Loneliness: A New Epidemic in the USA

Loneliness affects almost half of adult Americans

Posted Feb 12, 2019

MDLinx, a news service for physicians, reports “The newest epidemic in America now affects up to 47 % of adults—double the number affected a few decades ago” (1).

Loneliness, FJ Ninivaggi
Loneliness
Source: Loneliness, FJ Ninivaggi

This staggering data has relevance because of its correlation with increased risk for early mortality, risk rates similar to those for obesity and smoking 15 cigarettes a day. Also, the findings relate to adverse health risks such as higher systolic blood pressure, body mass index, and high-density lipoprotein cholesterol levels. Depression and suicide are also cited.

Vivek H. Murthy, MD, past U.S. Surgeon General, in 2017 spoke of loneliness and emotional well-being as major public health concerns (2, 3). Social connections are essential. The workplace, for example, is a significant arena for everyday relations since it is where most working adults spend most of their day.

Cigna and Ipsos (4) surveyed 20,000 U.S. adults ages 18 and older, and almost half report feeling alone (40%) or left out (47 %). One in four (27 %) feel they are not understood. Two in five (43 %) feel relations are not meaningful and they feel isolated (43%). Generation Z (those born after about 1995) was found to be the loneliest generation. And social media use alone is not a predictor of loneliness. In all the findings, a lack of meaningful human connectedness is paramount.

Those feeling lonely at any age perceive others are not listening to them, taking them seriously, making eye contact, and either explicitly or implicitly dismissing them. This perception, whether or not reflective of reality, reinforces feeling disconnected, dismissed, and uncomfortably isolated.

There is a difference between distressing loneliness and a healthy sense of aloneness. In addition, it is possible to cultivate a resilience mindset, including strategies preventing lonely feelings and building social strengths that enhance cognitive and emotional life skills. Enriching the strengths at any age counters loneliness, isolation, and fosters more in-depth self-confidence both when alone and with others.

What Is Loneliness?

Loneliness is accompanied by emotional suffering—the pain of feeling separate and disconnected. Loneliness as isolation is a deeply conflicted sense of the fear that one’s perceived inextricable attachments to others are being pulled and split apart, or are absent. Loneliness reflects a state of insecure attachment and “challenged bonding.” These are the common fears of loss all people experience. It is the disturbing sense of impending incompleteness, insecurity, and ungrounded-ness. The lonely person may feel inferior to others perceived as not lonely.  Loneliness emanates from the mind’s intrinsic default tendency toward irreparable splitting into twos.

Underlying loneliness are deep-rooted feelings, chief of which are envy, greed, and jealousy–in a highly nuanced fashion. The lonely feelings of incompleteness can make one feel consciously inferior. Conscious fears of loss are clear in jealousy. While this brief discussion on loneliness cannot detail these psychodynamic subtleties, a few key ideas are intriguing because they appear to attribute causation to forces outside oneself.

The "Envy This" series of blog posts has drawn from the seminal work of the British psychoanalyst Melanie Klein (1882-1960) and her voluminous papers on the unconscious roots of envy. These contributions are daring and viewed by some as controversial because they are innovative and unconventional. The thesis pivots on subliminal inferiority-superiority templates that are emotionally projected in interpersonal relations marked by conflict. Emphasis is on mindsets that are non-consciously biased and may be resistant to correction by logic and reason.

Although the psychodynamic process involved profoundly remains non-conscious, it acts to negate feelings of inferiority by denying and deleting any hint of perceived superiority in others. Non-conscious envy gives birth to more conscious jealousy and greed. These emotions show themselves by feelings of exclusion from a withheld or unobtainable superior good. Greedy impulses arise to restore what was lost even if it isn't the original lost item. 

The irrational manifestations of unconscious envy (e.g., I am inferior because others always have more) and of conscious greed (e.g., “I desperately need more than I have”) in everyday life may be the most common underlying triggers of loneliness. They are the emotional articulations of a feeling of absence (e.g., inferiority and fear of loss), feelings silenced only by strivings toward acquisitiveness. Loneliness results in the feverish pursuit of clinging to persons and of gaining material objects. The pain of loneliness is a feeling that life is an emergency in need of immediate action—forming connections at all costs.

Greed is more akin to feelings related to jealousy. Characterized by unsettling feelings of gnawing dissatisfaction of never having enough but hoping to make greed more benign than hopeless envy. Jealousy is a passionate feeling of disappointment and exclusion. Jealousy, unlike envy, is based on affectionate feelings—wanting the warmth of loving connections but using self-sabotaging ways to attain them. Envy, greed, and jealousy may be triggered when one experiences the condescension of others. Experiencing a sense of being inferior is relegation to being a “stranger." This alienation emerges from the mix of disdain and frustration becoming entangled with feeling dismissed and valueless.

The state of painful loneliness is often accompanied by perceptions excessively directed to persons and objects outside oneself. This reflects the often-seen attempts of the lonely person to behave as if all his or her needs could be and must be satisfied only by the external environment rather than from a balance drawing from more in-depth internal resources.

Since loneliness is a feeling of being isolated, unconnected, insecure, estranged, alienated, and empty, the natural defense of clinging and grasping is automatically elicited. People experience it as an endless series of repetitive, temporary arrangements of adhering to another or, for example, holding on to inanimate possessions such as money, property, video games, toys, power and control over others, or grasping a no-longer-adaptive ideology. 

Aloneness

The concept of aloneness has been central to both Eastern and Western meditative systems. Unlike loneliness, its perspective is positive—a value with merit and practical meaning. 

Aloneness (Sanskrit: Kevalam, Kaivalya) differs from loneliness. Eastern and many mindfulness perspectives regard aloneness as a healthy state---more a mindset than real numbers of friends. It is characterized by feelings of trust, security, and relative completeness. Being alone with one’s thoughts and feelings can open inner equanimity permitting a range of experiences from quiet self-reflection to flowing engagement in play, work, or just “being” amid others. A beautiful exposition is found in the thousand-year-old Hindu Kaivalya Upanishad within the Atharva-Veda (5). Western philosophical and many faith orientations also emphasize an essential trust in one’s inner core. Spiritual orientations have enhanced this with the grace and ineffable empowerment millennia-old religious scriptures describe.

Effective psychotherapy, understood in psychological and psychiatric perspectives, creates conditions whereby splitting/alienation processes diminish and self-integration is enhanced. Feelings of loneliness are restructured, and a greater sense of comfort with oneself is established. This entails an explicit acceptance of the present moment—the “now” of the experiential present. It is putting the silence of equanimity back into one’s experience.

Alone in this sense includes being related to others—but not emotionally fused. This state of interdependence may appear paradoxical because it describes experiencing one’s being simultaneously both as a single individual and as an integral part of one’s family and social context. Healthy interdependent aloneness is a psychological state of communicative, inner silence. This mindful state is one of equanimity, an absence of the inferior-superior dichotomy. Also, healthy aloneness is not troubled by fears of loss.

This view of aloneness manifests differently at each chronological age and at different developmental stages. Degrees of wholesome aloneness may be present in healthy children alone at play and also in the secure presence of a caregiving parent. In maturity, however, the fullness of being empathetically “alone in the presence of others” can flower in a more consciously experienced way in a variety of contexts, of which the work environment is significant.

Evidence-based Resilience Enhancement for Loneliness

Psychologists, psychiatrists, and social scientists have known from clinical work over decades that both intellectual and social engagement help to prevent loneliness. Now, studies show the social component associated with cognitive decline in Alzheimer’s patients can be enhanced. Robust intervention studies with youth are in process although findings from older individuals can apply. The crucial factor is social relations that are high in quality, not merely large in number—having in-depth authenticity and meaningfulness.

For example, in a large four-year prospective study, increased loneliness in cognitively intact older adults doubled the risk of Alzheimer’s (6). The PAQUID research study (7) showed a 53% reduction in Alzheimer’s risk in those with a secure social network. An issue of the 2017 International Journal of Geriatric Psychiatry discussed a relevant longitudinal cohort study.  Findings showed social activity positively associates with a decrease in the feelings of subjective cognitive decline, a recognized prodromal finding in mild cognitive impairment (MCI) and Alzheimer’s (8).

Mindfulness-based interventions deliver both subjective and physiologically demonstrable improvements in attention, well-being, and the modulation of inflammatory processes in elderly practitioners (9).

Loneliness is prevalent but manageable. Management includes identifying its presence, defining its parameters, and using all available measures to prevent and change its distressing effects. This brief review highlights social engagement and mindfulness. Nutrition, exercise, and active cognitive interests also play significant preventative and modulating roles. Health is a balance of physical, emotional, and social well-being. These provide a platform of inner resources making it comfortable to be alone both by oneself and while engaged in meaningful relationships with others—at any age.

References

1.     MDLinx (January 2019). https://www.mdlinx.com/internal-medicine/article/3272.

2.     Washington Post (2017). https://www.washingtonpost.com/news/on-leadership/wp/2017/10/04/this-former-surgeon-general-says-theres-a-loneliness-epidemic-and-work-is-partly-to-blame/?utm_term=.0734c8da5e4a.

3. Harvard Business Review (2017). https://hbr.org/cover-story/2017/09/work-and-the-loneliness-epidemic.

4. Cigna & Ipsos (2018). https://www.cigna.com/newsroom/news.

5. Whitney, W.D., & Lanman, C.R. (1996). Atharva Veda Samhita: Translation with

critical and exegetical commentary. Delhi: Motilal Banarsidass. (Original

work published 1905).

6. Wilson, R.S., Krueger, K.R., Arnold, S.E. et al. (2007). Loneliness and risk of Alzheimer disease. Archives of General Psychiatry, 64 (2): 234-240.

7. Amieva, H., Stoykova, R., Matharan, F. et al. (2010). What aspects of social network are protective for dementia? Not the quantity but the quality of social interactions is protective up to 15 years later. Psychosomatic Medicine, 72 (9):905-911.

8. Kuiper, J.S., Oude, Voshaar R.C., Zuidema, S.U. et al. (2017). The relationship between social functioning and subjective memory complaints in older persons: a population-based longitudinal cohort study. International Journal of Geriatric Psychiatry, 32 (10): 1059-1071.

9. Fountain-Zaragoza, S., & Prakash, R.S. (2017). Mindfulness training for healthy aging: impact on attention, well-being, and inflammation. Frontiers in Aging Neuroscience, 9:11.