Loneliness: The Neglected Epidemic of the Modern World

By Dr Debanjan Banerjee, Geriatric Psychiatrist, NIMHANS

Edited by Didhiti Ghosh, Bureau Chief (Kolkata), IOP

Kolkata/Bangalore, Sept 11, 2019: The World Health Organization (WHO) considers loneliness as a ‘red flag’ for suicidal risk, especially in adolescents and women. The terms like ‘self-concept’ and ‘interpersonal attractions’ which state that the constant need for human interaction is, in reality, the constant attempt to battle loneliness. Ironic enough, the apparently enhanced social proximity facilitated by modern technology does not do enough to battle the ‘inner loneliness’ that human minds feel. Irrespective of background noise or number of people, one can still be silent and lonely, often leading to catastrophic consequences.

Loneliness: Causes and Effects

Loneliness stems from physical, social or emotional isolation of an individual from his/her intimate surroundings. The concept of human emotions given by George Engel in 1977 states the multi-factorial role of biological (genetics, personality), psychological (emotional, thinking patterns) and social (environment, family and relationships) factors in creating a particular emotional state.

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According to the biopsychosocial model, factors contributing to loneliness are, among others:

• Marked change in life caused by an unwanted event or loss (ex: death, accident)
• Feeling ‘out of place’ or ‘out of sync’ with people around (ex: migrants)
• Having no close bonds/partner
• Having no proximal human/pets to share emotions or talk to (in the living space)
• Extreme degree of introversion
• Having a developmental illness that restricts expression (ex: mental retardation or autism) or illness causing significant social stigma (ex: HIV, depression)
• Not enough of ‘me’ time
• Excessive dependence on virtual relationships (social networking)
• Unfriendly or bullying environment (common in adolescents and children)

Loneliness can bring about the negative thinking patterns of ‘hopelessness’ (feeling that nothing is going to change) and ‘worthlessness’ (feeling one is not worthy enough to live), which in turn can spiral into depression. Anxiety and doubts generate about the future and the lonely person starts considering him/herself to be unwanted, unloved and unproductive. In this regard, we commonly notice the examples of marriages or relationships in which people stay ‘isolated’ and emotionally ‘lonely’ even after living together for years.

A study done in the University of Surrey, England in 2009 shows that the screen-time (total time devoted to any visual & digital media) is antagonistic with self-satisfaction and quality of life. Technology has the risk to create a virtual world of relationships for the lonely person, which is fragile thus causing more emotional trauma.

Worse again, the prevalence of loneliness is on the rise. Factor analysis of the National Mental Health Survey (NMHS) 2015-16 marks 30 per cent of the population as feeling ‘lonely’ most of the time, whereas 65 per cent of these people has at least one mental disorder or substance abuse. Loneliness is commonly linked to depression, anxiety, poor occupational performance and headaches. Furthermore, it is also the 6^th most potent risk for suicide.

Loneliness and Mental Health

Research clearly states that depression and loneliness are intricately linked. It can also lead to generalized anxiety disorder, panic attacks and increased risk of schizophrenia.

In children, it can lead to learning problems, school refusal, selective mutism (unwillingness to speak in specific situations), conduct disorders with decreased academic and social performance. In adolescents, it is a common trigger for violence, aggression and substance abuse.

Loneliness has commonly been termed as a ‘gateway’ factor for highly addictive substances like alcohol, cocaine and heroin. People can also retire to the digital world, leading to internet addiction and mobile overuse.

A study conducted in 2010 by the Tata Institute of Social Sciences (TISS) studied a large group of suicide attempters in the age group 15-40 years with or without mental disorders and concluded ‘loneliness’ as one of the most important preventable risk factors.

A recent study in old-age depression done in 2017 by the National Institute of Mental Health and Neurosciences (NIMHANS) identifies loneliness and social isolation to double the risk of suicide and quadruple the risk of depressive and anxiety disorders.

Feeling emotionally lonely for years together can influence the stress-handling mechanism of the body (adrenal glands) releasing excessive cortisol (hormone that is released in body at times of stress) causing persistent anxiety, hair fall, digestive and heart disorders, gastritis, high cholesterol and uric acid with increased risk of diabetes, obesity and stroke. Immunity can get affected in long-term causing increased vulnerability to infections.

In the elderly age group, dementia (disease of the brain leading to loss of memory and other abilities) risk is associated with physical and emotional loneliness.

Steps Ahead to Combat Loneliness

Loneliness is NOT an illness, but rather a state of mind. Hence it can be prevented or altered, the ways varying widely. Most suggested measures are lifestyle modifications (daily schedule, Yoga and exercise, walking, hobby and activity involvement), indulging in spiritual or humanitarian activities, pet therapy, reminiscence of olden days or memories and music.

Loneliness inevitably overlaps with some degree of depression and hence psychotherapy helps.

A lonely school student who is introvert and bullied repeatedly might have very different thoughts than a divorced IT professional with competitive employees all around. Each situation is unique and hence needs individualized planning.

A vital step in fighting the loneliness that arises due to fear of socializing is learning adequate social skills and behavior. There are separate social and cognitive skill training modules that are scientifically proven to encourage healthy thinking, adaptive patterns of dealing with loneliness and fearless interaction.

This Suicide Awareness and Prevention Day let us be sensitive to target loneliness, the silent promoter of suicidal risk. Combating the epidemic of loneliness is another healthy way of preserving humanity!

Image Courtesy: Medical Xpress, Everyday Health, Big Think, WHO

(Author Dr Debanjan Banerjee is Geriatric Psychiatrist, National Institute of Mental Health and Neurosciences, Bangalore).

[Editor DIDHITI GHOSH is India Columnist at La Agencia Mundial de Prensa, USA, Bureau Chief (Kolkata) of Indian Observer Post & Conference Interpreter (Spanish-English-Bengali). E-mail: didhiti.24@gmail.com | LinkedIn: https://bit.ly/2H6gNAv].