Loneliness can contribute to a constellation of mental disorders and/or psychosocial risk factors, including depressive symptoms: alcoholism, suicidal thoughts, impulsivity and aggressive behavior, social anxiety. It is also a risk factor for heart disease and obesity and appears to contribute to the progression of Alzheimer’s disease.
Since ancient times, millions of people have died due to plague epidemics, influenza, cholera and other infections (the recent Covid-19) caused by bacteria, viruses or other microorganisms. Thanks to medical advances, with vaccines and antibiotics, we have managed to greatly reduce or even eliminate these mass killers.
Modern societies, however, are facing a new type of contagious and rapidly spreading pathologies: the behavioral epidemics. Annual death rates from suicide and opioid overdose have increased over the past two decades and, to date, account for the death of one American every five and a half minutes. It is not a pathogenic microbe that contributes to it, but rather a “behavioral toxin”, difficult to detect and increasingly lethal: loneliness (1). More than one-fifth of American adults report that they often, or even always, feel lonely or isolated from others. Loneliness is a subjective condition, in which the individual perceives himself as socially isolated even when he is among other people (2): also called “perceived social isolation”, it is related to, but distinct from, social isolation, which is instead an objective state, linked to the number of interactions with other individuals.
According to the British historian Alberti (3), before the 19th century the English word loneliness (which, in fact, we translate as “solitude”) did not exist: people generally lived in small communities, considered as a source of common good. Of course, there was the condition of “being alone” which, when not chosen, could be very harmful; but the concept of “loneliness” – a term imbued with an emotional state of existential anguish – appeared with industrialization in the West and the creation of philosophical and political systems centered on individualism: it is fundamentally a product of modern ways of thinking about the self and to society. The Industrial Revolution was the first step towards a gradual reduction of social connection, the main reason for loneliness. Over the decades we have witnessed a progressive increase in the problem, which then exploded in the last 20 years: from a prevalence estimated at around 11-17% in the 70s of the last century (4), loneliness has increased by over 40%. % among middle-aged and older adults (5); according to a 2010 online survey (6), prevalence rates in the United Kingdom reached 45%. In fact, although technology and globalization may have improved the quality of life, they have also overturned social customs and interrupted the traditional way of relating: Information overload, 24-hour connectivity, countless but superficial and sometimes harmful relationships on social media have “opened the doors” to this emotional state.
Loneliness corresponds to a discordance, in the individual, between desired and actual social relationships (7), leading to the anguish of feeling socially isolated even when you are with family or friends (8). This implies that feeling lonely it doesn’t necessarily mean being alone, nor vice versa (9): one can feel alone in a crowd and, on the contrary, one can enjoy solitude to achieve personal growth experiences (for example through meditation) or, simply, to take a temporary break from face the demands of an increasingly hectic life. However, the fact that this condition exists underlines that the human being – a social mammal – requires not only the presence of others of the same species, but above all the presence of significant others with whom he feels connected, who give him a purpose in life and with whom he can plan, interact and work together to survive and thrive (10). Subjectivity and the perception of the friendly or hostile nature of one’s social environment is, therefore, a characteristic of loneliness. As comedian Robin Williams said: “I thought the worst thing in life was to end up alone. No it is not. The worst thing in life is finding yourself with people who make you feel alone.”
But who can feel alone? Loneliness does not discriminate: although it is more likely to be found in populations at risk of social alienation, isolation and separation (such as elderly people without a family network, patients with psychiatric disorders or health conditions that limit their communication skills and/or or mobility), anyone can feel alone at any time. A social relationship can be perceived differently by an individual based on different factors, including previous experiences, the situation in which she finds herself at that moment and the general preference towards that type of social contact. It is therefore evident that this condition is not limited to elderly people who live alone, but can occur in any age group, and even among those people who have numerous contacts/followers/friends on social media.
A recent study (11) reports that the majority of people who report experiencing loneliness are under 50, have lower incomes, and are unmarried. The study also shows that around six out of ten people say there is a specific cause of feeling lonely: the death of a loved one, physical or mental health problems, divorce or estrangement from their family. In fact, some negative life events can exacerbate or put people at risk of loneliness: for example, those who report feeling lonely are much more likely to say they have experienced a negative change in their financial situation, a serious injury or illness, or loss of job in the last two years.
Loneliness can contribute to a constellation of mental disorders and/or psychosocial risk factors, including depressive symptoms (12): alcoholism, suicidal thoughts, impulsivity and aggressive behavior, social anxiety. It is also a risk factor for heart disease and obesity (13) and appears to contribute to the progression of Alzheimer’s disease (14). A recent study on loneliness in monkeys found elevated levels of norepinephrine and impaired immunity (15). The perception of being socially marginalized and isolated increases, in lonely individuals, the tendency towards self-preservation, strengthening the motivation to connect with others, but at the same time also increasing an implicit hypervigilance for social threats, which leads the person to give greater importance to negative interactions which, if left uncontrolled, can reinforce withdrawal, negativity and feelings of loneliness (16).
The growing recognition of loneliness as a risk factor for adverse psychological and physical health outcomes has provoked greater interest in interventions that can reduce this condition. The behavioral neuroscientist Stephanie Cacioppo, after the death of her husband (with whom she had already studied loneliness), continued research on the topic, looking for a possible pharmacological treatment: she identified the hormone pregnenolone, demonstrating that the latter reduces the stress, acting on the amygdala but also on the insula, a brain area which, if dysfunctional, can contribute, in the lonely person, to hypervigilance towards social threats. However, after processing her grief over the passing of her spouse not through the use of a drug, but through outdoor exercise, she stopped the clinical trial of the implicated steroid hormone, indicating walking, meditation and time spent immersed in nature as possible solutions to combat loneliness which, according to the scientist, determine the same results as the pill, but with the advantage of the lack of side effects. Probably to heal a solitary mind the help of the body is generally not enough, but the intervention of the doctor is necessary, who should regain the role of intermediary between the patient and his real needs, trying to identify the components of chronic loneliness and identify an appropriate route (17).
Maybe – as suggested by a report on loneliness in America published by the Graduate School of Education of Harvard University (18) – cAsking the patient if they feel lonely should always be an element of the annual check-up, like blood tests or blood pressure checks. It would also be desirable to develop public education campaigns that provide people with information and strategies that help them identify and manage counterproductive thoughts and behaviors that are the result of loneliness. Finally, we should all work to restore a greater sense of responsibility, both towards others and towards the common good.
Letizia Fattorini, School of Specialization in Hygiene and Preventive Medicine. University of Florence.
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