Solitude, Intimacy and Mental Health
SOLITUDE, INTIMACY AND MENTAL HEALTH
--The intrapersonal and interpersonal dialogue within and without us --
No man ever will unfold the capacities of his own intellect who does not at least checker his life with solitude.
The checkered life of which DeQuincy speaks can be viewed as a reflection of the mental tension, and often the struggle, that results from the conscious intrapersonal and interpersonal dialogues and relationships that form the basis of existence for every thinking person. Most people are caught up in the dialectic between their inner and outer worlds that at times can result in a maddening dissonance. Should one rely on one’s inner voice? A voice that is capable of being transcendentally free of what, more often than not, is the din and cacophony of what comes from the outside? Or is it wiser to ‘think’ within the framework of the outside world as it can possibly provide a safety net or ‘reality check’ of sorts?
In all likelihood, when oneenjoys good mental health her inner and outer worlds are in harmony; when, soto speak, there is no cognitive dissonance between our perception of what’s happening within and without. Our thoughts and our relationship with ourselves, is not incongruous with what is happening outside, both in terms of what we say and hear, and in our relationships with others. How attainable is this idealized state? It is probably safe to assume that practically everyone in the English-speaking world by now has come across John Donne’s famous phrase “no man is an island”:
Who casts not up his eye to the sun when it rises? but who takes off his eye from a comet when that breaks out? Who bends not his ear to any bell which upon any occasion rings? but who can remove it from that bell which is passing a piece of himself out of this world? No man is an island, entire of itself; every man is a piece of the continent, a part of the main…any man's death diminishes me, because I am involved in mankind. And therefore never send to know for whom the bell tolls; it tolls for thee.
Donne’s profound insight notwithstanding, there are moments when humans feel like islands. This applies not only to those who suffer from autism or suffer from amental illness such as schizophrenia, but those who are considered mentally healthy and robust. How often does one experience the loneliness and isolation reflected in the Simon and Garfunkel song, “I am a rock”?
A winter’s day
In a deep and dark December;
I am alone,
Gazing from my window to the streets below
On a freshly fallen silent shroud of snow.
I am a rock,
I am an island.
I’ve built walls,
A fortress deep and mighty,
That none may penetrate.
I have no need of friendship;
friendship causes pain.
Its laughter and loving I disdain.
I am a rock,
I am an island.
Whereas somemight consider such a ‘petrified’ state as mentally unhealthy and undesirable, others such as De Quincy suggest tantalizingly that it has the potential to be energizing and creative. According to Anthony Storr, a Fellow of the Royal College of Physicians and a Fellow of the Royal College of Psychiatrists, the “current emphasis upon intimate interpersonal relationships as the touchstone of health and happiness is a comparatively recent phenomenon.”  He goes on to add that it is widely assumed that “those who do not enjoy the satisfaction provided by such relationships are neurotic, immature, or in some other way, abnormal”. Storr points out how in “Western society, extreme detachment from ties with others is usually equated with mental illness”, going on to add that chronic “schizophrenics sometimes lead lives in which relationships with others play virtually no part at all.”
So which way is it? Living in splendid mental andsocial isolation while tuned primarily to our inner voice and tendingpredominately to our relationship with ourselves, or in strong contrast to that embracing the world and all of its interpersonal and often contradictory cross-talk? As a hedge, one would have to conclude that both extremes are undesirable and unhealthy as the experience of life is too complex and at times, too terrifying to go it alone. A balanced life and mind requires constant input and feedback to avoid the frightening abyss of absolutism. It makes sense that we rely not just on our internal messaging system but need the sounding board that only others or society as a whole can provide, recognizing that then, everything becomes relative. Or in the words of Mahatma Gandhi: Happiness is when what you think, what you say, and what you do are in harmony.
This is not as easy as it sounds, particularly for some who have suffered from traumatic experiences, especially in their formative years. One such group comprises those suffering from borderline personality disorder (BPD). According to Andreas Meyer-Lindenberg, one of the BPD is one of the “most damaging mental illnesses.” BPD sufferers experience a pervasive instability in their interpersonal relationships because they have difficulty “controlling their impulses and regulating their emotions”. Researchers at the Baylor College of Medicine designed an experiment to study how the mind reacted to the issue of “trust” when dealing with others in a finance and investment game. Using the neuroimaging capabilities of fMRI scans, the experiments revealed significant neural differences between BPD patients and healthy players in how the two groups responded to trustworthiness. The area of thebrain that seemed most affected in this experiment was the anterior insula.
The anterior insula has long been associated with the representation of uncomfortable bodily sensations, such as pain. In addition, many studies have since shown that this area also strongly reacts to adverse or uncomfortable occurrences in social interactions, such as unfairness, excessive risk, frustration or impending loss of social status. This body of work suggests that the anterior insula tracks information about the intentions and behavior of others and colors them with a feeling of discomfort. If true, then one reason BPD subjects may be impaired in maintaining cooperation is because they lack the ‘gut feeling’ (corresponding to the anterior insula signal) that there is a problem with the relationship. Because they can’t detect the breakdown of trust, they are less likely to trust others at all.
It is painfully apparent then, that both intrapersonal and interpersonal relationships are probably, at least in part, shaped by factors outside of our personal control. This isimplicit in the words of the authors of the BPD trustworthiness study:
Together, these results suggest that the diminished insula response … does indeed reflect atypical social norms in this group. Put another way, thelow offers from social partners do not violate the social expectations of individuals with BPD, which accounts for the diminished insula response in the BPD group. Specifically, the incapacity of individuals with BPD to recognize norm violations as such and torespond so as to signal trustworthiness to their partner can result in an inability of both individuals to effectively model the intentions of one another.
If we are unable to “model the intentions of one another” because of some neurological deficitor malfunction, then how do we respond to either the internal dialogue withourselves or with the outside world? In all likelihood, what the Baylor researchers reported involved not just one, but degrees of borderline personality disorder. Although healthy participants were strongly differentiated in their anterior insula responses from those with BPD, surely like most illnesses, there are probably degrees of BPD. Is there a host of people who make up the spectrum comprising healthy at one end and BPD sufferers at the other? If so, which ‘voice’are they tuned into? How can they tune into any voice but their own? Without trust, how can they even consider intimacy with others? The question then becomes whether interpersonal relationships matter all that much? Perhaps John Donne’s view was less profound than it seemed at first. Where would sociopaths fit in the island-continentspectrum? According topsychologist Martha Stout, 1 in 25 ordinary Americans has no conscience or inner-voice telling them that they should have guilt feelings about something. Stoutpoints out:
We are stimulated by our meaningful ties to, negotiations with, and happy and unhappy moments alongside other people, and sociopaths do not have this emotional life to live. They[sociopaths] do not experience the sometimes harrowing, sometimes thrilling, ever-present arousal that unavoidably attends genuine attachments to other people.
So again, what are we to conclude? What if there is no inner voice, no Jimminy Cricket to listen to? Or if there is, how loud is it?
Anthony Storr suggests that a degree of solitude is important in human mental health and that many creative people notonly pursue, but thrive in solitude. In fact, it seems that it is the social state that they prefer. He writes: “The modern assumption that intimate relationships are essential to personal fulfillment tends to make us neglect the significance of relationships which are not so intimate. He adds that “many human beings make do with relationships which cannot be regarded as especially close, and not all such human beings are ill or even particularly unhappy.” He cites the lives of Descartes, Newton, Locke, Pascal, Spinoza, Kant, Leibniz, Schopenhauer, Nietzsche, Kierkegaard and Wittgenstein as creative geniuses who on the whole, seemed to prefer solitude to intimacy or socialization. He quotes Edward Gibbon: “Conversation enriches the understanding, but solitude is the school of genius”. It seems that these greats preferred their own personal voice to those of others.
Most people feel unfulfilled unless they canform close relationships with others. It is generally recognized that many of those unfortunates who are placed in ‘solitary confinement’ lose their sanity hearing only their own personal voice. It would appear thatthe vast majority of human beings need to feel a part of something greater than themselves; be it a partner, belonging to a family or a community, or having a workplace to report to. This isbecause they seek recognition and validation in an otherwise anonymous world. Without these attachments, life to them becomes meaningless. But there are exceptions.
…these unique and irreplaceable relationships act aspoints of reference which help us to make sense of our experience. We are, as it were, embedded in a structure of which unique relationships are the supporting pillars. We take this so much for granted that we seldom define it,and may hardly be conscious of it until some important relationship comes to an end. …[R]ecently bereaved persons often feel, at any rate for a time, that the world has become meaningless. When we lose the person who is nearest and dearest to us, we may discover that the meaning of life was bound up with that person to a greater extent than we had supposed. This is the usual patter; but we must also remember that some people, even after losing a spouse who was dear to them, feel a new sense of freedom and take on a new lease of life.
It seems that as we peel the onion in hopes of finding what is at its core, we begin to realize that it just is not as simple as we had hoped. It is not that we are disappointed when we find it hollow, only puzzled. It is evidentthat both the intrapersonal and interpersonal are important to all human beings as they provide the extremes of communication. Where one fits along that spectrum is not simply a function of that particular person’s mental health but also of one mental state at a given point in time. The ebb and flow of mood, environment, physical health, energy and countless other factors determine whether we feel as if we are “islands” or “continents”; whether we view ourselves as isolated or are experiencing a close connection with humanity. Inclosing, I am reminded of one of my favorite poems, entitled “As Much As You Can”, and written in 1913 by one of Greece’s most famous personalities, Constantine Cavafy, a poet who lived in Alexandria, Egypt from 1863 until his death in 1933:
As much as you can
Even if you cannot shape yourlife as you want it,
at least try this
as much as you can; do not disgrace it
in the crowding contact with the world,
in the many movements and all the talk.
Do not disgrace it by taking it,
dragging it around often and exposing it
to the daily folly
of relationships and associations,
till it becomes like an alien burdensome life.
 Storr, Anthony,Solitude, Ballantine Books, adivision of Random House, Inc., New York, 1988, p. 73.
 Donne, John, DevotionsUpon Emergent Occasions, Meditation XVII
 Simon, Paul, “I am a Rock”, Greatest Hits, 1972.
 Storr, p. 1.
 Storr, 5-6
 Ibid., 11
 Stout, Martha, TheSociopath Next Door, The Ruthless Versus the Rest of Us, Broadway Books,New York, 2005, p.8.
 Meyer-Lindenberg, “Borderline Personality Disorder:No Man Is an Island”, Scientific American,September 2, 2008,
 King-Casas, Brooks; Sharp, Carla; Lomax-Bream, Laura;Lohrenz, Terry; Fonagy, Peter and Montague, P. Read, “The Rupture and Repair ofCooperation in Borderline Personality Disorder”, Science, Vol. 321, August 8, 2008, p. 809. http://www.hnl.bcm.tmc.edu/articles/Read/Science08.pdf
 Stout, p.8.
 Storr, 13.
 Storr, ix.
 ibid, 12
 Dalven, Rae, “As Much As YouCan”, The Complete Poems of Cavafy,Harcourt, Brace & World, Inc., New York, 1961, p. 44.