“may came home with a smooth round stone
as small as a world and as large as alone.”
―e.e. cummings
Only the Lonely:
An Exploration of How Your Figurative Heart and Physical Heart
Share the Same Aches
It probably isn’t a surprise to anyone that loneliness has natural implications in mental health. Loneliness means we are missingsomething, sadfor someone or for a situation other than the one we’re in. If sadness stays with us long enough and deeply enough, it may evolve into depression. But loneliness precipitates other changes in us as well. Beyond our lowered mood and possible peril to our mental health, loneliness spreads over all aspects of our well-being: mental, social, emotional, and physical.
The concept of loneliness isn’t as simple as it may seem.There is an automatic assumption that those who live alone would be lonely and those with people around them do not have an opportunity to become lonely. That isn’t necessarily so. For instance, when loneliness was studied across age groups, those with the highest reported loneliness were high school students—and age group who are usually around people all day, almost every day. This was true even when compared to the elderly group (the focus of most studies of loneliness) including those who lived alone (Schultz & Moore, 1988). So, what is it, then? What makes a person lonely? Or, more importantly, notlonely?
What is different about situations that allow some to become lonely and some not? For the high schoolers, the loneliness materializes due to an increase in the perceptions of social roles and the uneasiness of in the adjustment in attempting to meet them (Schultz & Moore, 1988). But the lower levels of loneliness in the elderly group is intriguing, especially when considering around a quarter of this age group lives alone (American Psychological Association [APA] (2016). This is where the substantial difference between being aloneand being lonely comes to light. Surprisingly, one is not significantly correlated to the other (Holt-Lunstad, et. al., 2015). Rather than physical proximity, the strength and stability of social networks became the best indicator in staving off loneliness—even moreso than physical and mental health.
“But loneliness can’t be that big a deal, right? Everyone feels lonely sometimes.” It is true that experiencing the emotion of loneliness can be healthy for us. It can help us clarify what it is we would like to feel instead and motivate us to seek the necessary changes to bring it about. The problem comes when loneliness persists and becomes a living condition rather than a mood. Living in this particular condition can bring about dire health risks. Persistent loneliness has a strong comorbidity with high blood pressure, stroke, more visits to an emergency room (Theeke, 2010), cardiovascular disease, increased risk of mortality, slowed repair of blood vessel walls, poor sleep quality, immune deficiencies (Leigh-Hunt, Bagguley, Bash, Turner, Turnbull, Valtorta, & Caan, 2017; Zebhauser, Baumert, Emeny, Ronel, Peters, & Ladwig, 2014), and behaviors and choices harmful to health such as physical inactivity and smoking (Holt-Lunstad, et. al., 2015). The effects of loneliness reach deeper and wider than that of a passing mood. Much like the difference between feeling sad compared to experiencing depression, one naturally passes while the other becomes a condition all its own, spreading to other areas of our health, and often requiring professional help to work our way out of it.
This is one reason why there have been studies on the importance of integrating social rehabilitation into traditional therapies. While individual and group therapies along with medicines predominate mental interventions, there is a shift to acknowledge social health as an important component of overall mental health, as well. Elisha, Castle, and Hocking (2006) surveyed the social health of 3800 adults living with a psychotic mental illness. Of these, 58% had withdrawn from social activity, 39% lacked a close friend, and 45% desired friendship. Only 19% received social rehabilitation, however. In a more general survey of people with mental illness who attended social rehabilitation programs, 92% stated that they had done so at the referral of a health professional (Elisha, Castle, & Hocking, 2006). In other words, those who experience social isolation seem to be eager to accept help for rehabilitation when offered, but, as of right now, it isn’t often presented as an option in treatment.
“But what if isolation doesn’t cause mental illness, what if it’s mental illness that causes isolation?” It is true, these variables are both symptoms and causes of each other. Sometimes mental illness causes social withdrawal and loneliness. In order to help isolate and study loneliness as causal of mental illness, Rohde, D’Ambrosio, Tang, and Rao (2015) conducted a study of those with no prior or current mental illness who were forced to change geographic locations (due to work or school), effectively cutting them off from their social networks. The results showed a strong correlation between indicated feelings of loneliness to increased distress and a lowered overall mental health (Rohde, D’Ambrosio, Tang, and Rao, 2015). By removing the possibility of a pre-existing mental illness, this strengthens the causal power of loneliness.
“What does that mean for me?”The good news is that this is not merely a message of warning about the possible threats loneliness has on our health. Though loneliness creates deficits in our well-being, we are not in a fight to simply balance these damages to a neutral zero level. In as much as social isolation has negative effects on health, having and maintaining strong social connections actively benefits even those without loneliness or mental illness—pushing us further into the positive effects, adding to our well-being and increasing longevity (Holt-Lunstad, et. al., 2015). Some debate that healthy social networks only benefit us indirectly, by mitigating our day-to-day levels of stress and anxiety (Rohde, et. al., 2015). Whether this is true, the benefits are to our overall well-being, or the indirect effects are inseparable from the direct effects, the presence of positive effects is undeniable.
We would do well to listen to our thoughts and emotions when we experience loneliness. Some classify this as one of the most basic warning systems with which we are equipped, like thirst or hunger (Holt-Lunstad, et. al., 2015). Rather than suppressing this alert system, it would be better to examine what we might do to best restore our health, to take actions and move into behaviors which benefit our well-being, and to enlist the support of others as we also offer our support to them.
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References
American Psychological Association (APA) (2016). By the numbers: Older adults living alone. (2016, May). Monitor on Psychology, 47(5), 9. Retrieved September 23, 2018, from http://www.apa.org/monitor/2016/05/numbers.aspx
Elisha, D., Castle, D., & Hocking, B. (2006). Reducing social isolation in people with mental illness: The role of the psychiatrist. Australasian Psychiatry, 14(3), 281-284. doi:10.1111/j.1440-1665.2006.02287.x
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and Social Isolation as Risk Factors for Mortality. Perspectives on Psychological Science, 10(2), 227-237. doi:10.1177/1745691614568352
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health, 152, 157-171. doi:10.1016/j.puhe.2017.07.035
Rohde, N., D’Ambrosio, C., Tang, K. K., & Rao, P. (2015). Estimating the Mental Health Effects of Social Isolation. Applied Research in Quality of Life, 11(3), 853-869. doi:10.1007/s11482-015-9401-3
Schultz, N. R., & Moore, D. (1988). Loneliness: Differences Across Three Age Levels. Journal of Social and Personal Relationships, 5(3), 275-284. doi:10.1177/0265407588053001
Theeke, L. A. (2010). Sociodemographic and Health-Related Risks for Loneliness and Outcome Differences by Loneliness Status in a Sample of U.S. Older Adults. Research in Gerontological Nursing, 3(2), 113-125. doi:10.3928/19404921-20091103-99
Zebhauser, A., Baumert, J., Emeny, R., Ronel, J., Peters, A., & Ladwig, K. (2014). What prevents old people living alone from feeling lonely? Findings from the KORA-Age-study. Aging & Mental Health, 19(9), 773-780. doi:10.1080/13607863.2014.977769