Loneliness & Suicide in the Pandemic: reconstruct what it means to be human

“We lived through the pandemic.” For some, this would become a badge of honour, how we individually and collectively guarded each another amidst of adversity. For some, this would signify the loss of precious ones, a time to weep and mourn. Albert Camus <The Plague> has tainted how the absurdness in people’s hearts, the degradation of humanity spread along with deadly illness. Gabriel García Márquez on the other hand sees <Love in the time of Cholera>, that love transcends amongst fear of death, and the comfort of solitude. What does the pandemic mean to you? What would the pandemic mean to you?

The first sign of humanity begins with a healed femur bone. We – humanity as a whole – would have certainly progressed a lot from the past, haven’t we? We long possessed the strongest weapon against the virus, and no, you know I am not talking about the vaccines. I am talking about the shared values that marked the progression of humanity (No, not the small steps on the moon). COVID-19 feels much closer to Camus than to Márquez.

I recently saw an interview of the (in)famous Prof. Slavoj Žižek. The bits and bops about international relationships have proven to be too puzzling for my feeble mind, but something did caught my attention.

“We are more bodily isolated, but socially connected. In a situation of social distancing, we are more socialised, open to society, more than ever. What I miss the most is being authentically alone. We are more connected than ever! The most annoying part of COVID is not being able to be alone.”

Slavoj Žižek

I guess when you are Slavoj Žižek, you’re bounded to be crowded by people seeking advice or wanting to share your wisdom at all times. Complaining to be not alone in a pandemic- this must be an ubiquitous experience for Žižek. As UK has re-entered the lockdown for the second time, one literally can not be much more isolated than it is now. But since it is from Žižek, I had to deliberate, are people really more lonely in the pandemic?

Are people really more lonely in the pandemic?
Are people really more lonely in the pandemic?

Loneliness is a major public health concern, associated with a heightened risk of mental and physical illness, cognitive decline, suicidal behaviour and all-cause mortality (Leigh-Hunt, et al. 2017). Loneliness is also associated with severity of depression (Lee et al., 2020 – Shout out to Lee Siu Long, Early Career Psychologist from Hong Kong, first first-author publication on Lancet Psychiatry!). As social distancing measures were widely implemented to put a halt to the raging COVID-19, this led to many worrying and scaremongering claims in the UK, such as “lockdown will trigger a spike in suicide”, some even from “experts” in the field (see open letter from 42 mental health practitioners). These claims often argue that (1) increased loneliness would be an inevitable result of lockdown, and consequently (2) lead to increase number of suicides. I’d like to dissect these claims, and see whether they are supported by evidence.

It is key to separate the constructs of social isolation from loneliness, but differentiate their impact on mental wellbeing could be challenging. Social isolation can simply mean living alone, while loneliness usually is described as the subjective feeling of feeling alone, regardless of the extent of social contact. Although these 2 constructs are correlated, logically, one could be living a life of solitude and never feel lonely (rang me up if you’ve met someone like this).

Researchers in the UK compared the level of loneliness in the UCL COVID-19 Social Study (N = 60,341, March 2020) and the UK Household longitudinal study (UKHLS) (N = 31,064, 2017-2019). They also investigated whether the risk factors of feeling lonely changed in the pandemic. Loneliness levels were higher in the UCL COVID-19 Social Study than in UKHLS, with 32.5% of people feeling lonely sometimes (28.6% in UKHLS) and 18.3% often (8.5% in UKHLS). Around 40% scored 6 or above in the UCLA-3 Loneliness Scale (Range from 3-9 = most lonely)* in UCL COVID-19 Social Study (around 25% in UKHLS).

Despite being more lonely during COVID-19, the risk factors for feeling more lonely are very similar in the 2 cohorts, some significant ones include: (1) aged 18–30 (vs aged 60+) (2) living alone (social isolation) (3) Having a low household income (4) being unemployed. Risk of feeling more lonely as a student was much higher during the pandemic. Other known risk factors including non-white ethnicity, being a woman, having low educational attainment and living in urban areas – these were relatively small risk factors.

The first part of the argument stands – people appear to be more lonely during the pandemic (we need more Žižek?). From existing literature, relationship between loneliness and suicide is not crystal clear. There was evidence that the relationship between self-harm and loneliness was strongest when the self-harm had no suicidal intent or was not considered a suicide attempt. The pathway in which loneliness lead to suicide is often through depression. Majority of the studies were conducted in cultures where individualism dominates (Europe). It appears that the second part of the argument demonstrate some face validity. At least, I feel Émile Durkheim would agree!

(This paragraph is heavily inspired by Prof Anthony David – Into the Abyss – 10/10 read!) Durkheim published “On Suicide” in 1897, where he shared his observations on social factors on rates of suicide. One of his key observations was that Protestant Christians has a consistently higher suicide rate than Roman Catholics. Durkheim did not think it was the difference in rituals or doctrines that had led to this difference. He argued that “intense collective life” of Catholics inhibited suicide. This sense of collectivism is vital –

“… not because we need to sustain the illusion of some impossible immortality; it is because it is implicit in our moral being and cannot be lost… [If lost] the slightest cause for depression can give rise to desperate acts”

Émile Durkheim – On Suicide

This need of being part of a group, to live a collective life appears to be an anecdote to why immigrants are at elevated risk of feeling lonely and dying by suicide. There are many reasons why immigrants failed to assimilate into local culture: racism, trauma, and becoming more and more relevant, nationalism etc… I’d love to give this another take.

Catholicism vs Protestantism?
Catholicism vs Protestantism?

We all belong to groups – we all share identities with others. We are members of the family, workplace, country. Some groups are mutually exclusive: some countries do not allow their citizens to own dual-nationalities; some could care less as long as you pay taxes. Some of these groups are inherited, some are results of your choice. Regardless, it is not difficult to differentiate group membership from belongingness. You could be a member of the local gym (where you might have yet to visit twice), but belong to the charity you volunteer down the road. Membership solely denotes status, belongingness is tied to your values, emotions and your emotionally modified experiences (or simply, memories). In my opinion, every group must share at least 1 of the 2 key elements: (1) values (2) mission. A study group share a clear mission, to complete the group project. A great study group shares also the values of scholarship and commitment. A marriage share the same mission, to support each another economically, to share a household, legal responsibility and social rapport. A great marriage shares also the values of fidelity and love. One group could achieve its mission rely on their members, but only those who share its values would belong.

Nationality is an interesting example. Benedict Anderson described nations as imaginary communities, and nationality as a means to gather #wethepeople (jks) to defy against hereditary monarchies. Yet we all seem to be happy to play along as members, or strongly relate to this imaginary construct that we “inherited” (Well I guess in some it could also be a choice – holding the ”green card“ is still a highly-valued asset or social status). Anderson’s theory offers a partial explanation of why nations arise – it’s mission. Ask any patriots you’ve met, I’d hardly imagine their love for their country is fuelled by their will against a monarchy (in some countries, the opposite might be more relevant…). It is the values that the patriots truly support (at least claims to support). In the Era of gods, wars between nations are figuratively fights between divine beings. Religions then were much more than moral teachings, but rules of law and order, and the core of the culture. National boundaries were then defined not by sticks and stones, but by their values. Segregation is a bottom-up phenomenon, not a top-down demand. Projecting our thoughts back to the notion of immigrants, these increased rates of suicides, loneliness and dissociation from society might stem from their non-adjustment to a different set of values. Mere physical membership would not translate to belongingness.

Nationality - an imaginary construct.
Nationality – an imaginary construct.

Back to the topic, what we’ve discussed seem to support the claim that lockdown measures are detrimental to public mental health, and suicide rates should rise in the pandemic. Early studies predicted suicide rates to increase from 1% to 145% in the pandemic, using different assumptions. There is no ways to verify or disprove these claims, as there is no real-time suicide surveillance systems. It is a technical and legal challenge to determine whether a death is classified as a suicide (see this post for more). Finally, a long awaited report by the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) (UK) was published earlier this week, and a publication on the British Medical Journal describing suicide trends in several high-income countries. Paper suggested that suicide rates did not rise in Massachusetts, USA; Victoria, Australia; England, and fall in Japan and Norway in the early months of the pandemic. The claim that suicide would spike in lockdown is not supported by evidence.

Suicide rates did not increase in the pandemic. But this does not imply people do not need support on their mental wellbeing. People are feeling more lonely, and experiencing increasing number of mental health difficulties. Non-evidence based claims has achieved nothing but division, elicit our primal emotions of fear, and corrode our decision-making process. Ill-advised approaches, such as “herd immunity”, is killing off our comrades with the broken femur bones. Have we travelled backwards as a civilisation? Or progressively speaking, have we progressed beyond what humans should mean?

What has gone wrong in the argument? We’ve spend a big chunk of this article alluding the rise in suicide rates, but it did not convert. The answer has to be Slavoj Žižek. In the same interview. Žižek encourages his fellow philosophers that during COVID-19 is no better time to study philosophy. There is no better time to reflect and develop what it truly means to be a human in this trouble-found times.

We all belong to groups, we all support different values: Biden vs Trump, Science-first vs COVID-Deniers, no matter which group you are a member of or belong to, we all share a largest common factor – we are humans. We are, indeed. In the pandemic, we experienced collectively the brittleness of human lives. In this sense, along with Žižek, we were not alone. We were forced to accept “the new norm”. We had to resist our nature as social and communal animals. We are more exposed than ever from our concrete buildings, professional certificates and luxury, that we are – humans. Perhaps this sense of collective living/suffering protected us from the suicide spikes. Are we merely a member of the human class – our mission being sustaining the status quo? Or do we belong to this group, by uplifting our values in the ways we treat each another? This question warrants a rethink of the values of being human, and whether we’d share these values.

“We lived through the pandemic.” We can still right our wrongs. We can still win this war. We have to find our values, and uphold these values in every way forward. Because we all are rightful humans.

With the love of God.

 We have to find our values, and uphold these values in every way forward.
We have to find our values, and uphold these values in every way forward.

*UCLA-3 is one of the widely evaluated loneliness measure, consist of the 3 following questions:

(1) how often do you feel a lack of companionship? (Never – 1, Some of the times – 2, Often – 3) (2) how often do you feel isolated from others? (3) how often do you feel left out?

TL:DR; – People have been claiming that lockdown will lead to a “suicide epidemic” due to loneliness, thus refuted against the lockdown decisions. This narrative in my opinion led to regrettable public health policy and decisions. Lives were lost – not to suicide. Recent figures from Australia, British Columbia, US, UK & Norway compares suicide rates prior to and during lockdown. NONE of the figures show that suicide rates increased compared to pre-COVID numbers. This does not imply people do not need support on their mental wellbeing. People are feeling more lonely, and experiencing increasing number of mental health difficulties. These claims of increased suicides were busted. These non-evidence based claims has achieved nothing but division, elicit our primal emotions of fear, and corrode our decision-making in protecting lives. We dropped our comrades with broken femur bones in our “herd immunity” approaches – evident in the US & Sweden. The way forward has to begin from reconstructing what it means to be human – what are the values that group us together, and we should uphold these values every way forward.

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From Binary to Spectrum: A Thought Experiment

Saw this Tweet on Jul 31, 2020 by Twitter User: @ravenscimaven

I really don’t like being labeled “BIPOC*” y’all. I don’t know what it is, but I’ve had more people these past few months refer to me with an acronym than ever in my life and it doesn’t sit right with me. I wonder, how do LGBT+ folks feel about being identified with an acronym?

@ravenscimaven on Twitter

*Black, Indigenous and People of Colour

I’ve first encountered the term BAME (Black, Asian, and Minority Ethnic) when I first arrived in the UK. I never liked the term, as it was used and discussed as if the experience of ethnic minorities in the UK are similar/comparable. I appreciate the motivation to raise awareness and fight for the rights of the minorities. Yet I can’t help to feel elements of tokenistic labels in the imprecise languages around the topic. Why create this label BAME, when you can just describe – for example, Black Caucasian – and acknowledge the differences between this group and, say Black Caribbean?

The question then shifted from category of ethnicity to sexual orientation – whether the label of LGBT+ is identified by people of these orientations. In the current age, this comparison is appropriate in sense that, a person can identify their belongingness to their identities, based on their intuition, affection and resolution. Yet I think there is a slight difference between the two, as the latter is described as a spectrum is a varying index on a 2D scalar field; while the former is conceived as categories.

I think my question is, what qualifies the latter to be a spectrum, instead of groups in a wide array of categories? What are the 2 ends of the scale? Is a spectrum specifically used to encourage us to reject binary categories? Bunch of categories sprung up in my mind, I’d invite readers to help with this thought experiment and classify, which would be spectrums vs categories.

Ethnicity – Nationality – Mental Health – Political Philosophy

Photo by Sharon McCutcheon on Pexels.com

A Corresponding Tweet from Twitter User: @thecrobe caught my attention.

I do not mind being grouped into the queer community (usually). What I DO dislike is when it is used for performative action by someone doesn’t understand the nuances in the community (and does not educate themselves).

@thecrobe on Twitter

From this user’s experience, I am tempted to think: Rejecting existing binary categories doesn’t matter – discovering the new identity matters. Whether such category (within a spectrum) exist in the past doesn’t matter, but whether there is scope in the present to allow the development of character to this label matters. It is not the half-hearted belongingness to these labels that elicited negative feelings amongst the labelled, but the movements that attempted to create history, culture and character around that single ambiguous label/category – that failed to echo with these groups.

If this is the case, the central aim of the advocates – for whichever group – should shift away from proving that some people are different, and stop putting people into more complicated categories. We already know that. But to help create an enabling environments, such that these individuals can explore their individual identities to the fullest.

Voices from people with lived experience MUST stay at the centre of all advocative movements, research and policy-making. For the sake of the individuals, the community and humanity.

A Mental Health Enabling Society

Discussions of mental health cannot exist in a pure biological realm without considering how it is intersectionally embedded within our political and economic structures. There is mounting evidence on the social causation and social drift effects of poverty and poor mental health. It is the day-to-day lived-experience, negligence of the structure, disproportioned power and relationships – both historic and contemporary – that constructs the patterns of mental illness in our society (Nancy Krieger) – which shape the niche where people survive with mental illnesses (Rochell Burgess).

In Hong Kong, the government has invested on destigmatisation of mental illness – yet most work appeared to go south – but that is only to be expected whn mental health is viewed with a poorly focused lens, with healthcare, social welfare, housing & labour departments working in silos. Still awaiting evaluation reports from multi million dollars campaigns.

There is an extent destigmatisation workshops and talks are going to help, when the whole societal narrative has been horrendously stagnant. When people with mental illness continue to be ignored in work and pension system, struggling in underfunded and underresourced psychiatric care systems, and unsupported by community care running purely on charities by churches and NGOs. What, then, is the government’s role in building a mental health enabling society?

Photo by Max Mishin on Pexels.com

“What is promoted as fiscal discipline is a political choice. A political choice that deepens the already open and bloody wounds of the poor and precarious….But austerity is also a social contract. People accept severe restraints in public spending, actively in democracies or passively in autocracies, because they accept the unpalatable prescription of abstinence…”

“…Yet the public too has a choice. And they are exercising that choice in countries across the globe……After a decade of cutting back the reach of government, the public is now demanding a stronger and more generous state. The (social) contract authorising austerity has been torn up…” Richard Horton (2017).

Ethics lies at the heart of policy-making. Open dialogue and knowledge exchange is essential in developing the consensual ethics standards that drive attitude change and destigmatisation. Ability to identify strengths locally, ensuring safe social spaces and partnership is indispensable in vitalising these ethical standards in policy making. These are what we can do – speak, act, adapt and live truthfully to your beliefs – the fruit of democracy.

Yet all these must align with a wider narrative that the Hong Kong Government listen to her people, and reflect her observations through the budget plans. There would be much more leveraging and bargaining in-between, precisely a role of the elected members in the LegCo. Change is not impossible.

I often end with brief remarks of encouragement – I’ll do the same here – A Change is gonna coming.

Reasoning History

We now pursue evidence, theories and testable assumptions more than ever. When I was younger, for those who know me, I’d love to self-proclaim as a reasonable person [now spotted a few flaws of doing so]. More required to be now as an academic.

Yet its no better time amidst of a historical event, to reflect upon this stream of thought, and how this pursue of reasoning has shaped our education, progression in science and medicine, religion and history.

The role and meaning of history has claimed to be shifted away from edification, by providing moral or political exemplars to emulate or to avoid and to offer cautionary reviews of past events to guide future action, to “objective description”, pure records of evidence and events – and nothing more.

For example, stark similarities were shared amongst terrible emporors in ancient China – as if they were reincarnations of the same person. This could be represented as a sign of caution for later Kings. Yet the scientific paradigm crowned objective evidence, we’d discuss and criticise whether this description of x really originated from a reliable source etc…Personal insights, first-person experiences and qualitative work has little role in publication (other than fictions duh). Arts and poems disvalued as nothing more than a niche hobby.

The traditional value of histories lay in shaping individuals and societies toward the highest ideals of their times. History under scientific lens demands individual’s ability to evaluate evidence, speculate biases, and moral awareness to bring true value into societies. This creates an easy opening for those in power to shape reality, mould expertise and build pseudo-authority by limiting access to information.

I encourage you to list a few things that does not require reasoning. I’d always loved to lay on my bed and stare into the blue sky as a kid – just realised over the weekend that I haven’t done so in years. Trying to do that more. Notice what you feel in this period of time. This, instead of what the history book says, will be your history when you look back in time. We create our own history.

Stay Safe. God Bless.

*note: I am not advocating anyone to disregard history, tradition etc., but to encourage oneself to make personal sense of history. Also encouraging myself to relax a bit 🙂