The loneliness epidemic
Therapy Today, December 2022 / January 2023

Agnes* pauses. Then, very quietly, without looking at me, says on an exhale, ‘I’m just so lonely.’

Agnes is in a caring relationship, has family, a network of friends and leads a busy professional life. Yet she is lonely and lives, she says, with a constant sense of isolation. There is a glass wall between herself and others, she feels, this side of which is crushingly lonely – as there is no one there apart from her. Many years ago, something happened. Something so awful, she says, she watched it happening to her ‘as though hovering above’. Perhaps part of her never came back down.

My research into loneliness sprang from the counselling room where, usually in quiet, reluctant tones, the words lonely and loneliness would be brought as though the speaker were dragging in a shameful and taboo secret. It was never, in my experience, brought as the ‘main’ problem, although I’m sure that occurs – rather, loneliness slipped out, or seeped out into the narrative, and once it was there, stark and ‘confessed’, it spread like a stain, often opening areas of pain, yearning and longing that had not been voiced.

Often, the client would be perplexed and frustrated, ‘Who am I to be lonely?’, loneliness being seen erroneously as a state endured by others, people without friends, without family, colleagues or community. People who didn’t ‘know’ how to make connections. Sometimes, a client would explain the measures they had already taken: ‘I do voluntary work’; ‘I make sure I contact friends regularly’; ‘I go out and about’; ‘I keep busy’; or ‘I’ve joined an online dating site and a local walking group.’ The toolbox, it would seem, is open, but still… ‘I’m just so lonely.’ Probe a little with the client and what emerges is an emotional cluster rather than discrete emotion1 and a complex, shifting cluster it is too. The experience of loneliness with its waxing and waning of emotions and thoughts, its ebbing and flowing of physical sensation and mental (un)reasoning, its prompting and declining of contact and activity, is linked to depression, to anxiety, to bereavement and loss, to trauma, to early experiences of being overlooked. It is not ‘just’ the scourge of the elderly or those in remote settings or the recently bereaved, although research suggests there are groups in our communities more likely to suffer with it. Research has picked up on the vulnerability to loneliness of young adults, for example, marginalised groups and those with disabilities, or from ethnic/cultural minorities, and the LGBTQ+ population.

Termed a pandemic in the 1990s, referred to by The Economist in 2018 as ‘The Leprosy of the 21st Century’ and described in The Lancet as a public health problem,² loneliness began to seize headlines in both academic and popular imagination at least 20 years ago. This is unsurprising, perhaps, on a planet with around eight billion mobile and transient individuals, circumnavigating in various measures of uprootedness. War, economic desperation and the impacts of global warming have pushed millions towards a particular kind of loneliness, with the United Nations High Commissioner for Refugees estimating that the number of people forcibly displaced has for the first time in recorded history topped 89 million, those internally displaced nearly 54 million and the number of refugees hovering around 27 million. That’s a lot of people without a home, routine, community, networks, voice, being seen and validated, the anchor points we need to help us feel connected.

Physical effects

But the very word loneliness only picked up currency post-1800 as industrial society began dispersing us, capitalism fragmenting us and consumerism isolating us, leaving us, famously, to bowl alone, live alone, age alone and die alone.³ Loneliness is now so widespread that a lucrative business opportunity⁴ has emerged to meet the needs of those who do not know what to do about their loneliness.

Most widely described as ‘the lack of desired social relations’⁵ loneliness is still not a defined phenomenon although one arguably ubiquitous among humans in one form or another. Loneliness, not to be conflated with isolation or solitude, which are altogether different states, suggests at core a dysphoric condition. This may result from discrepancy thinking – that is, an incongruity between one’s ideal and real social relationships, a mode of thinking rife in our age of social media. The case for its evolutionary value, made through the evolutionary theory of loneliness,² suggests it is the pain of being alone that motivates us to seek the safety of companionship, which in turn benefits the species by encouraging group co-operation and protection.

Loneliness is associated with poorer mental and physical health with a corpus of studies exploring its correlations to specific illnesses such as cancer, heart disease and high blood pressure. It is also implicated in engagement with unhealthy behaviours such as smoking and alcohol consumption and psychological and physical conditions that are less obvious – chronic loneliness is, for example, said to decrease physical activity, which then leads to an increased risk of frailty. Loneliness, according to some research, is also considered a predictor of early death.

Looking deeper

Also demonstrated to have adverse impacts on mental health, loneliness with its relationship to specific conditions is now being investigated. Lived experience research I carried out with people diagnosed with a personality disorder, for example, told of the ‘emptiness… it’s almost the desperation of wanting to allow people in but not being able to’ and gave haunting testament to the deep, painful, ontological loneliness with which they lived. Some conditions such as depression appear to be particularly vulnerable to the impact of loneliness and the vicious circle of loneliness, self-loathing and bleak mental distress. Indeed, neuroscientific research has recently identified a region of the brain believed to generate feelings of loneliness, known as the dorsal raphe nucleus, or DRN, which is best known for its link to depression.⁶

Yet panic statements in the headlines about being alone mask a more granular view of the experience. Loneliness may be, for example, a price that we may pay for more choice. The rise of privacy, itself a product of market capitalism, is a driver of loneliness. While living in a remote or rural location has been indicated as a risk factor for social isolation and loneliness, the pandemic triggered a further rise in the drift to rural areas for affluent urbanites who cite a desire for privacy as part of their reasoning. We have more choice, too, about who we live with, whether or not to remain in unhealthy relationships, whether to uproot and continually move in search of a better life. The trend of rising single-person households appears to extend across all world regions. In fact, many of the gains made in the 20th century, perhaps most notably for women, did come at a price, and one that we may still be willing to pay. Critical evaluations of the family, for example, were to be welcomed as enabling more egalitarian alternatives to the family to develop. Choice always comes at a cost, and this existential conundrum faced by many who are extricating themselves from oppressive family, cultural, religious or institutional structures is one not helped by the alarmist discourse of loneliness.

The ways in which loneliness is framed in popular and academic discourse invariably both individualise and medicalise it, framing it as an issue residing in the individual rather than a socio-economic problem. This can lead to some of the shame I alluded to earlier, with loneliness being seen as located in the person’s ‘own’ shortcoming and weakness, rather than being a pernicious by-product of life events and harsh circumstance, poverty, discrimination, invalidation – and the testimonial injustice experienced by never being heard, which is surely one of the loneliest of human experiences.

Triggers

Alphonsine*, a Christian Congolese refugee I counselled, had suffered multiple severe losses. A victim of sexual violence during the early 2000s in the Congolese war, she had struggled to gain a precarious foothold in her new London life. A burglary at her temporary flat sent her into a tailspin, reigniting past losses, violations and traumas, and a sharp, unshakeable loneliness for which she felt guilty.

‘I can’t understand it,’ she says, shaking her head slowly. ‘I have people around me, I use Skype, I have a life here… why am I so lonely? I am a bad person.’ Loss piled upon loss, trauma and displacement can leave a person feeling utterly, utterly alone against the world, even with faith. Sometimes despite that faith, while guilt and shame are in themselves lonely emotions, pitting oneself against oneself. Shame and guilt can be sharpened by the prevailing idea that loneliness is something you can fight and do something about, an idea that is mirrored in countless campaigns urging us to get out, get connected and get friends. What these campaigns overlook is the existential clout of loneliness and the way it can begin early in the lifespan and be triggered and compounded by adverse life factors. A growing body of research indicates that sociodemographic and intersectional factors as well as social roles, quantity and quality of social contact, health and dispositions all contribute to individual differences in feelings of loneliness. Some findings suggest that low social capital, especially in terms of low trust, may be a risk factor for loneliness.

So loneliness – so keenly felt as something ‘in me’ – is rarely approached as an issue exacerbated or even caused by policies in housing, welfare and education that effectively isolate, separate, discriminate and stigmatise people. Perceived overcrowding, for example, has been shown to drive feelings of disconnectedness. Bereft of community and social structures such as libraries, community centres and swimming pools, populations are then ‘targeted’ by interventions against loneliness. These routinely prescribe behaviours that may well have already been in place before the local bus service, for example, was reduced to one bus a week, or before the community centre that doubled as the bingo hall closed its doors.

Materialism

While we may know that our wellbeing is inextricably linked to the lives of others, we are bombarded with the message that our prosperity is based on competitive self-interest, individualism and consumption, messages of core use to neoliberal economics. A key driver of a shift away from public-collective values to private-individualistic ones and to a commodification of mental health,⁷ neoliberal discourse employs a moralist undertone to craft the person as both expert and manager of their care with reiterated sentiments of ‘responsibilisation’ through which individuals are expected to take moral responsibility to be healthy, productive, committed, employable and successful. This process of ‘responsibilising’ citizens, however, also succeeds in ‘irresponsibilising’ governments and institutions. A 2021 study argues that neoliberalism ‘appears to be harmful to health because it can create a sense of being disconnected from others, as well as being in competition with them, in ways that feed feelings of loneliness and social isolation’.⁸ An increase in materialism has also been associated with loneliness and tragically, in this logic, we buy stuff that makes us feel lonelier so we buy more stuff. We need to be mindful, then, of the fact that the causes of loneliness can be political as much as social and psychological. Much revisited for contemporary considerations of loneliness is the work of philosopher Hannah Arendt⁹ whose deep take on loneliness suggests that we have entered a stage of organised loneliness, one encouraged by government in order to increase the docility of citizens. Loneliness, she argued, means that people lose contact with their thinking selves, and terror and panic replace solitary thought. In loneliness we are impotent, unable to realise our full capacity for action. Some commentators have even suggested that the most ominous thing of all about rising rates of loneliness is that therein lies a partial explanation for increased political polarisation, with increasing numbers of people attracted to more radical forms of political dissent on both the right and the left. A sombre thought.

Amid the headlines about loneliness, what appears lacking is an alternative framing of it, one that includes possible benefits. Literature and philosophy have throughout the ages been more alive to this, and the psychoanalytic canon has traditionally also been rich in this perspective. It has offered a view of being alone as an experience offering the opportunity for improved mental health, self-discovery and creativity. Often expressed is the opinion that being alone is in fact necessary to access imagination, concentration and inner discipline as well as invention and originality. For Clark Moustakas it is nothing short of a gift, in which a sense of one’s separateness from others offers a way back to oneself and an opportunity for an intense awareness of self, and an ability to return, renewed, to human fellowship and community.¹⁰ For Donald Winnicott, famously, the ‘capacity to be alone’¹¹ is nothing less than key to creative living, as in Melanie Klein’s poignant theories on the roots of loneliness, where she notes the painful pleasure in loneliness that opens the possibility of a creative element within a sensation that is usually negatively associated.¹²

When COVID-19 restrictions put an abrupt halt to contact, and ‘sudden-onset isolation’ began to be experienced, we learned the actual value of connection and the importance of touch and closeness. But we also saw more clearly how our society is striated by divisions. We saw how our economies are hungry for the discrepancy thinking fuelled by social media that keeps us buying and keeps us wanting. Yet we also encountered, some for the first time, the wonder of nature and experienced the power of being alone, to be. Loneliness discourse and study rarely capture the multidimensionality of loneliness and invariably overlook how our own resilience, resourcefulness and creativity may be brought to manage and even exploit it. In my research on loneliness during the COVID-19 restrictions, many people reported the isolation and loneliness that we all feared or experienced when ‘normal’ life and contact was denied us. But many, too, mentioned ‘strange relief’; finding ‘deep resources in myself’; ‘finally painting that picture’; ‘for once, talking to myself kindly’ and noticing the ‘soft hush of alone’. There is more to loneliness than meets the eye, and clients can be supported to explore its constituent parts and its origins, and to understand it as part of a complex context for which they need feel neither shame or blame. And we can all be helped to see the unique openings being alone offers us into the ‘oneliness’, from which the word loneliness is derived.

* Client names and identifiable details have been changed