From David Vincent in Shrewsbury, UK: Take a Pill

Big pharma is having a good war.  It is generally accepted that the only way of ending the pandemic is the discovery of a vaccine and its manufacture and distribution on a global scale by multi-national drug companies.  Everything else is just dealing with the symptoms.  Companies like AstraZeneca are making deals with governments around the world to make available the first vaccines to succeed in the current trials.  Never before have we been so aware of the virtues of their technological competence and organisational power.

There remain, however, areas where these companies stand to gain from the crisis in less welcome ways.  The widespread disruption to established patterns of social interaction has raised fears that loneliness may be on the increase.  As I have argued in earlier diary entries (especially May 27), the first batch of survey evidence suggests that acute loneliness, the kind that causes serious psychological suffering, appears remarkably stable in the pandemic at around five per cent of the population.  Nonetheless the preceding moral panic, which produced inflated loneliness figures of over fifty per cent and referred to a widespread ‘epidemic’, has gained in a new lease of life in a time when everyone’s relationships are under strain.

The drive to medicalise what is a form of failed solitude is partly a function of how political change works.  Pressure groups and concerned scientists have since the 1950s compelled governments to intervene in a growing range of private behaviours which have demonstrable physical consequences, starting with smoking, and, in recent days, finally causing the overweight Boris Johnson to commit his administration to tackling obesity.  Thus campaigners claim that loneliness has worse consequences than smoking fifteen cigarettes a day, or having too large a waistline.

As a recent newspaper report has revealed, the discourse has thrown renewed attention on the search for a loneliness pill.*  In Chicago, Stephanie Cacioppo, co-researcher with the late Stephen Cacioppo, is continuing work on isolating a pharmacological treatment for social isolation.  Another research group is investigating the prescription of oxytocin for loneliness sufferers.  Whether these pills are a self-sufficient remedy or part of a psychotherapy treatment, the prospects for the pharmaceutical companies are immense.  Whilst serious loneliness is a minority experience, the multiple transition points in late modernity mean that all of us at some point risk malfunctions in our social life.  The current pandemic in this regard merely highlights the fragility of the networks of personal relationships that we all seek to maintain.  If every time there is a failure of interaction, or a perceived danger of such an event, we could just pop a pill out of its foil sheet, how relaxed we might be, and how great the profit for the manufacturer.

There are of complex ways in which medical conditions, including mobility or communication disabilities, can impact on interpersonal relations.  Forms of acute depression can have a range of physiological consequences including damage to immune systems.  There is a longstanding debate about whether and in what form pharmacological treatments should play a part in psychotherapy.  None of these complexities are resolved by conceiving the existence of a loneliness pill or seeking to put one on the market.

Just as good solitude is a rest from the labour involved in effective social relationships, so bad solitude requires for its alleviation a wide range of public actions.  There is no pill that will resist the effects of the coming collapse in income and employment, or the continuing underinvestment in mental health and local support facilities.

*https://www.theguardian.com/lifeandstyle/2020/aug/06/loneliness-cure-pill-research-scientists?CMP=share_btn_link

from David Vincent in Shrewsbury, UK: Loneliness and Life Satisfaction

June 30. We are living through a time of drama.  Every week brings a new crisis, reported or anticipated.

History will record a belated response in the early days leading to thousands of avoidable fatalities, critical shortcomings in PPE, scandalous death-rates in care homes and amongst the BAME population, widespread failings in introducing test and trace procedures, the complete failure of the NHS testing app.  Today we have the return of lockdown in Leicester and later this week there is the predicted disaster of choosing a summer Saturday night to open all the pubs in England for the first time in three months.  And so it will continue in the face of a still unknowable virus and a government of still uncharted incompetence. 

And yet, if attention is paid to how people are feeling about the crisis, a very different picture emerges.  In my entry for May 27 I drew attention to the social surveys which have been launched at great speed in response to the coronavirus.  One of the larger enterprises, the UCL Nuffield Covid 19 Social Study, has now published four further weekly reports, displaying consistent data over three full months of the pandemic.*  The questions in the survey cover basic attitudes and emotions in the lockdown.  Each topic has its own trajectory since the last week of March, and its own variations by age, income, and living conditions.  But standing back from the detail, what is most striking is the absence of change over the period.

Graph after graph proceeds in an even line as each week passes, sometimes on a slightly upward trajectory, sometimes downward.  What is missing almost completely is the kind of volatility that we read in the headlines each day.  ‘Loneliness’ (see above) has been almost completely flat since the last week of March, unaffected by the recent marginal lifting of the lockdown.  ‘Life satisfaction’ has gradually risen from 5 to 6 on a 10-point scale [it should be 7.7].  ‘Happiness’ [you may not know what that is, but here it is measured by the Office for National Statistics wellbeing scale], has been at or just under 6, again on a 10-point scale, with very small fluctuations.  Levels of depression and anxiety have been higher than in pre-Covid times but have gradually declined through the Spring and early Summer.  Confidence in the English government showed one of the largest short-term changes, falling from 4.5 to 3.5 on a 7-point scale at the beginning of May, but has since levelled out. Notwithstanding this decline, willingness to comply with guidelines has barely altered, slipping over three months from almost 100% to just over 90.  The sharpest fall has been in worries about food security, which began at around 60% of the population and are now only a little above zero. 

The scale of the sample, which involves 90,000 respondents, inevitably has a dampening effect on variability.  Individuals who have lost their jobs, or have been ill, or have suffered serious bereavement, will scarcely report so uneventful an experience.  Nonetheless the absence of sudden change across the population in such fundamental areas as depression or life-satisfaction is a necessary corrective to the melodrama played out on the front-pages of the newspapers.

When the scores are broken down by issues such as income or living conditions, there are generally only minor differences.  In most categories the young are suffering more than the old, the poor more than the rich, but often the differences are small.  Much the largest variable on almost all issues is a prior diagnosis of mental ill-health.  Again the scores show little change over the period, but there are significant gaps between the graphs of the well and the unwell. On key issues such as depression, anxiety, loneliness and happiness, the mentally fit are between half and three times better off than those who entered this crisis already in trouble. 

According to a report by the charity Mind this morning, almost two thirds of those with a pre-existing mental health problem said it had become worse during the lockdown.**  When we consider where the effort should be placed in alleviating the consequence of the pandemic, the mental wellbeing of the population at the outset of the crisis will require particular attention.

* Covid-19 Social Study Results Releases 1-14

** https://www.theguardian.com/society/2020/jun/30/uks-mental-health-has-deteriorated-during-lockdown-says-mind?CMP=share_btn_link

from David Vincent in Shrewsbury, UK: Solitude and Loneliness

May 27 In my diary entry for April 8, I wrote that:

Enforced isolation has an ambiguous effect on the two experiences.  On the one hand it has made solitude a still more valued practice.  In families where the adults are working at home, the children are about all day long, the garden is small or non-existent, periods of solitary escape have become as desirable and unattainable as supermarket delivery slots … On the other hand, it has made loneliness still more threatening.  It becomes more difficult to make physical contact with such friends as the individual possesses.  Intermittent escapes from an empty home to shops, cafes, local libraries, public entertainments, are now forbidden.”  I concluded that, “Where the balance will finally be struck in these contrasting effects of isolation remains to be seen.”

Now the evidence is beginning to appear to answer this question.  The crisis has stimulated the creation of a number of major research projects across the social sciences, which have been planned, funded and put into practice in a remarkably short space of time.  One of the largest of these is the UCL Nuffield Covid 19 Social Study.  This is a questionnaire-based survey which currently has 90,000 respondents.  It is not a representative statistical sample of the population, but is large enough to generate substantial conclusions.  The research team, led by Daisy Fancourt and Andrew Steptoe, have a sophisticated grasp of the concepts and categories of mental health, and are publishing weekly bulletins of their findings.

The ‘Covid-19 Social Study Results Release 8’, on 13 May, was particularly interesting.*  Table 21 measured the incidence of ‘Loneliness’ on the industry-standard UCLA loneliness scale.  This was unchanged across the lockdown period at around 5%.  This is the same level as more cautious observers and social historians have projected across the entire post-war period, and about a quarter of the claims made in the Government’s current loneliness strategy.  Whatever else it is doing, the covid19 epidemic is not causing an epidemic of loneliness.

The team found that the condition was “higher amongst younger adults, those living alone, those with lower household income levels, and those with an existing diagnosed mental health condition.  They are also higher amongst women, people with children, and people living in urban areas.”  It was correspondingly lower than 5% amongst those over 60, those with higher incomes, those without mental health conditions, and those living without children.

Table 27, by contrast, measured ‘Activities missed during lockdown.’  At the top of the table, not surprisingly, were ‘Meeting up with family’ and ‘Meeting up with friends.’  Half way down was ‘Having time alone.’  This was the solitude measure.  The analysts broke down the emotion only by age.  The younger the respondent, the more likely they were to be lacking time alone.

What is really interesting is the volume.  Just over thirty per cent of the population were included in this category.

In other words, after an extended period of lockdown, solitude is being sought by six times as many people as are experiencing loneliness.

* https://mk0nuffieldfounpg9ee.kinstacdn.com/wp-content/uploads/2020/04/COVID-19-social-study-results-release-13-May-2020.pdf

from David Vincent, Shrewsbury, UK: Prime Ministers, Loneliness and Solitude

April 8. We are all of us having to adjust to the shocking prospect that the Prime Minister might actually die of Covid-19.  The historian in me struggles to find a previous case.  There have been examples in modern times of more or less concealed incapacitating (see Boris Johnson’s idol Winston Churchill, passim), and of sudden resignations following the diagnosis of a fatal disease  – Henry Campbell Bannerman in 1908 and Andrew Bonar Law in 1923.  Two leaders of the Labour Party, Hugh Gaitskell and John Smith, died in post, paving the way for the fortunate Harold Wilson and Tony Blair.  But not the nation’s leader at a time of absolute national crisis.  The nearest equivalent of such an event would be Pitt the Younger, who died in 1806 in the midst of the Napoleonic Wars (see also Spencer Perceval in 1812, though he was assassinated, and George Canning who expired in more peaceful times in 1827 after just 119 days in office).

Amongst the immediate responses was a curious tweet from Andrew Neil (note for non Brits: grizzled former editor of the Sunday Times and now the most feared BBC political interviewer.  In the recent General Election, Boris Johnson, alone of the candidates, refused to submit himself to an extended interrogation by him, which diminished his reputation as it enhanced Neil’s).  A reason, he said, why Johnson has proved vulnerable to Covid-19 was his ‘loneliness’ in Number 10.  It was not clear whether he meant social loneliness, given that Johnson has been living by himself in the flat above Number 11 while his pregnant partner self-isolates in the official country retreat of Chequers, or political loneliness in the Shakespearean sense of ‘Uneasy lies the head that wears the crown.’

Whichever is the case, it raises the question of the balance between solitude and loneliness in the present crisis.  The former, the tendency, as Johann Zimmermann wrote, ‘for self-collection and freedom’, has over the period since the eighteenth century become an increasingly valued an enjoyed condition.  The latter, which can be seen as failed solitude, the condition, as Stephanie Dowrick writes, of being ‘uncomfortably alone without someone’ has been a growing cause for concern in recent decades.

Enforced isolation has an ambiguous effect on the two experiences.  On the one hand it has made solitude a still more valued practice.  In families where the adults are working at home, the children are about all day long, the garden is small or non-existent, periods of solitary escape have become as desirable and unattainable as supermarket delivery slots.  The most basic form of solitude, taking a stroll out of doors, has become stigmatised or completely forbidden.  Walking the dog, for two centuries the most commonplace way of taking time out alone, has suddenly become a basic luxury.  A French friend tells me that Parisian dogs are becoming exhausted, as neighbours borrow them from their owners to legitimise exercise in the fresh air. 

On the other hand, it has made loneliness still more threatening.  It becomes more difficult to make physical contact with such friends as the individual possesses.  Intermittent escapes from an empty home to shops, cafes, local libraries, public entertainments, are now forbidden.  Access to medical or social services is yet more of a problem.  This outcome has been early recognised, and attempts are being made in functioning communities to identity those uncomfortably alone and provide them with necessary support.  And there is, of course, the ever-increasing use of digital connections. 

Where the balance will finally be struck in these contrasting effects of isolation remains to be seen.  At least we should emerge with an enhanced awareness of both conditions.