​Returning to his alma mater, Foundation for Art & Healing (FAH) Founder & President Dr. Jeremy Nobel was an honored guest speaker this November at a student-organized evening on “Creativity, Connection & Health” at the Harvard T.H. Chan School of Public Health (HSPH). 

Dr. Nobel gave the keynote address before an audience of students, faculty and staff addressing loneliness on campus and situating loneliness and isolation within a public health context. The event was organized by a Student Planning Committee on Loneliness composed of Harvard public health students and staff from the HSPH Office for Student Affairs.  

“Loneliness isn’t just a bad feeling. It can kill you,” Dr. Nobel told the audience in his address. “In fact, loneliness is associated with an increased chance of early death to a greater degree than sedentary lifestyle, alcohol abuse or obesity. That’s striking when you think about how much of our public health infrastructure is built around those well-known lifestyle issues, to realize that there is a pressing societal concern that makes those problems look small by comparison.”

Dr. Nobel also screenedveral films from the Third Annual UnLonely Film Festival, a powerful collection of shorts dedicated to sparking conversation about loneliness, to raise awareness of its pervasiveness, and help reduce stigma around the topic. He then led the students and faculty through a group discussion of the films, including their personal reactions and thoughts on isolation on campus and the impact of technology. 

Following Dr. Nobel’s keynote, a panel of public health students and faculty gave their thoughts on loneliness, connection, and health. “It is well-known that satisfying social relationships are an essential ingredient for human flourishing, but there are also many barriers to connecting with others in ways that are deeply meaningful and mutually beneficial,” said Professor Matthew Lee, Director of Human Research at the Harvard Human Flourishing Program. “I hope that more people will get involved in this important initiative.” Other speakers included Murphy Barney, a Global Health student, and Kelechi Okereke, a Health Management student, who cited personal anecdotes of the student experience of loneliness. 

Following the panel, students, faculty and staff gathered for food, games, and exercises. Students from the Planning Committee had designed prompt cards with questions for participants to get to know each other more deeply, and many in the audience stayed late into the evening to connect with each other and bond after the event. 

Leah Kane, Director of Student Affairs at HSPH, spoke about the merits of having students involved in developing programming. “We know that more students want to meet others across programs, and we hope that they will be a part of designing more intentional programming on connecting and reducing the stigma around loneliness moving forward.”

By Bradley Riew, UnLonely Project Communications Team

Founder and director of the Foundation for Art & Healing (FAH), Jeremy Nobel, MD, MPH keynoted an event in Washington DC entitled Arts and Health: The Loneliness Epidemic.  The November 14, 2019 program, which was co-sponsored by FAH, The Morris and Gwendolyn Cafritz Foundation, and the Greater Washington Community Foundation, brought together funders, health practitioners, educators, community activists, and artists to explore the role the arts can play in addressing loneliness in the community. Presented at the Edlavitch DC Jewish Community Center (EDJCC) to a packed auditorium, the program included a panel discussion, the viewing of short films on loneliness and connection, and audience engagement through a haiku writing exercise. 

In his keynote, Dr. Nobel spoke about how loneliness has long been associated with mental health concerns like suicide, depression, anxiety and substance abuse, but in the last decade, there’s been an emergence of medical research also linking it to physical health conditions, correlated with a 30% increased risk of early mortality. He expressed an urgency to raise awareness about loneliness and its toxicity and to support programs with an arts focus that can mitigate loneliness for individuals and communities. 

“The arts have been used in a variety of ways to help people who are facing significant challenges, such as recovering from trauma or illness. But with the growing crisis of loneliness, there is an increased appreciation of how the arts and creative expression can help people feel more connected to themselves and to others. The arts have the power to engage people, activate them, and connect them around shared stories and experiences,” Dr. Nobel explained.

Jessica Plocher, Program Officer of The Morris and Gwendolyn Cafritz Foundation, voiced a similar sentiment. “At the Cafritz Foundation, we firmly believe in the power of the arts to transform lives and communities. The arts bring us together in profound ways—and a growing body of research suggests that engaging with art can improve our well-being. The arts can not only move us past the stigma of acknowledging the effect of social isolation but engaging in creative arts expression can reduce some of the adverse outcomes.” 

After showing several compelling short films from FAH’s UnLonely Film Festival, Dr. Nobel had the audience write haikus relating to creative experiences that made them feel better, asking for volunteers to share what they wrote. Then he opened the panel discussion. The panelists spoke about the pervasiveness of loneliness and how we, as a society, face real challenges in addressing this crisis. They shared their convictions that the arts can be part of the solution, but that it’s an uphill battle to make this notion commonly accepted.

Eliza Heppner, a Senior Advisor for AARP Foundation Programs, spoke about ways to determine whether a person could benefit from some kind of loneliness-related intervention. “The first step is identifying that someone is lonely. We ask people we serve to create a “friend inventory” and when people realize they don’t have many friends, we can speak about how they can become more engaged and get more support.”

Building on this theme, Moira McGuire, the Division Chief of Integrative Health and Wellness at Walter Reed, spoke of the responsibility we all share in alleviating loneliness. “It’s important to continuously think about ways that you can have an impact on others. For example, acknowledging people you don’t know: ‘I acknowledge you and I see you.’ It’s positive for both people involved. There’s mood elevation when you have a positive interaction with someone you don’t know.”

Using the arts to combat loneliness is a pathway all panelists embraced, but they acknowledged some of the inherent challenges. Maria Manuela Goyanes, Artistic Director of Woolly Mammoth Theatre Company explained, “We are such a thinking society. Part of the challenge of making the case for the arts is that we are going to have to think about feelings—it’s hard to get to that place in our society.”  

All panelists agreed that it was important to broaden the tent of who participated in discussions about repositioning the arts as something that could improve well-being. Dr. Nobel concurred. “It’s important to recognize who is not around the table and find creative ways to invite them there.”

Jennie Smith-Peers, Director of Development and Communications from Iona Social Services, spoke about issues affecting older adults, the population that her organization serves, and why the arts matter.  “Older adults are invisible in our society. There are a lot of systems that keep older adults isolated. We have to support programs—and many of these exist through arts institutions—where older adults are seen for who they are and for their strengths.

A major takeaway from the event is that funding for the arts can also be funding for community health improvement. In the discussion that followed the panel, several funders and community activists engaged enthusiastically with each other, imagining the possibility for broader application of arts-based activities to improve health and wellbeing across a wide range of concerns, especially targeting vulnerable populations. 

As the program closed, Goyanes from the Woolly Mammoth Theatre Company, imparted some final words of advice to the audience: “Consider reaching out to someone who is on the outer periphery of your life. Take someone on an art date. Preach the gospel of the arts.”

By Bradley Riew, UnLonely Project Communications Team

Workplace Burnout and Loneliness: What You Need to Know

Understanding the reciprocal relationship between loneliness and burnout.

By Jeremy Nobel, MD, MPH
As published on PsychologyToday.com 

Loneliness at work is often affected by other aspects of an employee’s daily experience, and perhaps no factor matters more than workplace stress and burnout. The relationship between burnout and loneliness is a reciprocal one. Burnout can lead to increased feelings of loneliness. When people feel overwhelmed, exhausted and dehumanized, it heightens their risk for isolation. Loneliness, too, can exacerbate burnout, by decreasing one’s capacity for resilience. It is critical for those experiencing loneliness at work to understand workplace burnout, and vice versa, to best navigate the workplace experience in a healthy, connected, and low-stress way.

In recent years, social psychologists, organizational behaviorists, and human resource personnel have noted a significant increase in the chronic and debilitating state of work-related stress known as burnout syndrome. And burnout seems to be increasing. Two-thirds of full-time workers say they experience burnout on the job and burnout among physicians, with a rate of 78%, has been declared nothing less than a public health crisis.

Most of us who go through a rough stretch at work, perhaps feeling overextended or falling behind, recognize that taking some time away from the workplace gives us the chance to relax and recover. But there are gradations of burnout that are deeper and more pervasive—something that a day off or even a two-week vacation can’t remedy.

The Mayo Clinic describes burnout syndrome as “physical or emotional exhaustion that also involves a reduced sense of accomplishment and loss of personal identity.” According to the World Health Organization, burnout is characterized by increased mental distance, feelings of negativism, and cynicism related to one’s job. Burnout erodes one’s sense of engagement and purposefulness and can breed emotional detachment, self-doubt, and shame.

The hallmark of burnout is exhaustion, experienced as a deep sense of fatigue and the depletion of physical, mental, and emotional resources. It isn’t necessarily the quantity of time spent at work that’s so exhausting, but the quality and nature of the time spent.

Pharmacy employee Sara Cox told The Guardian, a major newspaper in the UK, that burnout symptoms emerged with her increased workload. “Every Sunday, I had that feeling of dread that the next day I was going to have to juggle everything all over again,” she said. “I’d wake up exhausted, it felt like every day I was walking through thick mud.”

Boston Magazine profiles a lawyer who practiced for 15 years before walking away from his career and getting a job at his favorite cheese shop. “It wasn’t so much the amount of time spent in the office that got to me,” he told the magazine. “It was the mental and emotional strain of feeling like it was never enough, and that I had to always be thinking about work.”

The second characteristic of workplace burnout is apprehension that one is not performing one’s job effectively. Lack of control over one’s own working conditions is often a factor, as when employees feel they have no influence over the scope or complexities of their work and no voice in the decisions that shape it. In addition, workers may believe they lack the skills or access to resources required to complete tasks. This results in feelings of frustration, helplessness, and a diminished sense of personal accomplishment. According to the American Psychological Association, “the chances of burnout increase if you feel that you can’t express yourself on the job, or if you are taking on multiple roles that conflict with one another.”

Finally, burnout leaves people with a general sense of futility or lack of purpose causing discomfort— a feeling of: “What’s the point?” Burned-out people often feel disconnected from their jobs, professions, colleagues, and the people they serve, and a general sense of depersonalization. A restaurant manager in a Wall Street Journal article described his experience like being on autopilot, “like you’re just going through the motions.”

Certain workplaces seem to carry a higher risk for burnout among their employees, including healthcare and clinical environments, educational facilities, and community service organizations. What these venues have in common is the tension between the infinite demand for their services and the finite availability of resources. In many cases, complex bureaucratic systems, burdensome clerical and documentation procedures, and the absence of operational processes that facilitate workflow present further obstacles to efficiency and effectiveness. These conditions can compound employees’ feelings of underachievement, futility, pointlessness, and can even make them feel emotionally detached from the recipients of their services.

So, what does workplace burnout have to do with loneliness and isolation? Well, …everything!

Feeling disconnected from the people you serve often disconnects you from yourself, especially for the many of us who are motivated by a sense of mission and purpose. This disconnection can lead to depression, substance abuse and even suicide, all well noted burdens associated with loneliness. So, while loneliness may not in itself be a symptom of burnout syndrome, it is almost universally a consequence. And loneliness can actually cause burnout, as well as one’s susceptibility to it. People in the throes of work-related exhaustion, self-doubt, and defeatism are more likely to withdraw, interacting less and less, and effectively isolating themselves from the people around them. And those who already are experiencing loneliness in their lives may lack the emotional and spiritual resources required to feel replenished and resilient under challenging circumstances.  A person in this position can be vulnerable to even more burnout, compounding the feelings of isolation and loneliness.

Dr. Doug Nemecek, Chief Medical Officer for Behavioral Health at Cigna, explained the current challenges that employers face.  “Stress at work is not new. CIGNA has been supporting employers and employees dealing with workplace stress and burnout for decades. But the rising epidemic of loneliness nationwide is putting even greater demands on individuals, limiting their resilience to burnout and increasing their risk for mental and physical health challenges. This makes it all the more urgent to go “upstream” in addressing stress and burnout preventatively, including fostering a sustained sense of connection and belonging in the workplace for all employees.”

Employers recognize that burnout disrupts performance at the organizational as well as  individual level. Burnout among the workforce is strongly associated with low rates of commitment, productivity, and morale, and high rates of absenteeism and staff turnover.

Fortunately, a growing number of leading employers, many of them large health systems, are beginning to identify burnout as a critical issue that needs to be addressed. For example, the Icahn School of Medicine at Mount Sinai, Stanford School of Medicine, and UC Davis Health have all recently appointed Chief Wellness Officers whose mandates include addressing burnout syndrome among their employees. Non-healthcare employers are also increasingly active in addressing this aspect of wellbeing. The American Bar Association, for example, has a Wellbeing Pledge & Toolkit that guides law firms in addressing the issue.

But implementing such system-wide changes can be challenging, time-consuming, and costly and employers want to know whether the return justifies the investment. A comprehensive meta-analysis published in The Lancet substantiates the benefits of both individual-focused interventions — particularly mindfulness, stress management, and small group discussions — and organizational interventions, such as modifications to clinical work processes, in reducing physician burnout. And in a recent Health Affairs op-ed that was co-authored by 15 leaders in the field of medicine, the group cited “mounting evidence that certain interventions can decrease burnout and depression and enhance optimal well-being.”

It is “good news” that a growing number of programs are being deployed by employers to help employees alleviate stress, prevent burnout, and maintain work-life balance. When these efforts begin to truly reflect a company’s culture and are not “one and done” programs, they can also lead to a reduction in loneliness. Ultimately, feeling a stronger sense of purpose, belonging, and connection in the workplace can strengthen an employee’s ability and willingness to handle work-related challenges, and increase resilience when feelings of burnout surface. Stress-reduction interventions do have costs, but with evaluation and measurement strategies to determine benefits and outcomes, employers can calculate the return on investment that justifies these programs’ continued use.

Employers are beginning to think creatively about new ways to foster connection at work. For instance, the signature initiative of the organization I lead, The UnLonely Project, partners with employers to make available streamable short films from its UnLonely Film Festival platform, that can be used to promote dialogue on the issue. We’ve worked with financial service firms, technology companies, healthcare delivery systems, and municipalities to use these provocative films to foster timely and important dialogues addressing loneliness and burnout.

It benefits individuals and employers alike when workers are given the time and the tools they need to perform their jobs; when they enjoy a sense of belonging and connection; when they come to work knowing that they are valued, they have a voice, and they are heard. We think it’s an opportune time for workplaces of all sorts to begin to address burnout syndrome with sustainable solutions, and to pay greater attention to the loneliness and isolation at work that can result from burnout as well as exacerbate it.

Lisa Schinhofen contributed to the research and writing of this blog post.

This column will be a space for us to examine the broad range of scenarios and circumstances wherein loneliness and social isolation affect people. And although it’s become a social epidemic among Americans as a whole – nearly half of all Americans report feeling lonely or left out and one in four feel that they are rarely or never understood by others – certain populations, such as the elderly, the chronically ill and their caregivers, veterans, immigrants, and college students, are particularly susceptible. 

Going forward, join me and the UnLonely Project in exploring the effects of loneliness and social isolation on these communities and the individuals within them, and the variety of innovative approaches that can be used to foster a sense of connection to one’s self and to others. Together, we can forge new pathways to reduce loneliness and its burdens.

 Grand Rounds presentations are an excellent opportunity for physicians, nurses, allied health personnel, residents, fellows, and medical students to gain exposure to new clinical challenges and treatment models in healthcare. But it is rare for Grand Rounds to also be an opportunity to talk about the creative arts in a patient-care context, aligning it with the growing concern about loneliness as a health issue.

In May, Foundation for Art & Healing (FAH) Founder and President, Dr. Jeremy Nobel, did just that with a clinical audience for Geriatric Grand Rounds at the Beth Israel Deaconess Medical Center (BIDMC), a Harvard affiliated care system in Boston, Massachusetts.

This was Dr. Nobel’s first talk at BIDMC and was a bit of a homecoming, as he had been an Internal Medicine resident himself at BIDMC more than thirty years ago. “I still remembered the callback number for the admitting office that meant that you had a new patient to admit to the hospital,” said Dr. Nobel, to laughter from the audience.

Dr. Nobel was the featured speaker and delivered a talk called “Loneliness in Older Adults: Why it Matters? What Makes a Difference?” Loneliness, Dr. Nobel noted, is a critical problem today in the field of geriatric care: as many as 40% of older adults, according to some estimates, feel lonely much or all of the time.

“We tend to think that maybe loneliness is just a part of being old, in the same way that we used to think that cognitive decline was just a part of being old,” said Dr. Nobel. “But it doesn’t have to be.”

In a fascinating twist on the usual Grand Rounds routine, Dr. Nobel then introduced the idea of creative arts expression in a medical context, as a powerful methodology for the care of patients at risk for loneliness. He explained that the arts can work as a neuro-modulator, actually altering the release of stress hormones, as well as reducing autonomic nervous system activity that modifies blood pressure and heart rate.

He then showed the short film “Drawings for My Grandchildren,” a heartwarming story about an older adult who learns to use Instagram to share his artwork with his grandkids, helping to reduce his loneliness and find a greater purpose. “Drawings for My Grandchildren” is an award-winning film from the UnLonely Film Festival, a collection of short films, currently streaming free at www.unlonelyfilms.org and devoted to creating awareness about loneliness while normalizing and de-stigmatizing it. Nobel also described The UnLonely Project’s arts-based support programs called “Creativity Circles” which have been shown to reduce distress, while fostering a sense of “connection” to oneself and others.

Dr. Lewis A. Lipsitz, Director of the Marcus Institute for Aging Research and Chief of the Division of Gerontology at BIDMC, noted the critical importance of initiatives such as the UnLonely Project for caring for aging populations.

“Loneliness is an under-recognized cause of the functional decline and disease in older people,” said Dr. Lipsitz. “But it is addressable if only we can identify those who are afflicted and use a range of humanistic and technological interventions to overcome it.”

By Bradley Riew, UnLonely Project Communications Team