Death by Loneliness: Laboratory mice, the U-shaped curve, and Antoine Roquentin

Who gets lonely?

As an academic psychologist, I find working with older adults illuminating for all sorts of reasons. It’s particularly interesting to learn what they won’t discuss. Loneliness seems to be a topic that people resist discussing. When asked about personal loneliness, the research participants that I interview often say evasive things, like “I know someone who is lonely, but I don’t feel lonely myself”. Most agree that it is a phenomenon, however, that is practically synonymous with old age. Most are surprised when I tell them about the many studies that find a second peak of loneliness – in young adulthood – which may even surpass old-age loneliness in severity. Yet more surprising to them is the apparent inseparability of loneliness and culture – different cultures have different social norms concerning relationships, expected social support, and as a result, loneliness.

Cultural and age variations notwithstanding, the reality is that anyone, anywhere, can get lonely, at any age. Loneliness can be passing or persistent, reactive or seemingly endogenous. While clear definitions of loneliness remain elusive, there is at least consensus on its undesirable nature– most agree that it is not a feeling they would like to have. While this would be reason enough for psychologists to try and develop treatments, there is an additional motivation: the clear pattern of poor health that arises from loneliness. As such, those working in public health are motivated to develop effective ways of resolving loneliness.

Loneliness and Health

Interest in the social context of health has been on the rise since the 1980s, due to pioneering efforts of researchers such as Sheldon Cohen and Lisa Berkman. Julianne Holt-Lunstad, in 2010, conducted a meta-analysis, from which she concluded that a lack of social relationships incurs a greater risk to health than smoking, lack of physical activity, or obesity. WHO measurements of wellbeing (such as the Quality of Life questionnaire and the World Health Survey) include items regarding social relationships. Loneliness itself has been linked with divergent undesirable outcomes, such as depression, early mortality, cardiovascular disease, Alzheimer’s disease, and suicidality.

In many of the studies that link loneliness to health outcomes, loneliness is considered as a facet of social functioning. For instance, loneliness is often described as “perceived social isolation”, yet this is a clear oversimplification. Social isolation is an objectively measurable lack of connection to others, while loneliness is a multidimensional construct, encompassing biological, cognitive, emotional, and behavioural responses to the (real or perceived) social world. Loneliness works on many levels, and cannot be objectively measured.

“I am alone in the midst of these happy, reasonable, voices” (Antoine Roquentin; narrator of Nausea, by Jean Paul Sartre)

Given its ubiquitous nature, it is not surprising that thinkers in different realms have also tried to define loneliness. Sartre’s Roquentin character finds he is lonely even in the company of others. Other existentialist thinkers considered loneliness to be the natural consequence of living and dying alone, and a state from which much can be learned (e.g. Moustakas, 1961).  Ami Rokach, the well-known sociologist, has defined loneliness in terms of one’s relationship to culture, while those working in the field of genetics are beginning to identify a loneliness genotype, albeit in mice who, when left alone, seem to crave the company of others. John Cacioppo, a neuroscientist at the University of Chicago who has contributed arguably more to what we know about loneliness than anyone else, describes loneliness as a functional state, echoing John Bowlby in saying that loneliness is a feeling which drives us towards the company of others, keeping us safe from vulnerable isolation. However, since lonely individuals often withdraw socially, this may not be the full truth about the phenomenon.

Loneliness – what now?

While the definition of loneliness is interesting from an academic perspective, it is also a practical matter, and one that should concern policymakers. How we define loneliness determines how we propose to reduce it. Geneticists may envisage a future in which we identify genetically “at-risk” individuals and focus our efforts on them; taking the perspective of Cacioppo, and others, that loneliness has a purpose, would presumably result in no intervention at all. If loneliness is analogous to perceived social isolation, as so many researchers have suggested, then resolving social isolation would have some effect on it.

Looking to previous attempts to resolve loneliness in this manner, it is clear that this is not the case. Christopher Masi and colleagues considered the effects of many different attempts to intervene on loneliness, and concluded that the greatest impact on loneliness was created by interventions that focus on changing maladaptive social cognitions. One such social cognition might be, for instance, that other people are inherently untrustworthy, a belief that would clearly challenge even a lonely individual to reach out to others. Simply delivering opportunities  for lonely people to engage socially does not seem sufficient to reduce it. However, There is still a great deal of disagreement about how best to intervene on loneliness.

What we do next?

It seems logical that in order to deliver a successful intervention that reduces or resolves loneliness, a consensus on definition must be reached. To contribute to the development of such a consensus, my colleagues and I are working on developing a definition of loneliness using two approaches. The first is an empirical qualitative approach. In previous work, we aimed to elucidate the contribution of culture to loneliness by exploring its meaning among a group of rural-dwelling older Irish adults, using an interpretative phenomenological analytic approach. We found that loneliness for these participants connoted inactivity, boredom, security, and vulnerability, which may inform culturally-sensitive intervention for these groups.

My colleague at the University of Exeter, Dr Luna Dolezal, and I are also using non-empirical, phenomenological methods. Existential phenomenology can tell us about the shared structural components of the experience of loneliness. Using a transdisciplinary approach to loneliness, given the multiple levels at which it has been considered (from the genetic to the cultural), appears to give us the best chance of defining it sufficiently well to know how to resolve it.

Ultimately, we hope to be able to inform policymakers on how best to resolve this undesirable, complex phenomenon, which affects us all, at all ages, and all levels of our functioning.

This post was written by Dr Joanna McHugh, National College of Ireland, Queen’s University Belfast and Trinity College Dublin.