Eric Tian

A few years ago, a psychiatrist I was following said something along the lines of:

“Loneliness is the biggest risk factor for physical and mental health that we do not talk about. In medicine, we focus too much on the disease, like blood sugar levels, renal function, or CT scans, and ignore the person’s connection to others.

It is the greatest silent epidemic that medicine is doing nothing for.”

At the time, I found this statement hyperbolic. There are clear clinical benefits for investigating blood markers and imaging – these help prevent and treat a staggering amount of illnesses. In medical school, our exams revolve around being able to interpret and correlate these findings, which are often backed by strong clinical evidence. To say that loneliness was on par with this was, well… surely an exaggeration.

But over the years, my view on this has shifted. Search “loneliness” into pubmed and you will find hundreds of papers in the last year investigating the link between loneliness and health – and that’s physical health, not just mental health. Consider some of these statistics from the CDC:

• Social isolation significantly increased a person’s risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.
• Social isolation was associated with about a 50% increased risk of dementia.
• Poor social relationships (characterised by social isolation or loneliness) was associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.

This is in a context of 1 in 6 Australians experiencing loneliness (a statistic likely underreported), and increasing rates of loneliness in Australian youth aged 15-24 since 2012.

Anecdotally, I have found that patients admitted with few or no social supports tend to have poorer outcomes compared to those with strong, supportive networks. This has manifested in sudden deteriorations or passings that were unexpected. Too often for coincidence.

So a few years on, I think this psychiatrist was onto something. Loneliness is most definitely a crisis. And it is the role of modern medicine to recognise this and intervene, similar to how we would treat a broken femur, or an infected lung: compassionately, alongside patient wishes, and urgently.

Last night, I returned home to find five adolescent males loitering outside my apartment. One of them was smoking a cigarette and the other four were on their phones. As I scanned into the building, the five of them followed me inside without a word.

When the elevator opened, I scanned my floor and they entered with me. No one pressed another floor. They stood silently between me and the exit, the room filling with cigarette smoke. One of the jackets smelt of alcohol.

The door opened and I excused myself. They shuffled to let me pass. As I turned the corner, I realised that the five of them were walking with me to my room.

It only struck me then that something potentially insidious was unfolding. The boys didn’t look threatening, but there was the potential for intoxication and with that, violence, and anything could happen then. I began to panic inside, until my neighbour opened the door.

“You can’t smoke in here,” he said. The person rubbed the cigarette out on his jacket and muttered a soft apology.

“You boys alright?” He asked. A silence emerged as the five glanced at each other, before walking away without a word. As they turned, I noticed one of them was carrying an empty beer bottle in his jacket.

All I could manage was a short “thank you”. He waved it off, as if this was a commonplace occurrence and didn’t just potentially save my life.

With the boys gone, we exchanged a few words, and for the first time, had a real conversation. I learnt his name, that he used to work in the ADF, and was renting as part of a year-long travel itinerary with his wife. After a while, we bid each other farewell, and I locked my door with a smile.

“Tonight, I could have been hurt, mugged, or died, but made a friend instead,” I wrote in my journal. Blessings can arise from the most unexpected of situations.

“Pho combination please.” I said.

“Ahhhh… of course,” she replied with a thick Vietnamese accent. “You happy?”

Bit of a strange question, I thought. “Yeah I’m happy.” I replied. “Are you?”

“I work here.” She said with a smile.

“Oh. I guess you’re happy then.” I smiled back.

She gave me an odd look. “No I work here. You happy?”

Now I was really confused. What did happiness have anything to do with this meal? Was this a cosmic sign reminding me to meditate? Some divine mental health intervention in the form of this Vietnamese aunt?

“She means to ask you having here?” another voice interjected. I looked up to see a younger caucasian waiter. “Or do you want takeaway?”

“Oh right. Yes, have here please.” I replied, face flushed.

I guess she didn’t care if I was happy after all.

It’s amazing how much your world shrinks when you are sick.

It effectively becomes your bedroom: keeping it as dim as possible, the right temperature, having water nearby. Any other considerations get thrown out.

Yes, it sucks. Yes, it is logistically inconvenient. But having it any other way is impossible.

Just as the valleys make the heights more stunning, so does sickness reveal the beauty in health. And better yet, when we recover our immune system will be stronger than ever.

Amor fati – a love of fate. Through the highs and lows.

If you think about it, we should have more time than ever.

Life expectancy has more than doubled in the last century. Healthcare interventions and new drugs are curing diseases that would have killed us not too long ago.

Emails are faster than letters. Washing machines are faster than hand washing. Car and trains are faster than travelling by horseback. Internet speeds get faster every year. We have unprecedented levels of time- and effort-saving devices at our disposal.

And yet, for a lot of our lives we feel rushed. We say things like, “I would love to read more/go to the gym/learn a language/cook my own meals/catch up with old friends… if I only had the time.”

The problem clearly is not that we have a shortage of time. Perhaps we have an overload of everything else.

It is a tale of two realities.

The developed world has brought with it many benefits. Rising life expectancy, more available food and shelter, instant communication across the world, decreasing poverty. Things our ancestors would see as miracles.

Yet along with its benefits are new problems we now face. Rising rates of addiction, mental health issues, obesity, climate change, economic inequality. It feels as though we replaced the problem of scarcity with the problem of excess.

It is possible to be grateful for the present yet ceaselessly yearn for more.

Personal highlights from Morgan Housel’s Some Things I Think:

• Many beliefs are held because there is a social and tribal benefit to holding them, not necessarily because they’re true.
• The best measure of wealth is what you have minus what you want. (By this measure, some billionaires are broke.)
• The most valuable personal finance asset is not needing to impress anyone.
• You can only ignore the critics if you also discount the praise.
• Past performance increases confidence more than ability.
• Schools are good at measuring intelligence but not great at measuring passion, endurance, and character, which tend to be more important than intelligence in the long run.
• A good bet in economics: the past wasn’t as good as you remember, the present isn’t as bad as you think, and the future will be better than you anticipate.

From James Baldwin, American writer and civil rights activist:

“I have always felt that a human being could only be saved by another human being. I am aware that we do not save each other very often. But I am also aware that we save each other some of the time.”

In the anime Frieren: Beyond Journey’s End, there is a scene where a young elf meets the strongest mage in the kingdom, who offers her any spell in existence. Behind the great mage are stacks of books that reach to the ceiling, filled with every known enchantment in history.

The young elf considers this offer for a moment and responds, “I don’t want one.”

“The greatest joy of magic lies in searching for it.”

A new Chinese restaurant opened downstairs last week. Whenever I walked past, it looked clean, well furnished and filled with customers. Tonight, I decided to try it.

I grabbed a menu from the counter and waited in line. Glancing through it, everything seemed to be in order. The usual dishes: fried rice, egg and tomato, soy sauce braised pork, stir-fried vegetables, were all available at a reasonable price. But the more I looked, the more an uneasy feeling grew inside me.

There were no typos.

Every word on the menu was spelt correctly. The address, the dishes, even the allergy warning. And to my mild horror, the menu looked neat: a clear font on a dirtless sheet of white, laminated A4. No crinkles or faded letters. It was a concerningly good looking menu.

There’s a rule for authentic Chinese restaurants: their menus are riddled with mistakes. I would even go so far to hypothesise that the worse grammar a restaurant has, the better chance you have of getting the real deal.

But it was too late to back out. I had made it to the front of the line and the cashier was looking at me expectantly. I reluctantly ordered one of their sets: sweet and sour tofu soup with braised pork on rice. Safe, classic dishes. Can’t go wrong.

Except it did go wrong. Here’s a list of some of the red flags:

• The dishes had were cooked in far too little oil. The fried egg that came with the rice tasted bland and soft – I suspect it had been partially boiled. True Chinese fried eggs taste like they’ve been deep fried.
• The food came in cardboard boxes instead of bowls. This gave it the appearance of a frozen meal from a high school cafeteria. All Chinese restaurants serve their food in metal bowls or plates.
• Western pop music was blazing on the stereo. I have nothing against Katy Perry, but California Gurls is not a song that belongs in a Chinese restaurant.
• The restaurant did not provide chopsticks. This was by far the greatest sin and requires no further explanation.

To give some credit, it was a fine meal. The lack of oil definitely made it healthier than most restaurants, the waiters were friendly and prompt, and the interior was clean and well spaced.

But it was not a Chinese meal – not by a long shot. And the thing that gave it away? The menu with perfect spelling.