The Loneliness Curriculum of Psychiatric Training.

Abstract

The young psychiatrist is learning to cope with such remarks. He feels his internal shield go up and a sense of separation arise. Though he has masked his feelings of awkwardness with bantering, he carries resentment for his membership in a residency program that has brought on the isolation he experiences at the table. The literature points to the consequences of loneliness for further psychological and health problems. A 1988 Science article underscored the importance of this issue. “Social relationships, or the relative lack thereof, constitute a major risk factor for health—rivaling the effect of well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity” [1]. Loneliness is a risk factor for increased blood pressure, insomnia, and heart disease as well as a number of psychiatric disorders. In a series of elegant articles, Cacioppo and colleagues have elucidated the biological mechanisms and psychiatric consequences of loneliness. Their work shows that loneliness is a risk factor for depression, and that loneliness longitudinally negatively predicts subjective well-being [2–4]. Loneliness is an issue for many mental health practitioners. Studies have identified higher rates of stress, substance use, depression, suicide, and behavioral and disciplinary problems for psychiatrists compared to physicians in most other specialties [5]. In a survey of 75 community psychiatrists, 38 (51 %) reported isolation as a specific emotional problem [6]. In a survey of 60 psychotherapists working in a variety of settings, participants reported that the isolation required to conduct therapeutic work contributed to high rates of burnout [7]. This experience may start early in the career for many physicians. In fact, loneliness has been associated with medical students and residents encountering psychological difficulties during training [8]. Loneliness has been characterized in different ways—an experience of social isolation following a move, for example, or a change in social status [9]. It is often described as an internal emotional experience despite the social surround. Luanaigh suggests that loneliness itself can be conceptualized in a biopsychosocial framework to characterize the entire scope of this phenomenon [10]. While the capacity to enjoy solitude is a hallmark of adult actualization, loneliness tends to have a negative connotation of being sad, lost, and yearning. A review of the literature underscores the risks of loneliness in the geriatric population and the medically ill and stigmatized populations of our society [11–13]. Of interest, there is a paucity of the literature regarding particular vulnerabilities to the experience of loneliness in professional training programs.We believe that psychiatric practice may confer particular risks for the development of loneliness and that this experience may begin in training. This should be addressed early to prevent untoward consequences. * Jeffrey Katzman jekatzman@salud.unm.edu