There is a condition that is twice as deadly as obesity and more dangerous than smoking 15 cigarettes a day. It is a sneaky, capricious beast that can overwhelm you at 4am, as the world around you sleeps.
It stalks you as you push the pram around an empty park. It is the sneering voice in your ear, the party that is always going on in the other room. It is the phone that never rings, the screens that glow with other people’s happiness.
It can be transient, a passing state precipitated by unfortunate events, or it can cradle you in its grip for many years. It is a greedy companion, agnostic about age, gender or status. It as much a part of being alive as hunger or love or death. Yet it remains one of our greatest taboos.
That condition is loneliness, the sadness that comes from lacking friends or company. You can be surrounded by people yet suffer an aching loneliness. “Fertile solitude” is often spoken of as an essential part of the creative process. But it is the searing, destructive pain of finding yourself involuntarily unable to connect with other people that wreaks havoc on everything from your mental health to your immune system.
A growing body of evidence links loneliness to dementia, depression and accidents, disrupted sleep patterns, altered immune systems, higher levels of stress hormones, and inflammation.
One study found that isolation increased the risk of heart disease and stroke by about a third. Another recent study, in the journal Cancer, found that socially isolated women had a 40 per cent higher risk of recurrence of breast cancer and a 60 per cent higher risk of dying.
Overall, data from 70 studies that examined the lives of 3.4 million people found that the lonely were 30 per cent more likely to die in the following seven years.
Alarmingly, the US Centers for Disease Control and Prevention reported last month that the average life expectancy of Americans fell between 2014 and 2015, from 78.9 years to 78.8 years – the first time it has declined since the height of the Aids epidemic. Researchers believe one factor is “death by despair” – rising deaths linked to drugs, alcohol and suicide – along with diseases of the heart, brain, lungs, and other diseases.
"It is possible that these phenomena are rooted in factors such as economic dislocation, cultural fragmentation, and social isolation, but more research is needed to confidently draw these potential connections," researcher David Squires wrote in a piece for the Commonwealth Fund last week.
Unseen destruction
Rose Anne Kenny, professor of medical gerontology at Trinity College Dublin and a director of Mercer's Institute for Successful Ageing, describes the unseen destruction caused by loneliness.
“Our body responds to infection or any insult by inflammation. That’s the normal way our bodies get rid of something toxic. But prolonged lack of social engagement can actually trigger a chronic background inflammation,” she says. “It starts to turn on the tissue and very gradually self-destruct. The consequences of that depend on the organ. For the heart it causes heart disease; for the brain it causes neurodegenerative diseases; for the gut it causes colonic carcinomas and other cancers. There are nearly one million different components involved in the inflammatory response, and the strength of the response can depend on the genetic vulnerability of individuals. That’s how loneliness can cause organ destruction.”
Today there are more ways to connect than ever, yet many more of us are suffering the crushing, visceral pain of involuntary social isolation. We’re living longer, lonelier lives. Families are shrinking, and more people are living alone.
Single-person households account for almost one in four households, at 23.7 per cent. In 1979 the figure was 16.4 per cent. In 1926 it was 8.3 per cent. Of the 392,000 people living alone when the 2011 census was taken, 56.3 per cent were single. In cities, more than a quarter of people in their 40s were single.
The changing structure of the family is exacerbated by this age of the curated self. Opportunities for meaningful human connection are being lost amid the pixels. People watch films on their laptops instead of going to the cinema. They do their banking online. They don’t know their neighbours. The engagements they make through the internet are a sugary snack instead of a nutritious meal.
Although scientists are better understanding how loneliness sets in train a series of potentially catastrophic physical changes, like the flap of a butterfly’s wing that precipitates an earthquake on the other side of the planet, there are many things we don’t know. How much engagement with other humans do we need to flourish? How is the inflammatory response triggered? What is it in us that drives our need for human connection?
“There is a really interesting hypothesis,” Kenny says. “Imagine if, when we were hunter-gatherers, the hunter had decided, I’ve got this lovely big boar, I could keep going on it for a month; I’ll just stay away from the community, do my hunting and eat it all myself. The community who had stayed behind to fulfil the other tasks would have starved.”
Eternal condition
Loneliness has always been part of the human condition. As our understanding of its negative effects has grown, so has our interest in it, leading to the emergence of a burgeoning loneliness industry. There are apps to help you deal with loneliness; dating sites for friends; Spotify playlists; countless books.
One of the most thoughtful explorations of the subject over the past year is Olivia Laing's The Lonely City: Adventures in the Art of Being Alone. "What does it feel like to be lonely?" she writes. "It feels like being hungry: like being hungry when everyone around you is readying for a feast. It feels shameful and alarming, and over time these feelings radiate outwards, making the lonely person increasingly isolated, increasingly estranged. It advances cold as ice and clear as glass, enclosing and engulfing."
Loneliness may be the result of circumstance, the effect of ageing, emigration, bereavement or a change in job or lifestyle. Dr Deirdre Plant is a GP in Waterford. A significant proportion of the patients she treats across every age group are suffering from social isolation and attendant mental-health problems, including social anxiety and depression.
“It’s chicken and egg,” she says. “Did the social isolation cause the mental-health problems or are they isolated as a result of those problems? Those who suffer from depression and anxiety tend to withdraw. The standard advice that’s given to people with mental-health problems, which is to talk to someone about it, isn’t always helpful to them. Sometimes they really just don’t have anyone they can turn to.”
Plant says social media can exacerbate the feeling that “everyone else is having a great life”, especially in teenagers. “All the insecurities we would all have felt at that age are hugely magnified now with social media.”
Exercise is a good coping strategy, she says. “Stay close to the people you love, and allow them to build up your self-esteem. Avoid people who bring conflict. And realise that no matter how great a time everyone else seems to be having, they’re probably feeling lonely and insecure too.”
First-time mothers and migrants are also vulnerable, Plant says. But it is among the elderly that loneliness is most visible and most acute. Tilda, the Irish Longitudinal Study on Ageing, is looking at, among many other things, the levels of social engagement of the Irish over-50s.
Now in its 10th year, the study, which Kenny leads, has found that one in four people of that age group had felt lonely, while between 6 and 8 per cent said that they experienced “frequent, painful loneliness”.
The organisation Alone runs a befriending strategy that pairs older people with a network of 500 trained, vetted volunteers. Sean Moynihan of Alone says loneliness and social isolation are urgent health problems for society as a whole.
“The demographics of our society are hugely changing. We’re on a journey from half a million to one million and a half older people. The fastest-growing age group in this country is over-80s. And the over-80s spend 80 per cent of their time in their home,” he says.
“Whenever we talk about ageing the focus is on, ‘Get yourself a pension and you’ll be fine.’ In reality, health, emotional wellbeing and relationships are far more important. The best thing you can do for your health is to stay linked in to your friends, family and community.”
Kenny says we can’t afford to wait until we are older to worry about building those opportunities for engagement. “Better social engagement should be a lifelong behaviour that we respect and encourage. It leads to a happier society, better productivity and fewer medical issues.”
Life stage
The factors that lead to loneliness can strike at any stage.
Jen Stirrup
is a busy, successful professional who runs her own technology company in the UK. In 2016 she spoke in front of thousands of people across three continents. She has a son and thousands of social-media friends.
But she spent Christmas alone and got just one present: a bar of chocolate. “It feels too hard to try to find friends,” she says. “I do get lonely. It feels as if the normal life is so easy for others to lead, but it’s out of reach for me.”
The circumstances leading to the life she leads now are complex. “I haven’t been on a single date since my divorce, in 2012, so I’m pretty unsalvageable, and mostly I’m okay with being single,” she says.
Stirrup’s problems started when she was sexually attacked by a stranger 20 years ago. “I’m as reconciled to it as I’m ever going to be. But I have been left with a mistrust of people. I tried my best to live a normal, social life, but I realised that I am happier on my own,” she says.
“I worry about the health risks, but I’m more bothered by the fear of lying ill or even dead for days and have nobody find me. I’m worried that I will have nobody at my funeral to comfort my son.”
Moynihan and Kenny would both like to see loneliness and social isolation made a public-health-policy issue and a priority for the Government.
“The medical evidence is there to show that loneliness is a health problem, and it will shorten your life. But unlike other things, like obesity or smoking, there is no health policy on it. There are no dedicated resources, no public-information campaign,” says Moynihan.
For individuals the best antidote to loneliness can simply be to acknowledge it, to let it in and to accept it as part of the human condition. John Cacioppo, a Chicago-based psychologist who studies the effects of loneliness, says that most of the negative effects relate to perceptions of social isolation rather than to the size of your network. He believes that effectively tackling loneliness relies on helping people to re-examine how they interact with others and their perceptions of social cues.
During her lonely sojourn in New York Olivia Laing eventually found meaning in art and peace in acceptance. "Loneliness, longing, does not mean one has failed, but simply that one is alive," she writes. "I think it's about two things: learning how to befriend yourself and understanding that many of the things that seem to afflict us as individuals are in fact a result of larger forces of stigma and exclusion, which can and should be resisted. Loneliness is personal, and it is also political."
