Loneliness, solitude, and awe
Plus: a novel explanation for sex differences in mental health conditions, the link between depression and cancer, and do we always need an RCT?
The benefits of solitude
Can being alone be a positive experience? This Nature Mental Health paper suggests that “awe” can make all the difference. “Awe” arises “when people encounter something physically or mentally vast (for example, the universe or profound wisdom) and feel a need to change their mental structure to accommodate the experience.” People feeling awe “transcend their current frames of reference and feel connected to a greater entity”.
But what does this have to do with mental health? The authors suggest that awe can have a positive effect by “enhancing positive attitudes toward solitude”, hence contributing “to spiritual well-being and peace of mind.”
I must admit to a little scepticism here, as one subjective concept (awe) is being associated with other subjective concepts (spiritual well-being and peace of mind) as a proposed mechanism. The authors marshal various strands of evidence in support of their proposal, but I remain unconvinced. In brief, my concerns are whether the experimental conditions for these studies (eg, picture-viewing or imagination tasks) really reflect the real-life awe-generating experiences that they describe in the introduction. And such effects that are shown on well-being seem to me moderate and short-lived.
However, there is an interesting idea here, and a useful counterweight to the idea that socialisation is everything. This isn’t a new strand of thought in mental health by any means (see Anthony Storr’s Solitude from 1988), but it’s good to see it revived. It would be intriguing to see how these authors’ ideas dovetail with other concepts of the therapeutic effects of transcendent conditions derived from psychedelic research, for example. But there really is so much to untangle.
As a side-note, it’s nice to see a paper that starts with quotations from Henry David Thoreau and The Exorcist’s Ellen Burstyn on the benefits of solitude. Though I would have gone with Sparks’ masterpiece I Married Myself: “I married myself / I’m very happy together / Long, long walks on the beach / Lovely times.”
Smoke trails
What factors link depression and anxiety with cancer? This analysis of 319,613 individuals in the Psychosocial Factors and Cancer Incidence consortium comes up with a straightforward answer: smoking and physical inactivity. But mostly smoking. “Specifically, depression/anxiety was associated with a 3–10% increased risk of [lung cancer and smoking-related cancers], and this was through smoking.”
People with mental health problems have long been the forgotten group in smoking cessation efforts (and this despite the fact that stopping smoking in turn seems to benefit mental health). Progress has been made towards smoke-free wards in the UK, at least—and without the disastrous consequences some predicted. But smoking cessation is still hard to sustain, and on the ground it might not be seen as a priority by hard-pressed services.
So this is a bit of an “Oh, dear” paper. But a reminder that smoking remains a substantial issue in mental health. We just can’t accept that people under the care of services in the 2020s should be experiencing the physical health outcomes of the 1970s.
Early days
What explains sex differences in the prevalence of specific mental health conditions?
As ever: it’s complex.
But this Biological Psychiatry review throws an intriguing new idea into the mix: what if some of the sex difference is related to immune factors in the intrauterine environment?
In brief (and summarised nicely in the second figure), they propose that males are more susceptible to early immune challenges than are females. Males then go on to develop a higher prevalence of neurodevelopmental conditions such as autism and ADHD, while females experience a greater degree of depression and anxiety.
This idea merits further investigation, I think, although the only interventions the authors can really propose at this stage are for mothers to get vaccinated and have a healthy diet. Which are both good moves, in any case.
I know but I don’t know
And finally, a spicy take by Helene Speyer and Jim van Os on a recent trial demonstrating the mental health benefits of exercise: “We postulate that engaging in active aspects of life might be seen as inherently valuable and should not need testing.” Do we really need RCTs for everything?