Fifteen cigarettes a day
Dangerous framings and the health consequences of loneliness
“You can quit. For free help, visit CDC.gov/tips”
This quote should sound familiar to regular TV-watchers: it’s at the end of each “Tips From Former Smokers” PSA from the CDC.
If you’re unfamiliar with these ads, they feature a former smoker suffering from illnesses related to cigarette use, such as COPD or lung cancer. This person offers advice based on their experience, like Tiffany, who says: “I talked to my doctor and with counseling, exercise and using the nicotine patch and gum I quit for good. My tip is: get help to find the best way for you to quit smoking. ”
The CDC’s message is clear: smoking is undesirable, it causes illness, and you can stop it.
Today, the U.S. is increasingly outspoken about loneliness as a health crisis. Loneliness, despite being a feeling, has a serious impact on our physical health. As the recent Surgeon General’s Advisory summarizes, loneliness increases your risk of stroke, heart disease, type 2 diabetes, dementia, depression, and anxiety.
John Cacioppo and William Patrick explain:
the culprit behind these dire statistics is not usually being literally alone, but the subjective experience of loneliness. Whether you are at home with your family, working in an office crowded with bright and attractive young people, touring Disneyland, or sitting alone in a fleabag hotel on the wrong side of town, chronic feelings of isolation can drive a cascade of physiological events that actually accelerates the aging process. (5)
In fact, as the Surgeon General and many popular articles will tell you, the health consequences of loneliness are as dangerous as smoking up to 15 cigarettes a day.
Loneliness has real implications for physical health, which makes it all the more urgent that we take it seriously as a public health crisis. That’s the first point I want to make today.
The second has to do with how we frame it.
The smoking comparison
It’s a stunning claim that loneliness is as dangerous as smoking 15 cigarettes a day, which is part of why this pops up in articles so often. Scholars Andrea Wigfield, Jan Gurung, and Laura Makey raise the concern that comparing loneliness with smoking is “sensationalist” and “has the potential to add to the burden of people who feel lonely and exacerbate the stigma associated with loneliness.”
Why might this comparison exacerbate stigma? One issue has to do with blame.
There are illnesses that we blame on personal choices – ones that, we say, could’ve been avoided if someone had just [eaten better, exercised, gone to therapy, not smoked, not drank, gone to rehab, used a condom, not used tanning beds, not drank soda]. These include addiction, type 2 diabetes, STIs, depression, and certain types of cancer.
By contrast, there are illnesses that we view as tragic and unfair, such as breast cancer or type 1 diabetes.
This is an example of what we call the social construction of illness. As scholars Peter Conrad and Kristin K. Barker explain, “certain illnesses have particular social or cultural meanings attributed to them. These meanings adhere to the illness and may have independent consequences on patients and health care.”
For example, breast cancer patients get messages of strength, support, and empowerment, while lung cancer patients experience blame. A stomach virus is recognized as a reason to stay home from work, while depression is not.
Framing any disease as “your fault” stigmatizes the people who suffer from it, making treatment and support harder to get. It also puts less pressure on policymakers to address social and environmental factors when we can simply tell patients that their illness is their fault.
When we put feeling lonely side by side with smoking cigarettes, we’re associating it with illnesses that we blame people for having and a stigmatized behavior that we’ve told people to “just quit.” In doing so, we risk treating loneliness with the same judgment and individual responsibility as we do other conditions.
Sure enough, “just quit”-type solutions for loneliness are common. Go volunteer. Make time for friends. Talk to your neighbors. These aren’t bad ideas, but they put the burden of healing on the individual – and for some people, these just aren’t options. Many people don’t have time to volunteer. Not everyone is safe or comfortable talking to neighbors. Friends aren’t a guaranteed source of positive social interaction.
It isn’t hard to imagine how this messaging could be discouraging for someone struggling with loneliness, and how a framing of individual responsibility could make loneliness slip into the category of conditions that are “your fault.”
Loneliness hurts our health. It’s our responsibility to make sure the messages we send and the solutions we provide don’t make it worse.