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5 Things We Can Each Do Help Solve The Loneliness Epidemic, with Dr. Mark B. Constantian and Fotis Georgiadis

Social media is not connection. First, it is inherently false. You see the selfie of a friend at a party, smiling and seeming to have a much better time than you are. How do you connect with that? You “heart” it. How does that help your isolation? As a part of my interview series about […]

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Social media is not connection. First, it is inherently false. You see the selfie of a friend at a party, smiling and seeming to have a much better time than you are. How do you connect with that? You “heart” it. How does that help your isolation?

As a part of my interview series about the ‘5 Things We Can Each Do Help Solve The Loneliness Epidemic’ I had the pleasure to interview Mark B. Constantian, MD, FACS. Dr. Constantian, has practiced plastic surgery in Nashua, NH since 1978 and has faculty appointments at the University of Wisconsin and the University of Virginia. He is the author of more than 100 professional journal articles and book chapters and two previous textbooks, including Rhinoplasty: Craft and Magic. His most recent book: CHILDHOOD ABUSE, BODY SHAME, AND ADDICTIVE PLASTIC SURGERY: The Face of Trauma.


Thank you so much for doing this with us! Our readers would love to “get to know you” a bit better. Can you share your “backstory” with us? What was it that led you to your eventual career choice?

When I was a third-year medical student at the University of Virginia, Dr. Milton Edgerton came from Johns Hopkins to start the Department of Plastic Surgery. He was a superb surgeon and a very charismatic man, always pushing the envelope in surgical technique — — immediate reconstruction after removal of large facial cancers, which was unheard of at the time, transgender surgery when no one was yet doing it, and so on. He was also interested in patients with body image disorders and in patients who had “minimal deformities” or “imaginary deformities” but were devastated by them. That interest stayed with me when I was in practice, particularly because I saw those patients as well and the medical literature didn’t have any definitive explanation for its cause. It still doesn’t. Now, all these years later, that is my primary focus of research interest — full circle — one that I discussed with Dr. Edgerton before he passed away last year. Gratifyingly, he agreed with my thesis completely.

Can you share the most interesting story that happened to you since you started your career?

Although I had taught instructional courses about body dysmorphic disorder (BDD) at national plastic surgery meetings for years, I didn’t have an underlying thesis. BDD, which fascinates the public, the media, and reality TV, is primarily defined as obsession with a “perceived” or “slight” imperfection — — in other words, something only the patient can see. Then I met a patient who told me that he once had body dysmorphic disorder about his nose but had been cured, which was true — by his own determination. He related a gripping story about emotional abuse by his stepfather, who, starting at age seven, forced him to submit to photographs only to show him that his nose was misshapen. Imagine doing that to a young child! The stepfather kept at him until, by his high school years, the young man was completely obsessed. This was my first crack in the wall: at least in one patient, child abuse and neglect had preceded the development of self-hatred and body dysmorphic disorder. Then I began seeing more and more patients who had undergone multiple rhinoplasties and other cosmetic surgeries for noses that they knew at the time were normal — — no bumps, no crookedness, no breathing problems — — but they had surgery anyway. Why? “Because my father told me I was the ugliest baby he ever saw.” “Because my mother wanted me to be as pretty as my sister.” “Because I wasn’t perfect enough.” “Because I wanted people to love me.” This was my second clue: for many patients who had undergone multiple cosmetic surgeries and were still dissatisfied, there had been no original medical indication, and the patients knew it. I thought I had defined “surgical body dysmorphic disorder” — surgery when you know you don’t need it, to be loved. But I hadn’t, quite yet.

Are you working on any exciting new projects now? How do you think that will help people?

I think I am getting much closer to the origins of body dysmorphic disorder. Through my research in more than 200 patients in my practice, I have shown that the prevalence of childhood abuse and neglect in patients with BDD is more than 80% — though it is 61% in my non-cosmetic reconstructive patients. Childhood trauma is surprisingly high, no matter one’s socioeconomic state.

But the defining characteristic of BDD is not, I believe, a perceived deformity. It is the presence of body shame, which childhood trauma can cause. Many of us, of course, have imperfect features but never have plastic surgery. If people have self-esteem and know that they have value that does not depend on physical appearance (or anything else external) they can’t have body shame.

Self-worth does not have to be earned and cannot be taken away. It’s when someone feels that his or her worth depends on “being perfect enough,” however that’s defined, that he or she gets get into trouble. Plastic surgery, no matter how well done, cannot provide self-worth. I think body shame is the key definer of BDD, not perceived deformity. BDD is a disease of emotions. It is shame that drives the surgery.

Can you share with our readers a bit why you are an authority about the topic of the Loneliness Epidemic?

Body dysmorphic disorder can become an addiction to plastic surgery. Those are the patients that my specialty sees, and that’s why I have a different view of the problem than mental health professionals, who see patients for therapy, not surgery. All addictions or self- harming behaviors wall people off. They lose connection. They become sequestered in their unhappiness. Disconnection creates loneliness, and that is a common characteristic among all addictions or behaviors created by a sense of ‘worth — less — ness.’

Ok, thank you for that. Let’s now jump to the main focus of our interview. According to this story in Forbes, loneliness is becoming an increasing health threat not just in the US , but across the world. Can you articulate for our readers 3 reasons why being lonely and isolated can harm one’s health?

We are made to connect with each other, to relate, to fall in love, to have relationships and love within families and among friends. So first, all types of childhood abuse and neglect foster feelings of shame, which leads to depression, self-hatred, and isolation.

Secondly, significant research from Kaiser Permanente in California, where the original Adverse Childhood Experiences study was performed, and supported by my own research, shows that the more types of childhood trauma people suffered, the more health problems they have in adulthood. It’s a significant effect: If you have 6 or more ACE’s, your life expectancy drops by 20 years; you are 50 times more likely to commit suicide. No other known life event does that.

Third, all of the common adult diseases can be directly linked to the brain, metabolic, and behavioral changes that come from abuse and neglect.

So loneliness is a symptom of isolation; and isolation often comes from feelings of unworthiness, and the childhood trauma that caused it translates into adult health problems. Even in my relatively small study, the number of ACE’s correlates directly with hypertension, high cholesterol, obesity, cancer, headache / migraine, irritable bowel, arthritis, chronic lung disease and asthma, and self-reported depression — which in our study is 56%, which is three times the U.S. average.

ACE’s also correlated directly with recreational drug use and excessive postoperative demands for narcotics, which has obvious implications for the current opioid crisis. The Kaiser study found additional connections to heart disease, multiple sclerosis, primary pulmonary fibrosis, difficulty holding a job, and risky sexual behavior. These problems provoked and stored in the body by childhood difficulties create disease decades later. It is not hard to see how all self- harming actions further isolate people from their families, coworkers, friends, and themselves. The wounded build walls.

On a broader societal level, in which way is loneliness harming our communities and society?

I have had many patients who recount stories of being misfits in a family where all the other members seemed more beautiful. They sought plastic surgery, or developed eating disorders, drug or alcohol addictions, or became isolated and socially anxious. When they have plastic surgery, it is to gain familial approval, or it is surgery to lose or retain the “family face.” It is surgery to combat criticism and loneliness. The abused return to the family again and again seeking approval. “I actually never heard one word from my family members such as, ‘Don’t you look great.’” Not once since I had surgery. They still tell me I look awful… They call me “Miss Piggy” or say that I look like a rhinoceros or some other animal. That is what I really find difficult. I guess it means that I just don’t belong to the family anymore.”

Is this perfectionism, is it obsessive compulsive disorder, is it depression, or is it body dysmorphic disorder? I don’t think it matters where you end up. The starting point is always the same. Its genesis and mediator is developmental trauma, its result is toxic shame, and its manifestations depend on how a particular shame bind — — the event or physical characteristic that triggers shame — — becomes attached and is expressed.

Abuse and neglect create feelings of deficiency. “My parents got divorced but it was my fault… I was beaten but I must have deserved it… I was criticized but I wasn’t very good…I got molested but the perpetrator said I made him do it . . . My mother said I made her drink.” When children grow up without feeling precious, they live at the extremes: self-esteem isn’t present. They feel either “worth-less” or better than everyone else. Their lives become dis-regulated so they deal with their pain by withdrawal and depression, or by self-medicating with drugs, food, or alcohol. Every week in the popular magazines there are stories of celebrities who had abusive childhoods and then became depressed, addicted, and sometimes body dysmorphic, and then have found sobriety. We often see the abuse and the addiction as separate without seeing that they intersect. That’s a deficit in our understanding.

Shame constricts, isolates, and turns us inward. Disempowerment or grandiosity, porous boundaries or walls, distorted thinking, poor self-care, and living to excess or hardly living at all disconnect us from our worlds. Trauma is isolating. Depression; eating disorders; mental illness; obesity; cutting; addictions to alcohol, drugs, sex, gambling, work; suicidal ideation; and body dysmorphic disorder are not group behaviors: they are almost always solitary. Untreated trauma detaches, sequesters, and isolates; it reflects distorted thinking, information processing, and behavior biased by childhood. Trauma is lonely. Thus the first part of resilience is the capacity to look outward and care about others. Like being fully relational, resilience requires connection. The door to freedom must be opened from the inside.

The irony of having a loneliness epidemic is glaring. We are living in a time where more people are connected to each other than ever before in history. Our technology has the power to connect billions of people in one network, in a way that was never possible. Yet despite this, so many people are lonely. Why is this? Can you share 3 of the main reasons why we are facing a loneliness epidemic today? Please give a story or an example for each.

Social media is not connection. First, it is inherently false. You see the selfie of a friend at a party, smiling and seeming to have a much better time than you are. How do you connect with that? You “heart” it. How does that help your isolation?

Second, connection, the antidote to loneliness, is a two-way process. One way transmission, which is what social media really is, dulls the senses and only increases isolation: nothing that’s going on actually includes the viewer. It’s easy to feel deficient — but for how many of us has life turned out to be exactly what we hoped? The closest to “connection” I see on social media is someone who posts “30 days sober” or “One year sober.” I always try to congratulate them because they are finding a way out and now can help others. You can see the self-respect in their eyes. That’s magnificent.

Third, loneliness requires the ability to share — — share intimate feelings: fears, joys, seeing facial expressions, laughing, getting hugs. Today many people work and go home to empty homes. There are no grandparents, jobs often aren’t local, and many are single parents. We don’t have pubs in the United States, and most local gathering houses have disappeared — except bars. Women’s clubs, garden clubs, bridge groups, many church groups — — these are becoming retirement activities because no one else has the time.

Ok. it is not enough to talk about problems without offering possible solutions. In your experience, what are the 5 things each of us can do to help solve the Loneliness Epidemic. Please give a story or an example for each.

I’ll speak for myself.

First, I need to treat myself first. If I am lonely, why am I lonely? Real maturity is recognizing that everything that happens in life is not about me; but on social media, it may seem like it is. If I feel defective, where did that come from? Was I taught it in childhood, or did I cope with my childhood environment by developing isolating self-harming behaviors? Trauma work really helps if that’s the issue. I know that from experience.

Second, I need to find ways to connect. For example, no one should be alone on holidays. We don’t burn out from hard work but from a sense of futility and isolation — — too much has happened, too fast, with no escape. That’s common in the world today. It’s burnout — it’s PTSD.

Third, I need to do something important to someone else. There is nothing like altruism to connect us with others.

Fourth, I need to be as generous as I can. Most of us have too much.

Fifth, I do better when I accept others for who they are; identities are obscured by social media. One of the great lessons of history is that people haven’t changed much over centuries.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

We need community — based solutions. That’s the strength of groups like Alcoholics Anonymous. People with a common thread tell their stories to each other and support each other. There’s a lot of power in that. Community builds “resilience,” which is not only the antidote to childhood and lifetime difficulties, but also the antidote to loneliness and burnout. My research shows that resilient patients are healthier and happier, even if their childhood traumas were extensive.

Resilience is not only inherited or neurochemical; it’s not something people are just lucky to have, like pretty eyes. Resilience is at least partly, perhaps primarily, the result of opening out, of being relational. When we are exposed, we are not walled; we are free to connect. From that expansion of personality and spirit come life philosophy, perspective, humor, optimism, and the capacity to receive support — impossible personal characteristics for those turned in on themselves. All of the unhappy people I have known, dragging their body shame, obsessions, addictions, and self-injurious behaviors behind them, are inwardly directed, closed to full human contact. People living in their wounds are humorless malcontents: we see them as sad or hostile. They ruminate and panic and don’t listen because they cannot absorb and process outside information without altering it unfavorably: we see them as argumentative, judgmental, and irrational. They live with intolerable emotional pain: we call them addicts. Toxic shame circulates within them: we see depression or self-injury. When this shame attaches to a physical feature, plastic surgeons see them as body dysmorphic patients. They cannot be resilient.

Unraveling trauma opens us toward each other. We are all less than we might be, maybe even less than we should be, but with growth we always become more than we were. Living as functional adults creates the abilities to connect, receive support, have life perspective, and be optimistic, perseverant, and spiritual. These are the characteristics that we see, admire, and call “resilience.” It is perhaps the most inspiring human quality.

Resilience is therefore an outcome, the result of a controlled, self-respecting life lived in moderation and connection with others. That’s when resilience appears — in fact, resilience seems inevitable for a life lived in abundance. “Self-understanding,” “optimism,” “control,” “hardiness,” “good defenses,” “interpersonal skills,” “sociability,” “support,” “life perspective,” “spirituality,” “self-confidence” — all the attributes of resilience are also the antidotes to trauma. Such lucky survivors feel autonomous: valuable, contained, protected, temperate, and clear-thinking. Life becomes reciprocal — connected. That’s the exit from loneliness.

We are blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch with, and why? He or she might just see this if we tag them 🙂

As a musician, my first thought was Paul McCartney because his music has pulled people together for more than 50 years. But Brian Wilson is just as provocative in a different way because his turbulent, unhappy childhood should have prohibited inspiring music — but he has been a prolific “anti — loneliness” writer throughout his career. I remember that in his autobiography he spoke about driving past the Hollywood Bowl showing a sign that read, “Appearing Tonight, Brian Wilson Performing ‘Pet Sounds,’ Sold Out.” Immediately, he remembered, the voices started in his head: “What if they don’t like me? What if they don’t like the music?” This is the irrational power of toxic shame, and yet this is the man who could write “Smile” and “Good Vibrations.” The real measure of a person’s power is how he or she behaves when things are going badly. Wilson is truly resilient.

How can our readers follow you on social media?

My website www.drconstantian.com

Facebook https://www.facebook.com/drmarkconstantianfacs

Instagram https://www.instagram.com/markbconstantian/

Twitter https://twitter.com/Mbconstantian

My most recent book, Childhood Abuse, Body Shame, and Addictive Plastic Surgery is available at most sellers, including:

Amazon https://amzn.to/2pbbc2Y

Barnes & Noble https://bit.ly/315wk82

BAM! https://bit.ly/33hJH6K

Thank you so much for these insights. This was so inspiring, and so important!

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