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We Are Suffering From a Social Famine

Surging mental illness isn't a pandemic. It's social starvation.

Key points

  • The disease model of mental health cannot account for recent spikes in mental illness.
  • Mental wellbeing depends on positive social bonds and satisfying work. When starved of those we suffer mental disorders.
  • The pandemic worsened preexisting deprivation creating a social famine.
Shutterstock/standard license
Source: Shutterstock/standard license

What happens when whole populations are subjected to social isolation? We have all been participants in that cruel natural experiment, and one result has become clear. COVID-19 driven changes to our lives caused rates of mental illness, substance abuse, anti-social behavior and suicide to skyrocket. Many who previously functioned normally have succumbed. The risk factors we typically look to—individual neurochemistry, life histories, and genetics—cannot account for the fact that mental illness rates were six times higher in 2020 than in 2019. So what does explain it?

Mental Health Impact of Pandemic Life Changes

The past two years have inflicted profound deprivations on us: isolation from family, friends, coworkers, and schoolmates; loss of work or extreme overwork; bereavement; scarcity of supplies, pleasures, healthcare, routines, and our accustomed way of life.

We already feel starved—deprived of the social, physical, and emotional connections upon which our wellbeing depends. Omicron is pushing more of us over the edge.

COVID-19 has demonstrated how such experiences of intense helplessness and the absence of warm social bonds cause mental illness. While some psychiatric disorders are genetically determined or predisposed, most are not like COVID-19 or cancer, an attack on us by something malignant. Instead, they are like starvation: evolutionary, biological responses to unmet basic needs from infancy onward.

What Is Mental Health?

To understand how deprivation leads to these disorders, we must first understand mental wellbeing. Wellbeing is not an absence of pain or negative thoughts, a particular outlook, or a state of bliss.

Instead, as Sigmund Freud taught us,

The good life… is one that is full of meaning through the lasting, sustaining, mutually gratifying relations we are able to establish with those we love, and through the satisfaction, we derive from knowing that we are engaged in work that helps us and others to have a better life. A good life denies neither its real and often painful difficulties nor the dark aspects of our psyche; rather, it is a life in which our hardships are not permitted to engulf us in despair, and our dark impulses are not allowed to draw us into their chaotic and often destructive orbit.( )

What Causes Mental Illness?

Longitudinal studies have repeatedly confirmed that mutually gratifying relationships and satisfying work are essential for normal human development and wellbeing.

When deprived of these necessities, we suffer as severely as we do when we are starved for adequate nutrition—not because we are flawed or sick, but because feeling urgent, even desperate distress is how evolution propels us to fulfill unmet survival needs.

Inadequate nutrition in infancy and early childhood causes lifelong damage, from height to metabolism to intellectual ability. As highly social animals, we depend to similar degrees on both food and warm, positive emotional connections for normal development and wellbeing.

The absence of mutually gratifying synchronous social bonds in the first months of life damages our physical, cognitive, social, and emotional development. Like the consequences of early malnutrition, these can be ameliorated but not reversed.

Of course, malnutrition can be disruptive, debilitating, or deadly at any age, and so can social deprivation. Both food and positive social bonds are essential to wellbeing throughout life – and there is no replacement for them.

Overcoming Social Starvation

You can’t overcome starvation with medications that blunt hunger pangs or with therapies aimed at reframing the situation to make it more tolerable. Those in crisis may benefit from treatment to speed their recovery and guide them toward healthier life situations. But to end the damage and effect a cure, unmet needs (whether social or nutritional) must be fulfilled. That is why falling in love is the fastest, most reliable path out of depression – and why pet adoptions surged amid the social isolation of the pandemic.

True cures for social deprivation may entail leaving an immiserating job, school, or relationship and learning to find and succeed in a more satisfying one. Unfortunately, for many of us, these remedies remain out of reach due to a dearth of satisfying, well-paying jobs, high-quality free education, and support for families (from childcare and paid leave to health and elder care).

America’s Social Famine

While COVID-19 created drastic new deprivations, pre-existing socio-economic conditions of widespread precarity had already undermined mental health. Case and Deaton, and William Julius Wilson, demonstrated that the absence of satisfying work makes it almost impossible for adults to establish and maintain mutually gratifying love relationships, undermining familial bonds and good parenting. This, predictably, increases rates of physical disability, mental illness, substance abuse, and premature death.

We are amid a social famine driving mental illness, substance abuse, and suicide at ever-increasing rates. Almost half of us, 40 percent, are now suffering symptoms of social deprivation and social starvation.

How We Can Make Progress

Viewing mental illness as a defect of individuals rather than the predictable consequence of social deprivation and structural socio-economic failures blinds us to its causes and cures – both individually and systemically. Until we address its sources, we cannot turn the rising tide of mental illness, substance abuse, aggression, and suicide.

Ending this social famine requires prioritizing positive emotional bonds from infancy through old age. Instead of capitulating to socially isolating preoccupations with technology, consumerism, overwork, and competition, we need to devote our most sustained, serious efforts to safely developing and maintaining positive relationships.

That means rewarding and systemically supporting parenting, caregiving, and social bonds at home, schools, and workplaces. It means making work-life balance possible for everyone and teaching relationship and parenting skills through mass media campaigns and at every level from preschool through graduate school.

We must create the conditions necessary for all of us to build the life-sustaining relationships that inoculate us against despair. Until we do so, social famine will devour more lives.

More from Ruth Bettelheim Ph.D.
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