By Dr. Andrew Smith, Clinical Psychologist, Professor, and Pat Tillman Scholar. To start the process of transforming your relationships now, download our free guide and checkout the REWIRE app
I often present my scholarly work at national conferences, and was recently in the audience at a symposium on the topic of social support and recovery from traumatic events. Scholars of national repute presented various studies from around the world, showing how important social support is in the prediction of disease proliferation or disease reduction. I recognized the measures, methods, analyses, and findings as near identical to those that I’ve presented and published for more than a decade.
I came to a moment of clarity: We have spent 50 years recycling the idea that social connection is the most important factor in the prediction of flourishing, health, meaning, thriving, and happiness.
Great! We’ve identified a problem ad-nauseum. So, since we absolutely know this to be true, social connection must be improving in our culture? No, it’s not. In fact, social connection and cohesion are in rapid decline in nearly every sector of our culture.
We will stay high level here with the evidence for the erosion of social connection. For starters, the U.S. Surgeon General recently declared loneliness and social disconnection problems as a priority public health crisis…DEFCON 1. Another data point comes from the work of Dr. Julianne Holt-Lunstad, who identifies the centrality of low social connection in the prediction of early death and poor quality of life. A third high level data point comes from the groundbreaking work of Jonathan Haidt (see “The Anxious Generation”) demonstrating the heartbreaking disconnection syndrome teenagers and emerging adults are mired in. If you need more evidence and don’t buy what I’m selling here— that we are in a social connection crisis— then this argument and focus of our work in this community building project is not for you. Full stop.
So, what are the options for me to learn to improve social connection? The truth: we’ve made no progress in developing scalable approaches that lead to better and deeper social connection for ‘we the people’ struggling to connect deeper out in the real world. For the 90% of us who live in the middle (between the extremes) and are experiencing the visceral decline of authentic social connection.
There are two key drivers of our lack of development in the area of social connection interventions that are worth understanding here. First, improving social connection is not aligned with profit driven healthcare that focuses on reimbursement ROI. Our medical reimbursement system and funding agencies can’t make money on treatments that target mechanisms of health and root causes of disease (for example— social connection and physical exercise). Instead, these systems are designed to reimburse and profit from symptom reduction and disease treatment (depression; social anxiety; PTSD; diabetes; cancer care). Said another way: healthcare systems prioritize reactive disease treatment rather than disease prevention. To take this thought to a more disturbing place, it’s also not profitable for people to improve social connection in ways that propels us to rely less on disease-focused medical interventions and more on natural social networks. Yikes.
A second driver of our lack of investment in social connection interventions is that there is no natural place or governing body from which these interventions would emerge. The field of clinical psychology is the group of people focused on the design and production of treatments. Unfortunately, clinical psychology as a field is also deeply dedicated to the medicalization of mental illness (cleverly “reappropriated” by using the term mental health) by focusing on disease diagnosis and reduction of symptoms.
This is problematic for many reasons. Foremost among them is that disease-focused, medicalized approaches do not align with what the majority of people want or necessarily need. As a case study in this reality, research among veterans seeking mental health care shows that 96% of them consider improvement in social relationships as their #1 priority for seeking care. In response, they are offered disease reduction treatments (e.g., PTSD treatments) rather than care that aligns with social relationship priorities.
- Are you experiencing a loneliness problem? Let’s focus on diagnosing and treating depression.
- Struggling in your marriage? Let’s focus on diagnosing and treating anxiety.
- Having difficulty feeling connected to your family and community? Here is a medication to help take the edge off.
Most often, regardless of who I am seeing in my therapy practice (veteran, physician, firefighter, nurse, college student), the reason for seeking treatment is that relationships are suffering in one form or another.
Try this thought experiment from a recent case:
Kathleen is a 21-year-old junior in college, presenting in my clinic for difficult feelings of loneliness, low motivation, and low meaning in her day-to-day life. As part of the intake assessment, we learn that Kathleen has struggled to develop deeper friendships, and she had hoped that college would be the place that this would happen for her. She feels this opportunity slipping through her fingers. We also identify mild-to-moderate symptoms of anxiety and depression. She states a clear goal: Please help me to improve my relationships, meaning, and mental health.
What would be the most natural place to enter improvement in Kathleen’s goals? Her presenting problems and motivation for seeking help revolve around improving relationships, meaning, and mental health. But the treatments that are prescribed as ‘best practices’ are designed to target disease reduction. A disease reduction offering in this case may focus on treatment with an SSRI for mood management, a benzodiazepine for anxiety flair ups, and cognitive exercises to manage anxious or depressed thoughts. This approach teaches Kathleen that her problems are medical in nature, and that the answer lies in medical/clinical treatment.
But that’s not what Kathleen asked for. Further, does Kathleen have a disease? We begin to discuss her mood and anxiety as possible downstream symptoms stemming from a lack of authentic and life giving social connection. Instead of organizing Kathleen’s care around disease reduction, we collaborate to organize our efforts around her natural motivation to develop more, better, and deeper social connection. To develop the kind of friendships that her parents said they made during their college years. We also work on anxiety management skills, which Kathleen naturally identifies as necessary when she notices the way that anxiety was undermining her relationship goals. Because she is motivated to improve relationships, she becomes motivated to build anxiety management skills.
_____
Through increased commitment to engagement in actual, literal relationships, we begin to grow experience and skills that build the inertia for more motivation, meaning, and connection. We can shift the model, to represent and target the loneliness and disconnection that are so prevalent in our age. We can do so without medicalizing or diagnosing disease. Further, if mental health diagnosis is a part of the picture for any person, a focus on social connection improvement can effectively reduce such symptoms. This can often be a helpful first step in separating the social connection ‘noise’ from the pathology signal (the remaining mental health symptoms).
In other words, by focusing on building healthier relationships, pathology severity can naturally reduce in parallel with increased quality of life. This is not an assumption. It is supported by expansive work on the science of stress buffering: That social functioning buffers or protects against (reduces) mental health problems.
Additionally, we can target social connection among healthy people who want to optimize and improve their relationships and health. This aligns with preventative medicine approaches that seek to reduce the likelihood and severity of mental health problems that can emerge in response to the inevitable suffering that happens upon us all at some point in our lives.