Has the pandemic made us lonelier? And when does loneliness actually become a depressive disorder? Anyone wishing to have these questions answered from a top-class medical perspective should turn to a leading specialist – such as Priv.-Doz. Dr. med. Dr. phil. Yasin Möller. He is not only a 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 Medical Director, PD Dr. med. Möller heads Akutklinik Albstadt GmbH, a private clinic for psychosomatic medicine. In conversation with the Leading Medicine Guide, this renowned expert on the human psyche answers our questions. He explains what distinguishes loneliness from social isolation, talks about his day-to-day work and reveals what really helps combat loneliness.
Leading Medicine Guide: Loneliness is one of the major issues of our time – in the UK, a ministry has even been set up to tackle loneliness. To what extent do you deal with this issue in your day-to-day professional life?
PD Dr Möller: Loneliness is a phenomenon I observe very frequently in my professional practice. I am also particularly interested in phenomena that are socially relevant 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 witnessing a social isolation for which there is as yet no end in sight. There has been a massive increase in the use of psychotherapeutic services, particularly among young people. Therapy places are scarce, and the psychosocial counseling centers are overburdened. How is this reflected in your own day-to-day work?
PD Dr 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 is a topic that hangs in the air, fraught with anxiety. People ask themselves: To what extent could I become infected and fall ill? But other consequences of the pandemic are also becoming apparent to people, such as when contact with family members becomes more difficult. Older people in particular suffer from the fact that their grandchildren, for example, 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 Möller: It is becoming increasingly clear that the pandemic is having serious mental health consequences for many people. Data is now available from a study that found mental health disorders in around twenty per cent of patients. These are primarily anxiety disorders and depression. The prevalence of these conditions is thus significantly higher than in the general population, and also higher than for certain other conditions, such as respiratory diseases. A nuanced assessment of the mental health consequences of Covid-19 is required.
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 Möller: The expectation that the suicide rate has increased during the pandemic was not confirmed in an international study. Existing psychological symptoms in people who were already ill prior to the pandemic may be exacerbated. In direct contact with, for example, patients with depression, it is often found that social isolation has increased further.
Leading Medicine Guide: How do you view the increasing shift of social contact into the virtual world? Is it just as good to meet your best friend on Zoom as it used to be in a café? Or does it make us lonelier?
PD Dr Möller: I see this as a positive development; it’s an alternative option. Put simply: contact via Skype is still better than no contact at all. Of course, this cannot replace personal interaction, including 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, non-verbal communication plays a major role, particularly 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 Möller: There is no clear evidence that the future proliferation of internet media is linked to the development of social isolation. However, it is important to distinguish between the terms here: the concept of loneliness is subjective – “I feel lonely”. This feeling can also overcome me when I am 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 utilized?
Leading Medicine Guide: The pandemic has certainly contributed to social isolation, but has COVID-19 made us lonelier as a society?
PD Dr Möller: COVID-19 has brought the issue of social isolation back into the spotlight: many people complain that they are socially isolated as a result of the pandemic. The increasing frequency of people seeking psychotherapeutic services, which you have already mentioned, is at least partly linked to feelings of loneliness. Loneliness is a symptom of most mental illnesses, particularly depressive disorders. In these cases, patients feel lonely – and, as their condition progresses, they experience a reduction in social contacts that were previously present.
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 Möller: The feeling of being lonely is not in itself an illness. There are probably 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. Such as sleep disturbances, appetite disturbances, physical discomfort, and depressive mood. A depressive mood is characterized by hopelessness, a loss of perspective, doubts about 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. What exactly does that mean?
PD Dr Möller: I believe that mental illness must be addressed at every level at which it manifests symptoms. This varies from patient to patient. For some, sadness is the main issue; for others, it is physical discomfort. For others, however, isolation is a key symptom of depression.
Leading Medicine Guide: How do you address this?
PD Dr Möller: Group therapy can be a key element in helping individuals to open up more to those around them and in creating an atmosphere of confidential exchange. But even beyond therapy, simply being together in the day-to-day life of a clinic can go a long way toward helping social contacts to re-emerge.
A leading center for psychosomatic medicine, psychiatry and psychotherapy: Aktuklinik Albstadt is perfectly equipped
Leading Medicine Guide: And what happens after discharge from the clinic?
PD Dr Möller: Countering social isolation is also a major part of post-discharge efforts. So one should ask 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 refer patients to groups; there are, after all, a wide variety of self-help groups for the various conditions. We also encourage people to perhaps start re-establishing social contacts they used to have, even while still in hospital. So this involves getting in touch with people with whom contact may have been lost, perhaps due to illness.
Leading Medicine Guide: Do you have experience with mindfulness and meditation exercises for loneliness and mental health conditions?
PD Dr Möller: Mindfulness and meditation are important therapeutic elements within a holistic approach. However, I would not view them as isolated therapeutic techniques, but always in conjunction with other therapeutic approaches. In that context, they can play an important role. But when we talk specifically about loneliness, I believe that activating and less contemplative therapeutic techniques must take center stage. This also involves prioritizing a clear daily structure – patients need to know how the day begins and how it ends. But sport, exercise and group activities are also important here.
Leading Medicine Guide: So what really helps against loneliness?
PD Dr Möller: It is 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. Initially, these factors can all be equally important. It is important that each individual patient chooses what suits them best from this range of options, as interests vary greatly.
Leading Medicine Guide: You are also a specialist in neurology – what effect does loneliness have on our brain?
PD Dr Möller: I’ll stick to the psychiatric side here and say that, in practice, there is a link between social isolation and the development of mental health disorders, particularly depression. There is research evidence showing that people living in extreme social isolation fall ill more frequently and have a lower life expectancy. One can interpret this in different ways and say, for example, that these people seek help too late. So, one cannot generally conclude from this that there are organic and neurological changes caused by loneliness.
Leading Medicine Guide: But?
PD Dr Möller: Of course, in psychiatry, one must always first rule out organic disorders as the cause of certain symptoms. It may be, for example, that a patient with severely reduced drive, who spends the whole day on the sofa 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 themselves as lonely.
Leading Medicine Guide: Thank you very much for the fascinating and insightful conversation, Dr Möller!
