My trusty thesaurus

“When you come to a fork in the road, take it!” This is from legendary baseball player and advisor, Yogi Berra. Unlike him, I have never played baseball and never felt quite comfortable giving advice to my patients. Rather, I tried to be an assistant to them in their problem solving. I learned this perspective in my role as a family practitioner during the 1956–1966 era from my mentor, Dr Clarence McNeill, pioneer North Shore doctor and soft spoken, kind, and wise man of few words. 

Early in my practice, Dr McNeill gave me a thesaurus. Since then I have acquired several more, including one that I can hardly lift. Early on I discovered that the word stress has over 100 synonyms. So when a concerned patient presented with stress and asked for something to relieve it, I tried to clarify what their concern over stress expressed. Was it a worry about something specific, an uneasy feeling, a feeling of being trapped, a pressure, or a foreboding? Can it be described or defined, and if so, what choices were available, applicable, and acceptable to a resolution? The feeling of being trapped or having no obvious way out of a situation is one of the heaviest burdens. 

Now in my 90s, I am not quite a fool yet—not willing to be my own patient—but I am using my thesauruses to clarify my own stresses and my growing feelings of loneliness associated with my life situation, made worse by the currently imposed social restrictions. As to my stresses: my sweet wife of 65 years is in the depths of her dementia, being cared for at home by live-in caregivers. Her situation is hopeless. Not surprisingly, most synonyms of the word stressfultaxing, traumatic, pressurized, frustrating, tense—apply to me. I do shed tears from time to time over what she has become. But I do have the good feeling that with medical guidance, support from family and friends, professional caregivers, technical equipment, and a bank loan, I am doing whatever needs to be done to ease her remaining time on earth. 

Things are a bit different for me when I extend the synonyms of stress to include feelings of being partnerless, alone, or lonely. By extension, synonyms of these feelings may include nostalgia, or the sense of being empty, isolated, solitary, longing, or yearning. I have experienced all of these synonyms, too, but for me, longing and yearning for a live partnership and for some physical closeness are the most difficult ones to deal with.

Of interest is that there may be an identifiable neural basis for some of these feelings. Recently a default network of the brain has been identified in a collection of brain regions with loneliness-linked neurobiological activity. This area is quiescent when the brain is engaged in various specific mental and physical activities, ready to turn on when the mind is resting. There may be a feedback mechanism between the physical reality or the perception of being alone—like in social isolation—and the neurology of the default network in action. Social isolation may trigger reminiscing, imagining, mentalizing, fantasizing, or creating negative subjective experiences of being isolated. In my situation, keeping to regular schedules in a day, walking alone or with friends, rowing, swimming (but not reading or watching TV) have served as useful distractions. 

Perhaps in the future we might have some control over this default brain network, and offer solutions to negative subjective experiences for people experiencing social isolation. Then we could discard Yogi Berra’s advice and when faced with a fork in the road we might take the road of our choice. 
—George Szasz, CM, MD

Suggested reading
Spreng RN, Dimas E, Mwilambwe-Tshilobo L, et al. The default network of the human brain is associated with perceived social isolation. Nat Commun 2020;11:6393. 

This post has not been peer reviewed by the BCMJ Editorial Board.

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