“One is the loneliest number that you’ll ever do.”

Three Dog Night

Well, dear readers, we have passed another holiday season, one that was magical for many of us, sad for others and downright lonely for a few. I was already thinking about this annual state of affairs the other day when I happened upon an article in the Dec 19/Jan 20 AARP Magazine, of all places, called “Is There a Cure for Loneliness?” It got me thinking more about some observations that apply to many of my patients, and perhaps to all of us to varying degrees. Please allow me to share some of these with you.

One of the last observations in the article, and I think one of the most important, is that loneliness is the difference between what we would like to have in our relationships and what there is in reality. This is a key idea, in that the rest of the article was predicated on the fact that it is very hard to nail down just exactly what loneliness is and how to best measure and study it. According to this article, it is fairly well known that older Americans are at risk for social isolation and that this can sometimes lead to physical illness, depression, even dementia. The piece tried to explore causation for loneliness, wondering whether there exist medical causes for and treatments for loneliness.

Louise Hawkley, a senior research scientist at the University of Chicago, stated that “Loneliness is a universal human experience, and being the social animals that we are, there must be implications when these social connections are not satisfied.” Steve Cole, Professor of medicine, psychiatry and biobehavioral sciences at UCLA School of Medicine, studied biological effects in lonely people. He found that blood cells in such folks “were in a high state of alert, as if responding to an infection”. Ms. Hawkley stated that “we humans have a need to be embedded, connected, integrated in a social network”. Ah, I can hear you right now, as you read this column, saying, “Well, I am embedded in Facebook and Twitter and Snap Chat! Of course I am connected to other people!” Alas, is that a truly fulfilling connection? Is it enough to ward off isolation, illness, mental health problems? See my previous columns and those of others over the last several years. What kind of connections do we desire, need, thrive on? Is it different one person to another? Of course it is. We are all human, but we are profoundly different from each other in many ways, the need for socialization and connection being one of them.

The one thing that does seem to be more and more clear, however, is that if we do not have some sort of meaningful connection to others, that we are adversely affected both physically and mentally. A friend of mine, who is a physician and also an Episcopal priest, was trying this holiday season to reconcile the religious and the secular in his life. He spoke of worship versus parties, as it were. He said that for him, it would be very important to spend worshipful time in quiet reflection about the mysteries of the season, but he also resolved to “accept every invitation to go to every party and gathering I am invited to!” He was always a wise man when he was my surgery attending in medical school, and he is still wise in the ways of social interaction. We do not need false, fake or superficial social networks and connections, but real, substantive connections with other human beings. That is why real time gatherings can be so satisfying and fulfilling. We need deep conversations; letters (not just texts, LOL); groups that support art, therapy, learning, and self-improvement; shared activities; and shared experiences that allow us and others to feel fulfilled and whole.

Is there a financial cost related to loneliness? According to the AARP article, people who live in social isolation add about seven billion dollars to Medicare costs due to longer hospital stays and lack of adequate family and social support at home. Loneliness is a killer. It may worsen heart disease, may make us more vulnerable to cognitive illnesses such as Alzheimer’s Disease, may worsen hypertension and may leave us vulnerable to infections. Loneliness may be more dangerous than obesity and the equivalent to smoking fifteen cigarettes a day. But wait, I hear you saying now, how can an emotion, a very abstract one at that, shorten a life?

Is it the loneliness itself or the social isolation, disconnection in a variety of ways that is fueling this problem? Again, per the AARP article, there are more people living alone these days as shown by census data, the marriage rate has declined, and the number of children has also decreased. Julianne Holt-Lunstad, professor of psychology and neuroscience at BYU, was co-author of a study that looked at three groups: those who were socially isolated from other people, those who described themselves as very lonely, and those who lived alone. The study included pooled data from seventy studies that followed 3.4 million people for seven years. Each group had about the same risk for early death, 29%, 26%, and 32%, respectively. The study data was independent of health status. It is a fact that people who live alone are not necessarily lonely, and it also follows that some who are surrounded by family and friends do indeed feel very lonely. One thing that seems clear, however, is that people who are socially connected live longer.

Can you definitely measure and quantitate something like loneliness? The UCLA Loneliness Scale, according to this AARP article, is the gold standard for research purposes. It is a twenty item questionnaire that asks about the feelings associated with loneliness, without asking about the thing itself.

How to approach loneliness? First, like many illnesses and conditions, this article states that we must recognize that there are likely multiple etiologies for what we see. These can include genetics, social situation and family environment. We must also try to look at this problem from the point of social connection, not loneliness per se. Why? Because like obesity and other conditions, people who are lonely often are subject to stigma and may be looked on as social failures. We can encourage those who are lonely to volunteer, help others, and encourage activities that qualify as life experiences that build connections and memories. Another concept mentioned in this article, that I like to think of as crowd sourcing care, is that we can ask that people who are in the arena (postal workers, healthcare providers, hairdressers and many others who come into contact with many people every day) to watch out for the needs of others and spot those who are struggling. Finally, we can stay abreast of the research that is being done on inflammation, pain and other issues that might be biologically related to loneliness. There are not many hard and fast guideposts for the medical aspects of loneliness yet, and no medical treatments that are panaceas, but more knowledge is sure to come as we learn more about this problem that can affect us all, not just at holiday time.

Happy New Year!

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