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Recently the U.S. Department of Health and Human Services released a report on a surprising, yet intriguing subject: loneliness.  According to various studies and surveys, isolation and a lack of social connectivity has become epidemic.  The COVID-19 pandemic may have exacerbated what was already problematic for millions of Americans.

“Our epidemic of loneliness and isolation has been an underappreciated public health crisis that has harmed individual and societal health,” declared U.S. Surgeon General Dr. Vivek Murthy.  “Our relationships are a source of healing and well-being hiding in plain sight – one that can help us live healthier, more fulfilled, and more productive lives.  Given the significant health consequences of loneliness and isolation, we must prioritize building social connection the same way we have prioritized other critical public health issues such as tobacco, obesity, and substance use disorders.  Together, we can build a country that’s healthier, more resilient, less lonely, and more connected.”

The physical health consequences of poor or insufficient connections are dire.  They include a 29% increased risk of heart disease; a 32% increased risk of stroke; and a 50% increased risk of developing dementia for older adults.  Lack of social connections is estimated to increase the risk of premature death by more than 60%.

In addition to our physical health, loneliness and isolation contribute substantially to mental health challenges.  In adults, the risk of developing depression among people who report feeling lonely often is more than double that of people who rarely or never feel lonely.  Loneliness and social isolation in childhood increase the risk of depression and anxiety both immediately and well into the future.  And with an estimated one in five adults living with a mental illness in the U.S., addressing loneliness and isolation has become critical in fully addressing the mental health crisis in America.

For better or worse, the COVID-19 pandemic exposed the loneliness dilemma.  It also seems to have amplified it.  As businesses either switched to remote work or shut down altogether, people found themselves isolated in the name of good health.  I think much of this was foretold by the obsession with social media in the preceding two decades; where people would establish cyber relationships and call each other “friends”.

As an only child and a confirmed introvert, I’ve dealt with loneliness my entire life.  Sometimes I really do get lonely; other times I’m just alone.  I’ve always been a loner – something my parents never seemed to understand – and I’ve rarely done well in groups.  I get bored easily and quickly grow tired of dealing with people’s attitudes and personality quirks.  I put up with a lot of people’s disrespectful behavior towards me most of my life, which is the primary reason I don’t consider myself a people person.

But I have to admit I do get lonely sometimes.  I’m glad my parents had each other and me (and even my dog, Wolfgang to some extent) as they aged.  One of my uncles lives alone in a dingy apartment with a cat.  (An older cat died a few months ago, which devastated him.)  He can’t drive anymore, so he either takes a bus or has someone transport him somewhere.  I’ve taken him to a variety of doctor appointments over the past few years and grocery shopping almost every weekend for months now.  His stepdaughter lives closer, but she has her own health problems.

I have an aunt who also lives alone.  Her son, like me, is an only child, but he’s married and resides several miles from his mother.  She’s fortunate, though, in that a neighbor has access to her house and keeps an eye on her.  My aunt frightened me a few years ago, when she recounted how she fell in the bathroom one night and had to drag herself into her bedroom.  It took her hours just to get there.  But she was able to call her neighbor who contacted the fire department.  I stay in touch with my uncle and aunt, as well as other relatives and friends – even if it’s just via text message.

I only know a few of my neighbors and have little contact with most relatives.  I’ve never been married and I never had children, so I don’t know how life will be for me if I grow much older.  Loneliness will be just one factor in my later life.

Some years ago a friend expressed concern that I was becoming a hermit.  “Why should I go out?” I responded.  I lived with my parents, so I certainly couldn’t bring anyone home.  Then again, I hadn’t brought anyone home who I didn’t know since before the turn of the century.

A close friend keeps urging me to get a dog, as he did a couple of years ago.  Aside from two household plants that languish nondescriptly on a kitchen counter, I’m the only living being in this house.  (That doesn’t include the occasional insect that invades my quiet abode.)  I’d love to get a dog, but I’m just not in the right situation now to get one.

Dr. Murthy has established a six-point plan to help the U.S. deal with its loneliness epidemic:

  1. Strengthen Social Infrastructure: Connections are not just influenced by individual interactions, but by the physical elements of a community (parks, libraries, playgrounds) and the programs and policies in place. To strengthen social infrastructure, communities must design environments that promote connection, establish and scale community connection programs, and invest in institutions that bring people together.
  2. Enact Pro-Connection Public Policies: National, state, local, and tribal governments play a role in establishing policies like accessible public transportation or paid family leave that can support and enable more connection among a community or a family.
  3. Mobilize the Health Sector: Because loneliness and isolation are risk factors for several major health conditions (including heart disease, dementia, depression) as well as for premature death, health care providers are well-positioned to assess patients for risk of loneliness and intervene.
  4. Reform Digital Environments: We must critically evaluate our relationship with technology and ensure that how we interact digitally does not detract from meaningful and healing connection with others.
  5. Deepen Our Knowledge: A more robust research agenda, beyond the evidence outlined in the advisory, must be established to further our understanding of the causes and consequences of social disconnection, populations at risk, and the effectiveness of efforts to boost connection.
  6. Cultivate a Culture of Connection: The informal practices of everyday life (the norms and culture of how we engage one another) significantly influence the relationships we have in our lives. We cannot be successful in the other pillars without a culture of connection.

All of this is easier said than done, and every plan looks good on paper.  But I know something has to be done, if the nation’s overall health is to improve.  I only have a small collection of friends, but that’s all I personally need.  As with most everything else, it’s quality, not quantity, that matters.  And quality of life is always important.

Image: Seher Bilgin

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Relief Art

Feeling anxious or upset?  A number of things exist to help you out – reading, walking, meditation, exercise.  But have you ever thought of visiting a museum to ease that apprehension?  Turns out that patronizing a museum might be one avenue of relief for anguished souls.  A University of Pennsylvania study entitled “Art Museums as Institutions for Human Flourishing” published in the Journal of Positive Psychology indicates as much.

The relatively new field of “positive psychology” studies “the strengths that enable individuals and communities to thrive.”  It draws on research from a variety of academic disciplines while examining how the arts and humanities affect the human condition.

“We believe our collaborative and interdisciplinary work is all the more vital at a time when so many individuals and communities lack the levels of well-being they need to thrive,” said James O. Pawelski of UPenn.

Pawelski and colleague Katherine Cotter had already planned to study the effects of museums on people’s mental health when the COVID-19 pandemic hit.  Since so many museums were forced to shut down, the duo compiled and reviewed over 100 research articles and government and foundation reports.

They discovered that visiting a museum reduced stress levels, frequent visits decreased anxiety, and viewing figurative art lowered blood pressure. They also found that museum visits lowered the intensity of chronic pain, increased a person’s life span, and lessened the likelihood of being diagnosed with dementia.  And those living with dementia saw mental and physical benefits as well: Spending time in a museum induced more dynamic stress responses, higher cognitive function, and improvements in the symptoms of depression.

Going to a museum also left elementary schoolers feeling “restored” and even made medical residents feel less emotionally exhausted.

To most artists, this shouldn’t be surprising.  Writers, painters, musicians and the like have always had the ability to unite people when politicians couldn’t.  And now, our desires to make people’s lives better has been vindicated once again.

Image: Dallas Museum of Art

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Video of the Week – July 25, 2020

In an interview on FOX News with Marc Siegel, an associate professor of medicine at New York University’s Langone Medical Center, President Donald Trump defended his recent cognitive test.

Sad.  So very sad.

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Mother Wolf Transitions

My mother’s official 1959 wedding portrait

My mother told me that one day in the early 1960s, she was strolling past a row of file cabinets at the insurance company in downtown Dallas where she worked at the time, when a man who had a history of playing pranks on his coworkers suddenly leaped out and popped her bra strap.  At a time when people could normally get away with such shenanigans in the workplace, my mother said she didn’t think twice once she saw the smirk on the young man’s face…and smacked him across his face, sending his glasses to the floor.  She cursed at him – something that most people, especially women could NOT get away with in those days – and merely walked away.  Trying to play the victim, she said he complained to his manager who subsequently called her into his office.  She reiterated the entire scenario, which generally would be a true case of he-said-she-said.  But she had a supporter.  Another man had witnessed the incident and confirmed her version.  The bra popper was merely reprimanded verbally, and my mother was forced to drop the incident.

Not until years later did she reveal that to my father who surely would have stormed into the office and cracked a few heads of the all-male management.  In fact, she told me she never told my father most of the stuff that happened to her at work – the ongoing and pervasive sexual harassment she endured in the old days – because she feared his retribution upon her male colleagues.  But really didn’t need to do that; she could fend for herself.

My mother, Maria Guadalupe De La Garza, passed away last Monday, June 22, at the age of 87.  She had endured a lengthy battle with dementia and the effects of a stroke she suffered last January, which almost completely rendered her left side immobile.  After a lengthy stay in a rehabilitation center, I had to bring her home in May; whereupon she entered home hospice care.  That, in and of itself, was an ordeal.

But I knew her time was coming to an end.

My mother had a difficult start in life.  Her mother, Esperanza, was seven months pregnant with her, when her parents traveled to Taxco, a town just outside of México City, to attend some kind of family gathering in December 1932.  While there, Esperanza suddenly went into labor.  My mother barely weighed 2 pounds at birth; she was so small they carried her home in a shoe box and used her father’s handkerchiefs for diapers.  She was born on December 12, which to Latino Roman Catholics is Day of the Virgin of Guadalupe (Día de la Virgen de Guadalupe).  Thus, her parents named her Guadalupe.  Knowing that she had slim chance of survival – like most babies born prematurely in the 1930s – a local priest baptized her and gave her last rites in the same ceremony.

But she did survive – and fought various battles throughout her life with that inborn sense of determination and perseverance.  I still believe the unique mix of German and Mexican extraction only accentuated her unbridled individualism.

Esperanza died in México City on Christmas Day 1940, just 11 months after giving birth to her only son, William.  They had wanted to name him after his father, Clarence, but no one could a Spanish language version of that name.  Esperanza’s mother, Felicitas Basurto, stepped in to help Clarence raise his 4 children.  Felicitas had lived in the United States for a short while and worked for a U.S. Navy admiral as a governess to his 2 children.  She had actually taught herself English.  Felicitas returned to México in the summer of 1940, as Esperanza’s health began to fail.  She was there when her daughter succumbed to an abdominal infection.

In the September of 1943, Clarence moved his children and mother-in-law to Dallas where he’d found a job working an auto plant.  He wanted to return to his native Michigan, but he spotted an ad for the job in Dallas.

It was a rough transition for my mother and her 3 siblings.  None of them could speak English.  Many strangers thought my mother and her older sister, Margo, were Americans because of girls’ fair coloring.  But their maternal grandmother helped guide them into their new lives.

My mother met my father, George, in 1957, and they married two years later.  I’m their only child.

My mother’s strong personality made her almost fearless.  At some a gathering in the early 1950s, a nun got angry with my Uncle William for some unknown reason and called him a “spic”.  My mother was nearby and slapped the nun across her face.  That got her into trouble with the church and her father and grandmother.  Shortly before my parents wed, a priest told my mother that he hoped she’d do the “godly thing” and have lots of children.  My mother said she didn’t want many children, but the priest insisted; telling her it was her duty as a married woman.  She then agreed – and told the old man she’d bring all those children back to him so he could help her raise them.

Her sharp criticism of some people – especially other women – was boundless.  She called Paula Jones – the woman who accused Bill Clinton of exposing himself to her – a “dumb broad” because Jones apparently believed that she really was going for a job interview at his hotel room at 10:00 at night.  In May of 2004, my father’s second oldest sister, Teresa, died of cancer.  At the rosary, we spoke briefly with the husband of one of my cousins.  He was a police officer and mentioned that he was part of the security detail for former First Lady Barbara Bush when she came to Dallas and had to carry his gun.

“Why did you need to carry your gun?” my mother inquired.  “I mean, who wants a piece of that old hag?”

I burst out into laughter, as my cousin’s husband tried to keep his eyeballs from falling out of their sockets.

She called another former First Lady, Nancy Reagan, a “screaming banshee”; said she didn’t realize how fat Oprah Winfrey was until she saw her in jeans, when the talk show maven visited Dallas; and denounced Monica Lewinsky (the woman who had a sexual tryst with Bill Clinton in 1996) as a “cheap-ass whore”.

My mother and me, Christmas Eve 1965

My mother first started showing signs of dementia more than a decade ago.  Recipes for the simplest things sometimes eluded her.  My father and I finally got her to start seeing a neurologist in 2011.  In the four years since my father died, she occasionally referred to me as her brother, William.  A few times I had to call the paramedics to help me deal with her increasingly erratic behavior.  Their sudden presence always managed to calm her down.  I believe it’s because they were all men, and my mother was partial to men.

At the end of this past January, she suffered a mild stroke.  I didn’t realize it at first, but noticed she couldn’t get up out of bed.  I had her transported to a local hospital where an MRI discovered bleeding on the brain, which had already begun to heal.  It had paralyzed her entire left side.

I had to make the difficult decision of admitting her to a rehabilitation center to help her recover.  I found one nearby, but I developed a sense of dread the night the hospital transported her to the facility.  I felt like I was abandoning her.  I had promised my father many years ago that, if she should die first, I’d do everything I could take care of her.  And, of course, he died first.

The rehab center turned out to be incredible.  Physical therapists helped her regain mobility in her left arm and even her left leg.  I brought her back home at the end of March, as the COVID-19 calamity was unfolding.  I’d reports of residents at similar facilities contracting the novel coronavirus and even dying.

I contracted a health care agency to help me care for her.  But, after a week, things didn’t turn out well.  She became increasingly hostile and combative.  She also developed a urinary tract infection, but I thought she was experiencing another stroke.  After one night at the hospital, I had her readmitted to the rehab center.  Unfortunately, health care in the United States is still very much an actual business.  Her Medicare benefits were exhausted, and the facility had to discharge her in May.  I wrote about this in an essay a few weeks ago.

After returning home again, she entered a home hospice care program with same health agency.  They were quite phenomenal in helping me.  I couldn’t depend too much on relatives, friends or neighbors.  But her health continued to decline.  I had told a long-time family friend who lives nearby – a woman who’s known my mother for close to 50 years – that I didn’t feel my mother would make it to the end of summer.  Our friend was shocked, but when she came over to visit on the 18th, she realized I was probably right.  My mother had grown incoherent; she didn’t seem to recognize anyone, even me; and would often lie in bed staring at the ceiling or a wall and asking for her sister, Margo.  Margo had died of cancer in June 1989.

It’s incredibly frustrating and sad to watch someone who raised me descend into the depths of cognitive bewilderment.  The once vibrant, strong-minded woman I’d known my entire life had reverted to a child-like state of mind.  Now I know why dementia is often called “the long goodbye”.  You see your loved one disintegrate before you, and there’s not a damn thing you can do about.

In the few weeks preceding her death, I often felt we weren’t alone in the house.  I had prayed to my Aunt Margo to come get my mother, and I actually began to sense it was her moving about.  I also began to see shadows of a small animal trotting down the hall or the sound of tiny footsteps.  I realized immediately the figure was my dog, Wolfgang, who died in October 2016; just less than four months after my father.  In many cultures, animals, birds, and butterflies are often seen as either an omen of death or a conduit between our world and whatever other world might exist.  Both my parents absolutely loved that little dog of mine.  He actually became our dog.  Since I never married and had children, Wolfgang became their pseudo-grandson.  I even mentioned Wolfgang as a “canine grandson” in my father’s obituary.  On just a handful of occasions, though, I actually did spot Wolfgang – but only for a second or two.  I needed no further reassurance that my mother’s time here was coming to a close.

There’s no easy way to say goodbye to a loved one.  As a friend told me, that person can live a thousand years, but their demise is still painful.  I’m at peace, though, with what happened.  I’m glad I could get her back home to die.  She and my father had worked very hard to get and to keep this house.  We’ve been here almost 50 years.  And I couldn’t let her die anywhere else.

Now, I move forward.  Goodnight, mother.

Alzheimer’s Foundation of America

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