Alone in a Pandemic

Coping when all we have is ourselves.

Posted May 21, 2020

A Flower Stall on the Boulevards
Source: PICRYL

During the COVID-19 lockdown, loneliness and isolation are everywhere. Nowhere to go, very few outlets. According to a recent study, more than 60% of Americans—over 3 in 5—reported feeling chronically lonely even before the outbreak, when they were free to go anywhere! Now add in the current restrictions, and we are struggling with two pandemics, side-by-side. Each exacerbates the other since, as the science shows, loneliness decreases the body’s defenses against disease.

Somewhere on the loneliness spectrum is my patient Teresa, an elderly French woman toward the end of her life. She never married and her only family is a brother, with whom she’s been estranged for years. Teresa presented for treatment over 20 years ago for an episode of depression and still sees me. Ostensibly, the cause was her retirement, which left her without a sense of purpose and colleagues with whom to socialize.

Teresa had experienced a traumatic childhood. Her father was an alcoholic and would come home drunk and out of control. Her mother, who worked as a maid, kept late hours. Her older brother, the family’s golden boy, had been violent towards Teresa growing up, at one point shooting her with a BB gun. Her one sexual relationship had been with a married minister, who promised his love and then left her. 

Teresa finally settled in a community for the elderly, where she was treated well and made friends. But when COVID-19 descended, her life narrowed to a couple of rooms. No more communal activities. The residents were not very tech-savvy, so Zoom parties or even Skyping were impossible. Rarely, like on her birthday, her brother and a niece would call. 

When we spoke (now by phone) she claimed not to mind being on her own and to enjoy the company of her cats, her books, and the occasional chat. She accepted the possibility of dying alone if she became infected with the virus. She wanted to be cremated, with her ashes to be spread at sea in the coastal village where she was born.

To be honest, I think I was more affected by her circumstances than she was. I had images of wartime France, no heat, people huddled in attics. A brutal brother on the next cot. I thought about how every day might have been their last, and no one would know or care ... or even possibly find them for weeks. Maybe not until La Liberation!

Of course, I realized that my imagination was racing. But psychiatrists can’t help running with their patients’ stories. They get lost in a kind of reverie and spin whole narratives around their patients in the mode of alternative history. Suddenly, they have to catch themselves before showing sympathy for what never occurred. When a couple of patients populate the same story, they know that it’s time to refocus. Such drama—and the patient is blissfully unaware.

The point is that we care about our patients, or rather, we get to care about them, and the stories that we spin are curiously legitimated because they intensify our concern. They seem almost instrumental in that regard—I mean who couldn’t care about a lonely old woman freezing in a wartime attic while the Nazis march through her town?  

But in our sessions, I returned to reality. I asked Teresa if there was anything that might help her feel less alone. However, she was insistently stoic, even proud to be on her own. She was actually enjoying her solitude with hours of reading, knitting, and keeping a scrapbook. “You know,” she said, “I’m an amateur historian, at least if you call scrapbooks history.” (“Oh, if you only knew about my flights of historical fantasy,” I thought. "They’re a lot less accurate than yours!”) She mentioned some old friends and work acquaintances to whom she was writing.

So, Teresa has set me thinking about being alone vs. loneliness. Loneliness is harmful. It’s when you feel no one is there for you, and you ache to connect. John and Stephanie Cacioppo anatomized it into “intimate loneliness” (when you miss someone you love); loneliness for quality friendship; and collective loneliness, when a supportive group can no longer operate. I think Teresa probably fell into the second category, but not so much that it posed a problem. Like the French, she was philosophical. 

Though Teresa was alone, she inhabited a kind of well-adjusted solitude. Such willing adjustment to circumstance is a personal achievement. It’s making the most of what you have, rather than rebelling and falling into despondency. You recognize yourself as independent and self-sustaining. The psychoanalyst Donald Winnicott wrote of aloneness as a developmental milestone, when the child separates from its mother without feeling the anxiety of separation. This requires internalizing a sense of being loved by a parent and eventually oneself. As adults on our own, we have to recapitulate that feeling.

Over years of psychotherapy, Teresa had come to better love herself and take satisfaction in meaningful activities. I asked if there was anyone that now, after years of retirement, she might still consider pursuing as a connection. After a pause, she said quietly, “Well, maybe my brother.” He had caused her real pain growing up, and their estrangement had only slightly abated with a few stiff phone calls. So, I wondered aloud if she might reach out. But the moment passed, and she talked about doing her laundry and paying some bills.

But today when we spoke again, she thanked me. She had reached out to her brother with some anxiety, even trepidation, and he was delighted to hear from her. They spoke by phone for over an hour. He even put his daughter on, who was sheltering in place with him. He alluded to how he regretted his early harshness, and she told him how she had forgiven him long ago. They also shared memories about some good times like a birthday when he went to pick out a bicycle with her. This helped her feel less alone, though she still disclaimed feeling lonely. 

Certainly, physical touch can be important in feeling less lonely. The British psychologist and psychoanalyst John Bowlby, who pioneered attachment theory, discussed the importance of a secure base. When this was not present, such as with young children in orphanages, they failed to thrive. When loving care was present, they did better and were less prone to depression. Even when physical touch was not present, the emotional connection was meaningful. The same applies generally.

I felt proud of Teresa for reaching out to her brother after years of being estranged and said so. She appreciated it. Sometimes when we reach out to someone—even when it’s not physical—we feel better. It becomes a source of energy, so that when we are alone—even if we not technically lonely—we feel as though we are in the world, resonating with others. The funny thing is that though we may be ostensibly self-sufficient, we never lose the desire for affirmation. That requires other people who appreciate us and show it.