COMMENTARY

The Medicine of Social Cohesion

Marieke Geijsels, MD,

Disclosures

June 30, 2022

Last week, I made my first home visit to a very elderly patient of a colleague of mine. I had just stepped inside when she asked me, "Couldn't you give me a shot? I don't want to live this way any longer."

The woman in question was in good health apart from ordinary problems of arthritis and mild hypertension, but she was feeling very alone. Never having been able to bear children and having outlived all her friends, she was now completely dependent on the help of others: a caregiver for housework, a caterer for food, a nurse for bathing and dressing, and the family doctor if she wasn't feeling well. She wondered what the point of living was.

In the ensuing conversation, there was suddenly a moment when she lit up with pure joy. When she turned 90 last year, the entire street honored her. People she hardly knew dropped by, brought flowers, etc. Tears came to her eyes when she recalled the feeling of belonging she experienced that day. It was a wonderful memory. Sadly, that moment didn't last.

Her story is far from unique. When I make my home visits, I go from one nonagenarian to another, often only a few streets away. They all feel alone and useless at home. They all wonder how long they are going to have to wait around here. They remember better times, spent with friends and playing card games together, but now they are the sole surviving members of their club. This solitude also causes them to develop symptoms of anxiety and depression and have even greater healthcare needs.

Fortunately, the family doctor, nurse, and eldercare aide visit them from time to time to relieve their loneliness. I have always found it ironic that these people live a stone's throw from one another and have the same needs and interests, but they still don't manage to connect with one another. When I suggest to them that they go to the local senior services center, they often don't want to hear of it. "Me, sit with all those old people?" said one such 91-year-old male patient. There is also fear of being a bother, or shame about incontinence, for example. And so, these people remain alone at home, and they ask us to put an end to this suffering.

Not Only the Elderly

It makes me wonder whether greater social cohesion might not be a remedy for some of our societal problems, because it isn't just in the elderly age group that people suffer from the lack of effective social support. How many young parents do I see struggling to find a balance between work and children or running around everywhere trying to take their children to their recreational activities?

Think, too, about the balancing act between working from home and taking care of children when they are sick or during quarantines these past few years. And that isn't even considering people who do shift work. How do you care for your child if you, a single parent, start work at six o'clock in the morning? I am amazed that all those parents manage it. They do a million things, work later in the evening, have yet another meeting in the car, all to keep the balls in the air all by themselves. All those parents at the school entrance, all those parents at the gym or music lesson.

Although objectively, it seems quite logical, why don't we ask others for help more often? "Bring them, I'll take them." "You watch the children on Monday, I'll watch them on Tuesday." My experience as a mother tells me that when you put two children together, you frequently have less to worry about than when they have to occupy themselves alone. We could be so much stronger together.

And then I see a large group of people who would benefit from more social cohesion: those who are at home and suffering from depression or occupational burnout. Activation is a key part of their recovery: the resumption of activities to gain a sense of fulfillment.

For some people, this is easy, but others find themselves stuck because it's too steep a hill to climb between being sick and resuming work or studies. These people should be able to make themselves useful somewhere, without too many obligations or worries. So why not prepare soup for an elderly neighbor? Or do some weeding with a newly retired gardener? Walk the dogs for the neighbor who's at work? Read aloud at a school, accompany a class to the library, etc? The list of possibilities is endless. And best of all, this wouldn't help just our citizens who are ill, but the rest of the community as well.

Crises and Opportunities

During crises, we sometimes get a glimpse of what's possible. During the first lockdown, people suddenly started ringing the doorbells of their neighbors who lived alone to see if everything was okay. People who were isolating or in quarantine received — often unexpectedly — occupational therapy and food care packages. Balcony concerts kept spirits up in towns. Teddy bears were placed on windowsills to send children on a treasure hunt. It is only when contact is prohibited that we have sought to reconnect.

Today as well, with the arrival of the Ukrainian refugees, we are once again seeing our fellow citizens show tremendous solidarity; some are making donations, others are literally opening up their homes to strangers. It's great to see what a community can do when it works together. It not only helps the recipient, but it also gives satisfaction to the giver. After all, is there any better feeling than seeing that you have had a positive impact on someone else's life? I think that we caregivers can absolutely agree on that point.

So, what's preventing us from maintaining this cohesion? What pushes us to withdraw to our own individual islands all the time?

When I ask my patients why they don't ask their family members for help, they frequently answer that they don't want to be a burden. They are ashamed of not being able to manage on their own. Asking for help is showing that one is vulnerable. But it is precisely because more people don't ask for help that we no longer realize that everyone needs help, that everybody is vulnerable. And the less we see the vulnerability of others, the more hardened we become, both toward others and toward ourselves. It's a vicious circle.

As a doctor, I can scarcely relieve the suffering of my one lonely patient, let alone meet the needs of my many patients. I can't put my depressed patients to work at my home. But I can call for more solidarity and tell people that they are not alone in their struggle, that we are all up against the same challenges, all in the hope that they will be moved to act in their own surroundings to create connection. If we succeed in changing our mindset and in telling ourselves that asking for help is not admitting failure, but rather giving someone else a chance to become fulfilled by helping us, I think we could take a huge step forward as a society.

Marieke Geijsels, MD, is a general practitioner in a large non-fixed rate group practice in Edegem, Belgium. In her general practitioners' circle, Regio Mortsel, she leads a working group on the general practitioner shortage. She is also the head physician of a practice organization specializing in Home Medicine. This op-ed expresses her personal opinion.

This article was translated from MediQuality.

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