Has the pandemic made us lonelier? And when does loneliness actually become a depressive disorder? Anyone seeking answers to these questions from a top-tier medical perspective should turn to a leading specialist—such as Priv.-Doz. Dr. med. Dr. phil. Yasin Möller. He is not only a board-certified specialist in psychiatry and psychotherapy, but also in neurology and addiction medicine, as well as a specialist in public health and social medicine. As Medical Managing Director and Chief Medical Officer, PD Dr. med. Möller heads Akutklinik Albstadt GmbH, a private clinic for psychosomatic medicine. In an interview with the Leading Medicine Guide, this renowned expert on the human psyche answers questions. He explains the difference between loneliness and social isolation, shares insights into his daily work, and reveals what truly helps combat loneliness.
Leading Medicine Guide: Loneliness is one of the major issues of our time—in the United Kingdom, a ministry has even been established to combat loneliness. To what extent do you deal with this issue in your daily professional life?
PD Dr. med. Möller: Loneliness is a phenomenon I observe very frequently in my professional practice. I’m also particularly interested in phenomena that have societal relevance and touch on both psychiatry and psychotherapy. The topic of COVID-19 also has many psychological and psychiatric aspects.
Leading Medicine Guide: In the wake of the COVID-19 pandemic, we are experiencing a societal isolation whose end is not yet in sight. There has been a massive increase in the use of psychotherapeutic services, particularly among young people. Therapy slots are scarce, and psychosocial counseling centers are overwhelmed. How is this affecting your own daily work?
PD Dr. med. Möller: The topic of COVID-19 often comes up with our patients, but less because the patients themselves have COVID-19, and more because it’s a topic that’s in the air and fraught with anxiety. People ask themselves: To what extent could I become infected and fall ill? But people are also feeling other consequences of the pandemic, such as when contact with family members becomes more difficult. Older people, in particular, suffer when, for example, their grandchildren can no longer visit because of the fear of infection. Furthermore, any significant social phenomenon can become a factor in mental health issues—including the pandemic.
Leading Medicine Guide: So is the pandemic leading to an increase in mental health issues?
PD Dr. med. Möller: It is becoming increasingly clear that the pandemic is having serious mental health consequences for many people. Data from a study is now available showing that mental health disorders were found in about twenty percent of patients with the disease. These disorders are primarily anxiety disorders and depression. The prevalence of these conditions is thus significantly higher than in the general population, and also higher than that of certain other conditions, such as respiratory diseases. A nuanced assessment of the mental health consequences of COVID-19 is needed.
Leading Medicine Guide: It is often said that the pandemic could lead to an increase in suicides. What is the situation regarding this?
PD Dr. med. Möller: The expectation that the suicide rate has increased during the pandemic was not confirmed by an international study. Existing mental health symptoms in people who were already ill—regardless of the pandemic—may be exacerbated. In direct contact with patients suffering from depression, for example, we often find that social isolation has increased further.
Leading Medicine Guide: How do you assess the increasing shift of social interactions to the virtual world? Is it just as good to meet your best friend on Zoom instead of at a café like in the past? Or does that make us lonelier?
PD Dr. med. Möller: I view this positively; it’s an alternative. Simply put: Contact via Skype is still better than no contact at all. Of course, this cannot replace face-to-face interaction or physical closeness. But I support virtual contact whenever possible, because I believe it can at least partially counteract the feeling of social isolation. Above all, however, nonverbal communication plays a major role, especially with children—having a grandchild on your lap and holding them close provides a sense of closeness that no virtual contact can replace.
Leading Medicine Guide: This development could lead to certain areas of society, such as university teaching, switching entirely to a virtual or hybrid format. Should we view this with caution?
PD Dr. med. Möller: There is no clear evidence that the future proliferation of internet media is linked to the development of social isolation. However, it’s important to distinguish between the terms here: The concept of loneliness is subjective—“I feel lonely.” This feeling can also overcome me even when I’m in the company of other people. Social isolation, on the other hand, is an objective concept that asks: How many social contacts are there, and how are they being utilized?
Leading Medicine Guide: The pandemic has certainly contributed to social isolation, but has COVID-19 made us lonelier as a society?
PD Dr. med. Möller: COVID-19 has brought the issue of social isolation back into the public spotlight: Many people complain that they are socially isolated as a result of the pandemic. The increasing frequency of use of psychotherapeutic services that you already mentioned is, at least in part, also related to experienced loneliness. Loneliness is a symptom of most mental illnesses, especially depressive disorders. In these cases, patients feel lonely—and as their illness progresses, they experience a reduction in social contacts they previously had.
Leading Medicine Guide: Where does “normal” loneliness end and where does a mental illness, such as depression, begin? What are the signs here?
PD Dr. med. Möller: The feeling of being lonely is not an illness in and of itself. There are likely also people who seek out loneliness, who have chosen it as a way of life. It becomes a mental illness when other symptoms accompany the feeling of loneliness. These include sleep disturbances, changes in appetite, physical discomfort, and a depressed mood. A depressed mood is characterized by hopelessness, a loss of perspective, doubts about one’s self-worth, and the associated perceived inability to change things in one’s own life.
Leading Medicine Guide: Many people come to your clinic with these symptoms. You take a very holistic approach there. What exactly does that mean?
PD Dr. med. Möller: I believe that mental illness must be addressed at every level where it manifests symptoms. This varies from patient to patient. For some, sadness is the primary symptom; for others, it’s physical discomfort. For others, isolation is a key symptom of depression.
Leading Medicine Guide: How do you address this?
PD Dr. med. Möller: Group therapy can be a key element in helping individuals open up more to those around them and creating an atmosphere of trusting exchange. But even beyond therapy, the sense of community in the day-to-day life of a clinic like this can already go a long way toward helping social connections form again.
A Top Destination for Psychosomatic Medicine, Psychiatry, and Psychotherapy: The Aktuklinik Albstadt is perfectly equipped
Leading Medicine Guide: And what happens after discharge from the clinic?
PD Dr. med. Möller: Counteracting social isolation is also a major part of post-hospitalization efforts. So we should ask ourselves early on: What happens after discharge? How can we ensure that the patient has more social contacts again after discharge? The options available here are limited, but they do exist. We can connect patients with support groups; after all, there are a wide variety of self-help groups for different conditions. We also encourage people to reconnect with social contacts they had in the past, perhaps even while they’re still in the hospital. So this involves reaching out to people with whom contact may have been lost due to their illness.
Leading Medicine Guide: Do you have experience with mindfulness and meditation exercises for loneliness and mental health conditions?
PD Dr. med. Möller: Mindfulness and meditation are important therapeutic elements within the context of a holistic approach. However, I wouldn’t view them as isolated therapeutic techniques, but rather always in conjunction with other therapeutic approaches. In that context, they can play an important role. But when we’re talking specifically about loneliness, I believe that activating—rather than contemplative—therapeutic techniques must take center stage. This also includes prioritizing a clear daily structure—patients need to know how the day begins and how it ends. But sports, exercise, and group activities are also important here.
Leading Medicine Guide: So what really helps combat loneliness?
PD Dr. med. Möller: It’s important that opportunities are available for anyone who wants them to find a way out of loneliness. A healthy and balanced diet, regular exercise, and routines that provide structure all play a role here, as does pursuing cultural interests. At first, all these factors can be equally important. It’s crucial that each individual patient chooses what works best for them from this range of options, as interests vary greatly.
Leading Medicine Guide: You’re also a specialist in neurology—what effect does loneliness have on our brains?
PD Dr. med. Möller: I’ll stick to the psychiatric perspective here and say that, in practice, there is a link between social isolation and the development of mental disorders, particularly depression. There is research evidence showing that people who live in extreme social isolation fall ill more frequently and have a lower life expectancy. This can be interpreted in different ways; for example, one might say that these people seek help too late. So, at first glance, we can’t make a blanket assumption that loneliness causes organic or neurological changes.
Leading Medicine Guide: But?
PD Dr. med. Möller: Of course, in psychiatry, one must always first rule out organic disorders as the cause of certain symptoms. For example, it may be that a patient with severely reduced drive who spends the entire day on the couch and no longer leaves the house has reduced drive for organic reasons. However, based on the current state of research, we cannot say that there are neurobiological reasons why people experience loneliness.
Leading Medicine Guide: Thank you very much for this fascinating and insightful conversation, Dr. Möller!
