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Lonely In A Crowd

Mar 4, 2020

An eight-year-old boy clutches his ball looking forlornly around the schoolyard at the other children playing, talking and calling out in small groups. People moving by a young woman walking along a busy sidewalk are unaware that she hasn’t spoken to anyone in four days. An elderly man watches passersby from a park bench. Since his wife’s death five years ago, he sorely misses a companion to share his daily ups and downs.

Loneliness manifests in different forms making it an epidemic that impacts nearly half of all Americans, according to a recent article that quotes former U.S. Surgeon General Vivek Murthy as saying “during my years caring for patients, the most common pathology I saw was not heart disease or diabetes, it was loneliness.”

“I totally agree,” says Dr. Neha Narula, a clinical assistant professor and primary-care physician at Stanford. “Research has shown us that it’s a risk factor for many diseases and has become a huge problem in the last 10 or 20 years. Even though we are more technologically connected, the rates of loneliness have actually risen.”

Social science researchers define loneliness as the emotional state created when people have fewer social contacts and meaningful relationships than they would like — relationships that make them feel known and understood. “A lot of people think loneliness and social isolation are synonymous,” Dr. Narula says, “however, social isolation is physically not having people around you, whereas loneliness is a subjective feeling of being alone; of being disconnected from people even though they may be around you. It’s very important to differentiate between the two and realize that it could be hard to recognize that your family and friends can also have these feelings of loneliness.” In short, if you feel lonely, you are lonely.

Dr. Narula frequently sees social isolation and loneliness in her practice. Urban centers like the Bay Area are melting pots that draw transplants from different parts of the world with different cultures, languages and lifestyles who come there for work, many bringing their families. They face many challenges adjusting to a new way of life, including loneliness. A few patients open up and willingly share their feelings; more often, she finds them either shy or nervous, with some unwilling even to acknowledge loneliness because of the huge stigma associated with it. Spouses and family members who do not work are especially susceptible because they lack even the social aspect of the workplace, and sometimes face additional barriers of transportation and language. Regardless of ethnic, social or cultural background, loneliness is more common in adults over 45; however, there’s a higher prevalence in seniors – those over 65. Studies show that nearly one-fifth of seniors live alone and over 40 percent report feeling lonely on a regular basis. Family physicians increasingly observe it in adolescents and pre-teens as well, who tend to be very active on social media, but have difficulty forming real relationships.

“Evolutionarily we needed social connection to survive,” Dr. Narula points out, “over hundreds of thousands of years, we humans were able to survive as a species among much stronger animals due to the advantage of our brains and our ability to communicate and work as a collective species rather than as individuals. Fast forwarding to 2020, we need to remind ourselves of the importance of finding those people who will help us survive in terms of our health and life span.”

An abundance of research shows that loneliness is a risk factor for many illnesses, just as smoking is for heart disease and lung cancer. In particular, a Harvard study that followed people for over seven decades established the inverse: one of the clearest indicators of physical health, quality of life and longevity is how happy people are in their relationships.

Loneliness is an evolutionary phenomenon designed to make humans seek protection in a group for survival by triggering a physiological response: the release of stress hormones like cortisol. In small doses these hormones help solitary humans be more aware of surrounding dangers. However, repeated long-term occurrence results in damage to health leading to high blood pressure, increased inflammation, a weakened immune system, and consequently a reduced life span. Additionally, without the emotional support of family and friends, people who are lonely often stop exercising, overeat and tend towards substance abuse, further compounding impact on health. Research shows that the reduced life span linked to loneliness is similar to smoking 15 cigarettes a day. Poor social relationships were associated with a 29 percent increase in risk of coronary heart disease and a 32 percent rise in the risk of stroke. The impact of higher inflammation on the immune system is particularly severe on the elderly; immunity declines with age, and this serves to accelerate that decline. Isolation can be especially deadly for seniors in the event of an emergency like a bad fall or a heart attack.

We should take action at individual, community and societal levels to acknowledge and normalize loneliness, and work to remove the stigma that makes it a taboo topic. “We can be the medicine that each other need,” says Dr. Murthy. Let’s begin with an honest examination of our own condition. Next, let’s pay attention to family and friends, making sure that they feel like they are connected, are able to express their feelings of loneliness and where needed, help them find solutions. Shaping the circumstances and communities we live in can do much more than medicine can. Recognizing that it was a public health challenge, British Prime Minister Theresa May appointed a Minister for Loneliness to her cabinet in 2018 to implement a cross-government strategy to combat it. More societal and governmental action along these lines is needed.

We are an ingenious people. Let’s work together to develop creative solutions to help each other – especially the young and the elderly – develop and lead more connected, healthy and fulfilling lives. No one in our midst should be or feel alone.

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