Edvard Munch, Anxiety (1894) [Image is in the Public Domain]

Apparently, though, I'm not alone in this rather counterintuitive reaction.  A paper last week in the journal Brain Sciences found that the social isolation a lot of us have experienced over the past year has caused a measurable spike in the levels of a hormone associated with stress called cortisol.  Cortisol is a multi-purpose chemical; it has a role in carbohydrate metabolism, behavior, resilience to emotional stressors, and reducing inflammation (cortisone, used for treating arthritis and joint injury, and topically for relieving skin irritations, is basically synthetic cortisol).  This last function is thought to be why long-term stress has a role in many inflammatory diseases, such as ulcers, acid reflux, and atherosclerosis; just as overconsumption of sugar can lead to the body losing its sensitivity to the hormone that regulates blood sugar (insulin), continuous stress seems to lower our sensitivity to cortisol, leading to increased inflammation.

Apropos of its role in emotional stress, the authors write:

There are important individual differences in adaptation and reactivity to stressful challenges.  Being subjected to strict social confinement is a distressful psychological experience leading to reduced emotional well-being, but it is not known how it can affect the cognitive and empathic tendencies of different individuals.  Cortisol, a key glucocorticoid in humans, is a strong modulator of brain function, behavior, and cognition, and the diurnal cortisol rhythm has been postulated to interact with environmental stressors to predict stress adaptation.  The present study investigates in 45 young adults (21.09 years old, SD = 6.42) whether pre-pandemic diurnal cortisol indices, overall diurnal cortisol secretion (AUCg) and cortisol awakening response (CAR) can predict individuals’ differential susceptibility to the impact of strict social confinement during the Coronavirus Disease 2019 (COVID-19) pandemic on working memory, empathy, and perceived stress.  We observed that, following long-term home confinement, there was an increase in subjects’ perceived stress and cognitive empathy scores, as well as an improvement in visuospatial working memory.  Moreover, during confinement, resilient coping moderated the relationship between perceived stress scores and pre-pandemic AUCg and CAR.

I thought it was pretty interesting that heightened cortisol has the effect of improving visuospatial working memory, but it makes sense if you think about it.  When a person is in a stressful situation, there's a benefit to being on guard, to keeping constant tabs on what's around you.  The downside, of course, is that such perpetual wariness is downright exhausting.

The last bit is also fascinating, if hardly surprising.  People who were capable of resilient coping with stress beforehand were less affected by the new emotional impact of being isolated; people like myself who were already struggling fared more poorly.  And interestingly, this was a pronounced enough response that it had a measurable effect on the levels of stress hormones in the blood.

This may explain my odd reaction to being taken off furlough.  Cortisol can be thought of as a sort of an "adrenaline for the long haul."  Adrenaline allows a fight-or-flight reaction in sudden emergencies, and has a rapid effect and equally rapid decline once the emergency is over.  Cortisol handles our response to long-duration stress -- and its effects are much slower to go away once the situation improves.  For people like myself who suffer from anxiety, it's like our brains still can't quite believe that we're no longer teetering over the edge of the cliff.  Even though things have improved, we still feel like we're one step from total ruin, and the added stressor of jumping back into a work situation when we've been safe at home for months certainly doesn't help.

In any case, yesterday's work day went fine.  As they always do.  I'm hoping that after a couple of weeks, my errant brain will finally begin to calm down once it realizes it doesn't have to keep me ramped up to red alert constantly.  It helps knowing I'm not alone in this reaction, and that there's a biochemical basis for it; that I'm not just making this up (something I was accused of pretty much every time I had an anxiety attack when I was a kid).

But it would also be nice if my brain would just think for a change.

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I've always been in awe of cryptographers.  I love puzzles, but code decipherment has seemed to me to be a little like magic.  I've read about such feats as the breaking of the "Enigma" code during World War II by a team led by British computer scientist Alan Turing, and the stunning decipherment of Linear B -- a writing system for which (at first) we knew neither the sound-to-symbol correspondence nor even the language it represented -- by Alice Kober and Michael Ventris.

My reaction each time has been, "I am not nearly smart enough to figure something like this out."

Possibly because it's so unfathomable to me, I've been fascinated with tales of codebreaking ever since I can remember.  This is why I was thrilled to read Simon Singh's The Code Book: The Science of Secrecy from Ancient Egypt to Quantum Cryptography, which describes some of the most amazing examples of people's attempts to design codes that were uncrackable -- and the ones who were able to crack them.

If you're at all interested in the science of covert communications, or just like to read about fascinating achievements by incredibly talented people, you definitely need to read The Code Book.  Even after I finished it, I still know I'm not smart enough to decipher complex codes, but it sure is fun to read about how others have accomplished it.

[Note: if you purchase this book using the image/link below, part of the proceeds goes to support Skeptophilia!]

Social media and social isolation

One of the reasons we have science is that our intuition is so often wrong.

We're misled by dozens of things, from simple failures of our perceptual or processing apparatus, to our preconceived notions and cognitive biases, to falling prey to others who want us to think a certain way.  Science gives us a way around all of that; its understanding relies on data and evidence.  What we thought beforehand, what someone else told us -- none of that matters.

Now, I'm not saying that science has no biases.  There is no endeavor that is completely bias-free.  However, if you want to find a way to the truth, based on the current best knowledge we have, science is the only game in town.

This comes up because of a paper released last week in the Journal of Information, Communication, Society that addresses a commonly-held belief, especially amongst those who are (like myself), "of a certain age;" that social media and the ubiquity of cellphones and other internet-connective devices are going to result in a generation of young adults who don't know how to interact with each other in person -- or, perhaps, who simply don't want to.

Note that this belief is usually founded on nothing but annoyance.  Looking around a bus stop or a doctor's waiting room, and seeing all the faces glued to their Smart Phones, it's easy to imagine that it might be true.  After all, it seems kind of logical, doesn't it?  You stare at your phone rather than connecting to the people around you.  Of course that's going to isolate you, right?

[image courtesy of the Wikimedia Commons]

So Jeffrey A. Hall, Michael W. Kearney, and Chong Xing, of the University of Kansas Department of Communication Studies, decided to test that supposition, and their results appeared last week in the paper "Two Tests of Social Displacement Through Social Media Use."  And the results were unequivocal; frequent social media use had no effect whatsoever on social isolation in teenagers.  Those who were already isolated stayed isolated; those who were already connected stayed connected.  The authors write:

[We present] two tests of the hypothesis that social media use decreases social interaction, leading to decreased well-being.  Study 1 used the Longitudinal Study of American Youth (N = 2774), which is a national probability sample of Generation X, to test displacement over a three-year time period.  Latent change scores were used to test associations among social media adoption in 2009, social media use in 2011, direct contact frequency across years, in relation to change in well-being.  Although social media adoption in 2009 predicted less social contact in 2011, increased social media use between 2009 and 2011 positively predicted well-being.  Study 2 used experience sampling with a combined community and undergraduate sample (N = 116).  Participants reported on their social interactions and passive social media use (i.e., excluding chat via social media) five times a day over five days.  Results indicate that social media use at prior times of day was not associated with future social interaction with close others or with future face-to-face interaction.  Passive social media use at prior times predicted lower future well-being only when alone at prior times.  Neither study supported the social displacement hypothesis.

But... but... our intuition on this seemed so logical, didn't it?  On the other hand, when I think back on my own misspent youth, my memory tells me otherwise.  I was painfully shy, and to say I had no social life in high school is an understatement of colossal proportions.  This was long before the days of Smart Phones and Facebook (hell, my students think it was long before the days of Gutenberg and the Printing Press).  I can therefore guarantee that my own social isolation had nothing to do with social media, because it didn't exist.  And my guess is that if there had been social media, at least it would have given me some way of interacting, other than my preferred method of getting beaten up in the gym locker room.

Jeffrey Hall, who co-authored the study, elaborated on its results.  "It was not the case at all that social media adoption or use had a consistent effect on their direct social interactions with people," Hall said.  "What was interesting was that, during a time of really rapid adoption of social media, and really powerful changes in use, you didn’t see sudden declines in people’s direct social contact.  If the social-displacement theory is correct, people should get out less and make fewer of those phone calls, and that just wasn’t the case."

In fact, the use of social media didn't even affect who they chose to socialize with.  "What we found was that people’s use of social media had no relationship to who they were talking to later that day and what medium they were using to talk to people later that day," Hall said.  "Social media users were not experiencing social displacement.  If they used social media earlier in the day, they were not more likely to be alone later.  It’s also not the case that because they were using social media now, they were not interacting face to face later. …  It doesn’t seem that, either within the same time period or projecting the future, that social media use indicates people not having close relationship partners in face-to-face or telephone conversation."

So science here gives us a chance to challenge our preconceived notions, and in this case finds that our tendency to rant about "kids these days" and "it wasn't like that back in my day" turns out to be false.  The sad postscript, however, is that I don't expect this to change anyone's attitudes.  It's like the study, released last year, that not only does spanking not work to change a child's behavior, it's associated with a host of mental problems later in life, including depression, suicide risk, and drug abuse.

After that study came out -- and it is one of several studies that have reached this conclusion -- there was an outpouring of outrage on social media that "the liberals are trying to stop us from disciplining our kids" and "kids these days are disrespectful and lazy, and wouldn't be that way if they were spanked for it" and (most often) "I was spanked all the time as a kid, and I turned out fine."  Which proves that you can have controlled scientific studies out the wazoo, and it won't stop people from falling back on anecdote and personal experience and what they already believed.

Which is kind of distressing, now that I come to think of it.

Anyhow.  If I can get one person to stop and reconsider what they think, and perhaps base their understanding on hard evidence, I'll have done my job.  Now, y'all will have to excuse me, because it's been a while since I've checked Facebook.  You never know what might have happened in my absence.