The New York Times, (March 25, 2009) quoted, “loneliness leads to poorer physical and mental health.” Similarly, BBC News (January 31, 2011) pronounced loneliness as a “hidden killer” of elderly.
Loneliness has now become an important public health concern. It leads to pain, injury/loss, grief, fear, fatigue, and exhaustion. Thus, it also makes a person sick and interferes in day to day functioning and hampers recovery.
A few years back, Mother Teresa said, “The greatest disease in the West today is not TB or leprosy; it is being unwanted, unloved, and uncared for. We can cure physical diseases with medicine, but the only cure for loneliness, despair, and hopelessness is love…”
Loneliness, therefore, is no more an event or concept or factor. Loneliness with its epidemiology, phenomenology, etiology, diagnostic criteria, adverse effects, and management should be considered a disease and should find its place in classification of psychiatric disorders.
Loneliness has been defined in different ways, including:
- A state of solitude or being alone.
- Loneliness is not necessarily about being alone.
- It is the perception of being alone and isolated that matters most.
- A state of mind.
- Inability to find meaning in one’s life.
- Feeling of negative and unpleasant.
- A subjective, negative feeling related to the deficient social relations.
- A feeling of disconnectedness or isolation.
Could it be more?
Loneliness may be pathognomic – a symptom — of depression in old age. It is reported to be more dangerous than smoking; 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 of well-being 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 of placement in nursing homes.
To date, loneliness is being treated as a symptom of mental health problems; however, for elderly (aged 60 years and above), loneliness has become a disease in itself.
Solitude and loneliness
Solitude and loneliness should not be explained in similar ways. Solitude is enjoyed by people and it leads to creativity, self-realization, and is totally an approach for developing one’s own individual space. It is often considered as an essential component for spirituality and self-growth but loneliness is a state of mind, a feeling of emptiness, separateness, and it often becomes a compulsion. When it develops dysfunction, is perceived as stressful combined with physical ageing, the situation turns out to be a toxic cocktail.
Loneliness being a common human emotion is, however, a complex and unique experience to 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 his/her problems than an elderly person who has lost his/her spouse in the recent past.
To understand loneliness, it is important to have a closer look at exactly what we mean by the term “lonely” as well as the various causes, health consequences, symptoms, and potential treatments for loneliness. A person, who experiences loneliness does not find anyone with him/her and thus increases risk for developing biological dysfunctions, psychological distress, and behavioral problems as well. It is commonly seen in older adults and has its phenomenology, complications, etiology which needs proper diagnosis, care and management. This may be called as ‘pathological loneliness’.
The pathological loneliness has its roots in medical model consisting of a host, an agent, and an environment and is thus, a disease. The problem due to pathological loneliness is increasing worldwide and needs to be handled as a disease; not just as a situation or a symptom of a disease or mere a social concept.
It has been described as the major problem associated with old age; and therefore, 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:
- Increasing dependency
- Economic dependency
- Environmental factors like type of family, social network, transportation issues and 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 his/her needs and social contacts, and migration of population, interpersonal conflicts, accidents, disasters or emptiness syndrome, etc., lead to loneliness in old age. The increased life expectancy and feminization of elderly population is a significant factor in developing situational loneliness in females.
- Developmental loneliness: Every one of us has an innate desire of intimacy or a need to be related to others. This need is essential for our development as a human being. Apart from this need, a higher level of need for individualism also exists which is related to knowing and developing our own real self that requires some solitude too. For optimum development, there should be a balance between the two. When a person is not able to balance these needs properly, it results in loss of meaning from their life which in turn leads 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 essentially 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. Reasons for this type of loneliness are personality factors, locus of control, mental distress, low self-esteem, feeling 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 is, thus, can be diagnosed as a disease entity. A lonely person often feels low, helpless, separated, or discriminated; finds difficulty during interactions; feels abandoned and alone. For diagnosing loneliness in elderly following measures may be used.
- 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 of well-being and may cause:
- 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
Loneliness predisposes a person to physical diseases too as it has an adverse impact on immune, cardiovascular, and endocrine system.[
Consistent, overwhelming and pervasive loneliness develops stress and ultimately culminates into serious physical disease. Feeling 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 a period of three years compared to those who do not experience 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 members of intervention groups favorably responded on social contacts 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 like:
- 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