Loneliness, a common human emotion, is a complex and unique experience for each individual. It has no single common cause, so the prevention and treatment for this damaging state of mind considerably differs. A child who tries to make friends at school needs different strategies to resolve their problems than an older adult who has lost their spouse in the recent past.
Loneliness has become a significant public health concern. It leads to pain, injury/loss, grief, fear, fatigue and exhaustion. Thus, it also makes a person sick, interferes with daily functioning and hampers recovery. Loneliness should be considered a disease and should be included in the classification of psychiatric disorders.
Loneliness has been defined in different ways, including:
A state of solitude or being alone
The perception of being alone and isolated
A state of mind
Inability to find meaning in one’s life
Feeling negative and unpleasant
A subjective, negative feeling related to deficient social relations
A feeling of disconnectedness or isolation
Solitude and loneliness
Solitude and loneliness should not be explained in similar ways. People enjoy solitude, which leads to creativity and self-realization. It is an approach for developing one’s own individual space. It is often considered an essential component of spirituality and self-growth. However, loneliness is a state of mind, a feeling of emptiness and separateness, and it often becomes a compulsion. When it develops, dysfunction is perceived as stressful combined with physical aging; the situation turns out to be a toxic cocktail.
To understand loneliness, it is important to have a closer look at exactly what the term “lonely” means, as well as the various causes, health consequences, symptoms and potential treatments for loneliness. A person who experiences loneliness does not find anyone with them and thus increases the risk of developing biological dysfunctions, psychological distress and behavioral problems. It is commonly seen in older adults and has its phenomenology, complications and etiology, which needs proper diagnosis, care and management. This may be called “pathological loneliness.”
Pathological loneliness
The pathological loneliness has its roots in the medical model consisting of a host, an agent and an environment and is, thus, a disease. The problem of pathological loneliness is increasing worldwide. It needs to be handled as a disease, not just as a situation, a symptom of a disease or merely a social concept.
It has been described as the major problem associated with old age; therefore, it has been identified as an appropriate condition for therapeutic intervention or prevention. Studies show that loneliness is found to be more common among those who live alone.
Some other factors that impact loneliness:
Widowhood
Increasing dependency
Economic dependency
Environmental factors include type of family, social network, transportation issues, place of residence, population migrations, etc.
Loneliness may be categorized into three types according to its causes.
Situational loneliness: Socio-economic and cultural milieu contributes to situational loneliness. Various environmental factors like unpleasant experiences, discrepancy between the levels of their needs and social contacts and migration of population, interpersonal conflicts, accidents, disasters or empty nest syndrome, etc., lead to loneliness in old age. The increased life expectancy and feminization of the elderly population are significant factors in developing situational loneliness in females.
Developmental loneliness: Everyone has an innate desire for intimacy or a need to be related to others. This need is essential for our development as human beings. Apart from this need, a higher level of need for individualism also exists, which is related to knowing and developing our authentic self that requires some solitude, too. For optimum development, there should be a balance between the two. When a person cannot balance these needs properly, it results in a loss of meaning in their life, leading to emptiness and loneliness in that person. Personal inadequacies, developmental deficits, significant separations, social marginality, poverty, living arrangements and physical/psychological disabilities often lead to developmental loneliness.
Internal loneliness: Being alone does not make a person lonely. It is the perception of being alone which makes the person lonely. People with low self-esteem and less self-worth are seen to feel lonelier than their counterparts. This type of loneliness is due to personality factors, locus of control, mental distress, low self-esteem, feelings of guilt or worthlessness and poor coping strategies with situations.
Impact of loneliness
Loneliness, which leads to distress and dysfunction in the elderly, may be assessed in many ways and, thus, can be diagnosed as a disease entity. A lonely person often feels low, helpless, separated or discriminated against, finds difficulty during interactions and feels abandoned and alone. The following measures may be used to diagnose loneliness in the elderly.
Level of experience of separateness
Levels of cumulative wear and tear
Complete physical/mental health status
Social network
Frequency and degree of loneliness
It is generally accepted that loneliness frequently results in a decline in wellbeing and may cause:
Depression
Suicidal behavior
Sleep problems
Disturbed appetite
The consequences of loneliness are found more among those adults who develop personality and adaptation disorders, such as:
Overconsumption of alcohol
Loss of self-esteem
Extreme forms of anxiety
Powerlessness
Stress
Loneliness also predisposes a person to physical diseases, adversely impacting the immune, cardiovascular and endocrine systems.
Consistent, overwhelming, pervasive loneliness develops stress, ultimately leading to serious physical disease. Feelings of loneliness and being alone were found to be independent predictors of motor decline in old age.
Loneliness was also found to be an independent predictor of mortality and functional decline after controlling for depression. It also leads to memory impairment and learning difficulties and makes the person prone to Alzheimer’s disease. A Dutch study reports that people who feel lonely are more likely to develop clinical dementia over three years compared to those who do not experience loneliness.
Could it be more?
Loneliness may be pathognomic, meaning a specific sign or symptom strongly suggests or is unique to a particular disease, such as a symptom of depression in old age. It is reported to be more dangerous than smoking; a high degree of loneliness precipitates suicidal ideation and para-suicide, Alzheimer’s disease and other dementia and adversely affects the immune and cardiovascular system.
It is a generally accepted opinion that loneliness results in a decline in wellbeing and has an adverse effect on physical health, possibly through immunologic impairment or neuro-endocrine changes. Loneliness is, thus, among the latent causes of hospitalization and placement in nursing homes.
To date, loneliness is being treated as a symptom of mental health problems; however, for older people (aged 60 years and above), loneliness has become a disease in itself.
Fighting loneliness
Several researchers report interventions for loneliness. These interventions are to be individualized to control expectations for personal efficiency and improve capacities to socialize.
Studies show that members of intervention groups respond favorably to social contact and loneliness. Thus, loneliness is a treatable rather than an irreversible condition.
Apart from planned interventions, there are some other useful strategies to fight against loneliness:
Keeping self-busy
Sharing feelings
Involving self in some activities (spending time together, discussing problems, maintaining interactions)
Helping others
Avoiding escapes
Developing quality relationships with people who share similar attitudes
Interests and/or values, collecting good thoughts and managing unfortunate happenings
Joining groups of self-interest
Pharmacological management of physical ailments
Staying in contact with family and friends
Source: U.S. National Library of Medicine National Institutes of Health