LONELINESS & SOCIAL WELLBEING: Who Among Us is Lonely?

It was a rainy Thursday morning. With umbrella and purse in hand, I clumsily opened the entrance door of my favorite bread store. Its overhead bronze bell made a familiar clamor reminiscent of the candy shop that once inhabited this space, a shop my sister and I as children would patron with pockets full of coins and hearts oversized with sweet treat wishes. As I approached the counter I was greeted by the slightly sweet, yeasty, tang of baking bread and ready to take my order was a pleasant young man, whom I had met very briefly during my first trip to this bread store when they opened 18 months earlier. He was wearing the most interesting, colorful baker's apron and a large smile to match. And when he engaged in the usual customer service chit-chat, "how are you? how is your day?" he did so with unusual authenticity.

As a self-professed introvert, my conversational goals in public are generally small and brief, and only entered upon when I have a solid exit plan. However, being knee-deep in the social neuroscience research that unequivocally demonstrates social interaction and engagement and creating and maintaining diverse social networks is critical to health and longevity, I made an effort to converse with this near stranger, a "weak social tie" as referred to in Social Network Theory. I asked him if daily exposure to that aroma ever made it less than incredible.

"Nope. It pretty much always smells great. It's taking the product home with you every day that gets a little old."

"Old?" I asked with genuine puzzlement. "I mean, please tell me how taking bread home everyday is an occupational hazard?" I asked with a teasing tone.

"Well, it's the eating it part," he chuckled. He then proceeded to tell me he is a type 1 diabetic.

"I also have a sister with type 1, since the age of 2. It has not been easy for her, physically or socially."

"Since 6 for me. A lot of people just don't know what it means when I say I'm a diabetic. I think they're thinking of their moms or grandpas with type 2."

I hesitated before responding. What I wanted to ask is not always comfortable for some individuals. But I figured we were this far into the conversation, both of us taking some risks. "Is that lonely? The parts about having some unique challenges and not being understood or seen?"

He looked up from the register to me, then quickly looked to his right. I thought maybe I had been too intrusive on a Thursday morning with a nameless bread baker. But then he nodded slightly and returned eye contact. "Yeah, that's kind of weird, but it's sort of the perfect word for it. It's funny but I always thought it was the other hurdles in life that were the big lonely times until you found where you belong."

"Like school, career, identity hurdles?"

"Yeah for sure. More lonely before I found work for sure. Didn't know I would be baking bread but when I did, everyone is like 'that's cool.' And I can make it because of the insurance we get. It all fell in place; you'd think finding an LGBTQ community would be tough and it was, but this is the perfect company. And it feels good to give back by baking for the shelters and food pantries."

Here was an opportunity to express gratitude as a patron who lives in the city that is her hometown. But it's the belonging to a community of shared values that is actually the place that feels like home. "This bakehouse has been a tremendous asset to the community. Some of us make consumer choices based on those things. I do. It all really matters."

"Thanks. We work hard as a group here but we love it. It's like you said about your community, working here is a place of belonging. We have a lot in common. But..."

"But the diabetes, that's probably not a shared experienced?"

He shook his head. "Never has been. Since I was 6 I kind of knew that I was alone in that one. Like you said. Lonely. It's not terrible and so much you get used to. But. I don't know. I think that word fit. Lonely."

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DEFINING LONELINESS:

Few would disagree that the experience of loneliness is a painful one; one that is described as feeling empty, invisible, and disconnected from others, often generated by a lack or perceived lack of meaningful, intimate, and reciprocal relationships. The emphasis is on the subjective, the felt perception of loneliness or emotional isolation, rather than simply a description or the experience of being alone. Loneliness can be transient or chronic, with chronic loneliness exhibiting higher rates of physical and emotional consequences. Exacerbated by its gross under-recognition, loneliness is rapidly emerging as the great public health crisis of our time. In May of 2023, the U.S. Surgeon general, released an 85-page advisory declaring loneliness as a public health epidemic in the United states. And this is not the first time Dr. Vivek Murthy has discussed the perils of loneliness. While no doubt the global coronavirus pandemic and its lockdowns have made loneliness even worse, particularly among groups that already suffered from it, even before the pandemic loneliness was becoming a national concern for many countries.

"The whole conviction of my life now rests upon the belief that loneliness, far from being a rare and curious phenomenon, is the central and inevitable fact of human existence." --Thomas Wolfe

THE BURDEN OF LONELINESS:

Loneliness is more than an emotionally painful individual experience. Loneliness is a painful experience for the whole of society. Loneliness costs the United States approximately $7 billion annually in additional medical costs, alone, due to its risk of increased illness and mortality. A 2017 AARP study revealed a cost of an additional $6.7 billion to Medicare. It costs U.S. employers $154 billion annually in lost productivity and attendance. Loneliness is sometimes the cause of and other times a factor in the deterioration of mental illness, an economic burden itself, costing the U.S. over $950 billion. But loneliness levies an even darker burden; it is among the strongest predictors of suicidal ideation, suicide attempts, and other self-harm behavior. Just as loneliness is increasing in the younger adult population so too is suicide where, sadly, it is now the second leading cause of death among individuals aged 15 to 24.

WHO IS LONELY:

Courtesy of Flingorlove.com "Loneliness Statistics in America"

In 2018 and again in 2019, Cigna reported that nearly half of all men and women surveyed are lonely. Nearly 50% of the 2000 United States residents surveyed stated they sometimes or often felt alone and sometimes or often felt left out. And while once conceived of as a problem specific to the elderly, loneliness is staggeringly prevalent among younger individuals (e.g. Figure 1). Gen Z adults (ages 18 to 22) are the loneliest, with more than half identifying with 10 of the 11 feelings associated with loneliness on the UCLA Loneliness Scale. Loneliness seems to lessen with age, with each subsequent generation reporting less loneliness. But this downward trend in loneliness with age abruptly changes in in the oldest of old population: after the age of 80, loneliness rates rise.

Courtesy of Rootsofloneliness.com

Men and women, overall, report similar levels of loneliness, with some recent data suggesting that young adult males may be slightly lonelier than females. While disproportionately experienced by ethnic and sexual minorities, feeling unsafe, unwelcome or fearful of hostile encounters in the workplace, services, and/or neighborhoods significantly raises the risk of loneliness for all persons. And though being "alone" is different than being "lonely," some researchers believe that a decline in social interaction and friendships are responsible for the rise in loneliness. They cite a decades long trend in fewer friendships and a decline in social integration and belonging as evidenced by declines in sports, religious, and civic engagement. In general, loneliness risk increases for persons with severe mental illness, with chronic health problems, persons who repeatedly feel unvalued and not respected, those who have lost a significant other, persons geographically or culturally displaced, those with lower income, and persons whose social networks have-for any reason-few friends and/or barriers to a sense of community belonging.

CONSEQUENCES & RISK FACTORS:

The mechanism by which loneliness affects health is thought to be stress and its physiological consequences, particularly dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis, one of the main stress response pathways and responsible for the production of the stress hormone cortisol. While the negative effects of stress on the body have been known for a long time, loneliness is a more recently recognized health risk factor and a stressor in its own right.

Deficits in one's social network-low levels of social connection- are associated with declines in physical and psychological health, and can lead to higher likelihood for antisocial and aggressive behavior that then leads to further isolation. Social isolation alone is associated with a 29% increase in cardiovascular heart disease and 32% increase in stroke. It is also associated with premature mortality and earlier cognitive decline. Loneliness is associated with exacerbations in mental health disorders, both relapses and acuity, and is particularly detrimental to those with severe mental illnesses such as schizophrenia and bipolar. Chronic loneliness, which is defined as an unrelenting feeling of being separate or cut off from others and may be accompanied by self doubt and/or an inability to connect to others, is more strongly associated with physical and mental health consequences versus transient loneliness. Individuals with social anxiety, chronic low self esteem, and depression are more apt to experience chronic loneliness.

SOCIAL WELLBEING:

The extent to which you feel meaningfully embedded in and connected to your social networks has profound effects on your physical wellbeing, your mortality, and your general sense of happiness. Social wellbeing, as defined by the CDC, the WHO, and social-psychologists, is building and maintaining healthy relationships and having meaningful interactions with those around you. It is having a sense of belonging while valuing diversity. While it is important for most of us to have at least one close relationship with whom we have some daily contact (living with, sharing a meal, a phone call, even a text message) having a healthy social network does not necessarily mean connecting with many people daily; rather it is having relationships that feel warm and friendly, that typically involve open communication, boundary setting, accessibility, and mutual respect. In fact, social connectedness generates a positive feedback loop of social, emotional, and physical well-being. Research demonstrates a strong correlation between social health and ability to recover from stress, episodes of dysphoria, and other life setbacks. Individuals who have strong social connections are more apt to make healthy choices and, as a result, tend to have better sleep hygiene and other healthy lifestyle behaviors. But, regardless of lifestyle factors, the research is pretty clear that those with stronger social bonds live longer, as much as 30-50% longer than their isolated and lonely peers.

Social isolation alone is associated with a 29% increase in cardiovascular heart disease and 32% increase in stroke.

CONCLUSION:

Much like the baker's experience described at the start of this blog, having a chronic illness, being identified as "different" from the mainstream, unemployment, uncertainty about one's available social support and acceptance, and younger age are all risk factors for loneliness. However, having a sense of community or belonging are key protective factors against loneliness and can also resolve, or be one among a combination of approaches in resolving, episodes of loneliness. It is important to remember that nearly all of us are apt to experience at least one bout of loneliness within our lifetime. As eloquently stated by one of America's influential writers of modern literature, Thomas Wolfe, "loneliness, far from being a rare and curious phenomenon, is the central and inevitable fact of human existence." Loneliness is thought to have been evolutionarily selected for; as a painful experience, it incentivizes us to return to our social networks, networks that were once vital to mankind's survival thousands of years ago. This is a critical reminder that the stigma sometimes attached to loneliness and felt by the lonely is an artificially created set of negative and shaming beliefs that have no legitimacy in understanding the universal experience of what it is to be human. Who among us is lonely? It could be, and often is, any one of us.

ADDITIONAL RESOURCES: