A blog by Araminta Jonsson.

Humans are naturally social creatures. Our brains are wired around social connectivity. Historically we have grown as a social species, with the innate knowledge that our survival depends on each other. However today we are seeing our society fractured and fragmented. There is a phenomena of loneliness and isolation across the globe and, as Gabor Maté stated in a recent presentation in London: loneliness, not opiates, is the global epidemic. In January 2018, Britain acknowledged the seriousness of this problem by appointing a Minster for Loneliness in the Uk. This came after a 2017 report published by the Jo Cox Commission on Loneliness which stated that over nine million people in the country often or always feel lonely. This isolated lifestyle we seem to have adopted is having a serious impact on both our physical and mental health. In an article written for the Harvard Business Review in 2017, Dr. Vivek Murthy said that loneliness can be associated “with a greater risk of cardiovascular disease, dementia, depression and anxiety.” It can also kill, according to Mark Robinson - the chief officer of Age UK, who says that “it’s proven to be worse for health than smoking 15 cigarettes a day.”

If loneliness has such a grave impact on our mental and emotional health, as well as our physical well being, we’d also like to examine whether this global phenomena could be contributing to the opioid epidemic which is spreading from the United States today. In order to examine this question, we will be looking at the work of two eminent women: Psychologist, Naomi Eisenberger and Neuroscientist, Rachel Wurzman.

Whilst Eisenberger was studying for her doctorate at UCLA she began to develop an interest into the language we use to describe our feelings of rejection. Often we’ll use terms like ‘my heart was broken’, or ‘it was like a slap in the face’. These expressions convey the feelings in a physical sense and Eisenberger wanted to know why we used these particular phrases and whether there was a deeper connection between physical and emotional pain.

To examine this further Eisenberger developed an experiment called Cyberball, which involved participants playing a game of virtual reality “catch”. Players would press a button to throw the ball to each other, whilst researchers measure their brain activity through fMRI scans. After a brief period of team playing, the participant whose brain activity was being measured started, being left out of the game. The other virtual reality players would only throw the ball to each other and ignore the third player. This was in order for the researchers to be able to measure how exclusion, or social pain as they called it, affected the brain.

Physical pain involves several brain regions, some of which detect its location, while others, such as the anterior insula (AI) and the dorsal anterior cingulate cortex (dACC), process the subjective experience, the unpleasantness, of pain. The interesting part of the Cyberball experiment was that both these parts of the brain that detect physical pain lit up when the player was rejected, with the players who were most emotionally upset showing the most activity on the scan. The results suggest that our brains make no distinction between physical pain, such as a broken bone, and emotional pain, such as a broken heart.

The conclusions of the Cyberball study prompted Eisenberger to take the idea further and ask the question: if we feel emotional pain in the same way we feel physical pain, surely pain killers that help relieve our physical aches, should also help relieve emotional distress? In a study to prove this theory, Eisenberger and her team asked participants to take twice daily doses of paracetamol - some of the group taking actual pain medication whilst others took placebo pills, and keep a diary of their emotions. As you may have guessed, the results showed that those taking pain medication recorded less emotional upset and less brain activity in the dACC and the AI regions than those taking the placebo.

Eisenberger’s experiments can therefore perhaps offer us some insight into the opioid epidemic that is so ravaging the world today. If we are being prescribed, or indeed overprescribed, opiates for our physical pain and discover that they are also helping with our emotional distress, it is understandable that when the finite physical symptoms of pain are no longer there, we want to continue to ease our daily emotional stressors in the same way.

Further to Eisenberger’s findings, if we look at loneliness and isolation as a kind of suffering, it is then not too much of a stretch to see the link between the global loneliness epidemic and the opioid epidemic. Today many of us are victims of our own success. Within our genetic make up is the drive to make things better and the positive side to this is that the western world has become advanced and thrives in certain areas. However this same need to fix and solve issues, when distorted and made personal instead of for universal good, makes us impatient and look for quick relief. The prosperity we have hinders our ability to sit still in our suffering. Our society offers us many ways to run from the gnawing emptiness many feel inside, including food, alcohol and, of course, prescription opiates.

As a global nation we do not suffer well and we seem to misunderstand what comfort actually is, seeing it as a state as opposed to a process. Real comfort comes in time, it comes knowing that you have others around you supporting you in your moments of need. These moments and the actions and aid from others help form our characters and our ability to grow through suffering.

The Neuroscientist, Rachel Wurzman, is also in agreement with Eisenberger’s results believing that loneliness translates in the brain into literal pain. This, she says in her TEDxMidAtlantic talk, “contributes to opioid addiction — fueling drug use, relapses and overdoses.” The work that she has done with the striatum, a region at the base of the forebrain that helps enable decision-making through social connection, reinforces Johann Hari’s pronouncement that “the opposite of addiction is connection”. This concept is further explored in Philip Flores’ book, “Addiction as an Attachment Disorder”, in which he looks at several theories including: attachment, ego psychology, and self-psychology and believes that ‘addiction is a retreat into a ‘‘grandiose-self or false-self personality as a way of avoiding the need for attachment’’, thus addiction is a manifestation of unmet developmental needs. The basic premise here being that, not having had a secure attachment in childhood creates an inability for an addict to properly connect with others. Therefore an internal conflict develops whereby they have the human need for connection, but they are unable to satisfy this through fear or inability. So they seek connection through substances.

Wurzman’s career found her entering a relatively new subfield of neuroscience known as social neuroscience where she discovered that the social neurochemistry in the striatum is linked to things like oxytocin and signalling between opioid receptors. She explains that there are naturally occurring opioids in our brains that are linked to our social processes. In her Ted talk she explains that experiments giving healthy people naloxone, a drug that reverses opioid overdoses by blocking opioid receptors, have indicated that by hindering the brains ability to use its normal opioid signalling, the participants of the study found it harder to feel connected to people they knew and cared about.

She explains that “not having opioid-receptor binding makes it difficult for us to feel the rewards of social interaction.” Further elaborating by saying that “the effects of social disconnection through opioid receptors, the effects of addictive drugs and the effects of abnormal neurotransmission on involuntary movements and compulsive behaviours all converge in the striatum. And the striatum and opioid signalling in it has been deeply linked with loneliness.” Essentially what she is saying is that when our opioid receptors aren’t working at full capacity, we can still end up feeling alone in a room full of people we care about and who care about us.

Wurzman goes on to describe loneliness as similar to “a hunger in the brain which neurochemically hypersensitizes our reward system.” When we are in this hypersensitive state, our brains tell us that we are deeply unsatisfied and that we need to find something to satisfy us immediately. If then we are in a country that supplies opioids as a relief from physical pain and we are also feeling lonely and isolated receiving messages from our hypersensitive brains telling us to seek relief from anywhere, we end up in a perfect storm. It therefore isn’t much of a leap to recognise that when our ravenous brains demand for their social neurochemistry to be rebalanced, we will reach for something we know will help remove the “physical” pain of loneliness and give us a fake sense of connection - opiate painkillers.

Therefore in a society where we seek relief from the pain of loneliness through pain killing medication, perhaps a solution would be to start practicing connective behaviours instead of compulsive behaviours. One such way of connecting can be seen in the therapeutic alliance that forms between a therapist and their patient. According to Phillip Flores in his book Addiction as an Attachment Disorder, he states that ‘the addicted person is always vulnerable to addictive behavior until the self-structure is repaired. ‘‘The patient needs a consistent, nurturing, mirroring, holding environment that can contain and manage negative, destructive impulses while giving the patient the opportunity to identify, internalize, and incorporate a healthy set of introjects and internal object representations. You could take this even further and suggest that there is a hidden part of therapy that works to combat our feelings of loneliness. One that goes beyond the clear need to set the therapeutic goals of “curing” the thoughts and feelings that we struggle with. As Yalom says, it is part of the privileged moment of the experience of two people in the room. Two people together and connecting in this way can be seen as a moment of de-isolation. The point being that when two people connect around what is broken, they connect as human beings. In that way they are able to heal from the compulsive self-destruction which was the original response to the pain of disconnection.