Researchers from the United Kingdom and Ireland recently published an article in the Journal of Theoretical and Philosophical Psychology focusing on how to conceptualize loneliness in health research. Definitions of loneliness are plentiful and vary across disciplines, but the authors, McHugh Power and colleagues, argue that to adequately address both the root causes and the outcomes of loneliness an integrated definition across multiple fields is necessary.
“Loneliness is insufficiently operationalized, defined, and conceptualized, not just across disciplines but also within them,” the authors write. “Specifically, it will be difficult to understand the true impact of loneliness on health, the mechanisms through which it operates, and the interventions that best stand to alleviate it, without a clear and evidence-based conceptualization of loneliness and agreement on its ontology.”
Past research has shown loneliness to both be a cause and symptom of a variety of health issues, ranging from physical problems such as cardiovascular mortality to mental health issues such as depression and anxiety. Even though there is evident importance to understanding such a complex issue, there are multiple definitions across medicine, social sciences, and the humanities. While broad interest lends itself to a breadth of research, it also introduces ambiguity into the description. To address this issue, the team aimed to demonstrate this heterogeneity in definition, describe the lack of effectiveness of existent interventions, and propose an agenda to move forward.
McHugh Power and her team directed a theoretical synthesis in an attempt to cultivate a causal understanding of loneliness, arguing that previous efforts to compile loneliness research are insufficient. To do so, they first extracted and summarized aspects of relevant theories, then compared those theories for similarities and differences, and lastly combed the synthesis for additional theoretical insights. A template analysis was conducted, delineating causes of loneliness, which included a lack of intimacy, cognitive discrepancy, a confused response to Western society, and lack of social or emotional relations. From this, 38 articles were explored and integrated, from which five intraindividual levels (biological, developmental, cognitive, personality factors, and existence) and four interindividual and societal levels (intimates, network, situational factors, and cultural factors) were uncovered.
There are a variety of personality and affective factors that may dispose one to loneliness, ranging from individual elements (such as introversion or pessimism about others) to relational factors (such as difficulty forming relationships or high standards for others). Philosophical literature argues that simply existing and acknowledging death is sufficient to cause loneliness; this existential loneliness may overlap with the remainder of the levels. Others say that a lonely personality as a whole exists.
“This individual would feel themselves to be unlovable, have a poor sense of self with poor social skills, high neuroticism, low extraversion, deficits in self-disclosure, emotion regulation, social information processing, and relationship formation,” said the authors.
There are also varieties of cognitive factors that may determine loneliness, again on either an individual or a relational level — these range from self-blame or maladaptive social cognitions to dysfunctional attributions of others. The cognitive discrepancy model postulates that loneliness arises when there is a discrepancy between actual and desired relationships, though other research within cognitive psychology has demonstrated loneliness is more complicated than that; loneliness seems to be about the interplay between dysfunctional beliefs about the world, others, and self, which negatively impacts existent and potential relationships by reinforcing loneliness and isolation from others. Others still argue that loneliness may serve an adaptive function, bringing people closer together, though this is more adaptive in the short term than the long run, where loneliness may become chronic.
Evolutionary theories posit that loneliness is an output of neural substrates of pain to encourage individuals to avoid isolation and to have a sensitivity toward social rejection. The limitations of evolutionary research are that many evolutionary studies are conducted with animals and are thereby lack generalizability. Psychoanalytic thought suggests that anxious or avoidant attachment can make one susceptible to loneliness, as can the characteristics of early life caregivers, social support during childhood, and adult attachment style. There have been attempts to integrate attachment theory and social neuroscience to explain loneliness. In this regard, the authors write:
“Brain regions related to social signal processing are stronger than typically dampening cognitive and executive areas during adolescence, and as such, the developing brain is particularly sensitive to social cues and resulting feelings of social rejection and loneliness.”
There is a high degree of interaction between the interindividual/societal levels of loneliness and the previously mentioned intraindividual levels, such that the interindividual levels provide a context for in which individuals develop and act. One such context is “intimates,” which is the thought that loneliness arises from the absence or loss of someone whom the individual is intimate with, like a spouse. Other intimacy theorists suggest that loneliness may be reflective of a lack of intimacy in the primary relationships of adulthood.
Another framework for loneliness is the theory of network deficits, which suggests that one’s social network provides a context for close relationships to bloom. Loneliness, by this theory, develops when there is a deficit or aberration in the qualities of the social network, such as social withdrawal and disengagement.
“Clearly, from the extent of literature regarding the impact of the network on loneliness, etiology extends outside of the individual,” write the authors. “There is clear evidence that personal and network factors interact to produce loneliness. For instance, beliefs about oneself and about others will in part shape the social network surrounding an individual, and the existence of loneliness can shape social interactions to such an extent that an individual becomes marginalized in their network.”
Similar to network deficits, situational factors set a context by which loneliness is more or less likely to occur, ranging from more transient factors such as sickness to more stable factors like rural living.
The last framework McHugh Power and colleagues suggest is that of cultural and societal factors, which have a significant impact on situational factors. While loneliness has been theorized to be universal, in that it has been reported in every culture investigated, cultural factors may shape social norms that influence one’s evaluation of their relationships and, in turn, their loneliness. As evidence for their claim, the team cited research showing that individualistic societies may be more prone to loneliness.
There have been public health interventions in an attempt to “cure” loneliness, though their results have been mixed. This effort is hindered in part by the lack of consensus regarding the definition and measurement of loneliness, coupled with a lack of evidence-based treatments and disagreement over the best way to intervene upon loneliness. A transdisciplinary approach (which has been successful across other health research) to defining loneliness is the first necessary step, argue the authors.
“Forging a mutually agreed definition, or conceptual model of loneliness across the fields of psychology, sociology, medicine, and social policy, would be of use to all domains, at least providing new perspectives that might help us arrive at a consensus on effective ways to intervene to improve outcomes,” they write. “[Our] current synthesized model of loneliness could constitute a starting point in informing interventions in this manner.”
The paper concludes by offering both empirical and non-empirical routes forward. From an empirical perspective, the authors argue that the conceptual fuzziness surrounding loneliness can be broken down through inductive, qualitative and exploratory research, of which there is a shortage in the field of loneliness. Further, studies have suggested multiple divergent directions that the field could head.
One such study imagines loneliness as being a combination of self-alienation, interpersonal isolation, distressed reactions, and agony, while another found that loneliness was not frequently associated with social isolation, but rather with boredom, lack of security, shame and lack of activity. Further empirical research could clarify the legitimacy of this distinction, and further investigate the foundational elements of loneliness.
From a non-empirical perspective, the authors argue that conceptual clarity regarding what individuals experience as loneliness should be investigated via a philosophical phenomenology approach. Philosophical phenomenology has been used to approach a variety of adjacent topics to loneliness, such as solitude, depression and solitary confinement. Through rich existent literature on issues similar to loneliness, loneliness can perhaps be conceptualized.
“We have argued that loneliness is insufficiently operationalized, defined, and conceptualized, not just across disciplines but also within them,” write the authors. “It will be difficult to understand the true impact of loneliness on health, the mechanisms through which it operates, and the interventions that best stand to alleviate it, without a clear and evidence-based conceptualization of loneliness and agreement on its ontology… We advocate the use of qualitative methods to further characterize the subjective experience of loneliness, exploiting, and in tandem with, a transdisciplinary psychological–philosophical approach that will ultimately go some way toward explaining how and why it impacts upon physical health outcomes.”
McHugh Power, J. E., Dolezal, L., Kee, F., & Lawlor, B. A. (2018). Conceptualizing loneliness in health research: Philosophical and psychological ways forward. Journal of Theoretical and Philosophical Psychology, 38(4), 219-234. http://dx.doi.org/10.1037/teo0000099 (Link)
Addiction Related Suicide Prevention:- There’s only one effective approach to addiction that I know of, and that one is self supporting and freely available in the community.
So loneliness will soon be a “mental illness,” it sounds? Is there ever a point at which the “mental health” industry stops pathologizing all aspects of being human?
But once loneliness becomes a “mental illness,” the mental illness creators will be able to drug up almost half of the population! Hurray for the mental illness creators! Maybe drugging up all the lonely people is a bad idea? No, definitely that’s a bad idea. Our “mental health professionals” have lost their minds.
They won’t necessarily drug the population; they might instead “prescribe” various “psychosocial interventions”. There are already reports of doctors doing this in the UK, and it’s just as sinister in my opinion.
That should be great otherwise they will start you on some dangerous psychotropes.Psychosocial interventions should be there always because these drugs are not very efficient on their own.They won’t help you to survive in this world.
I am lonely thanks to psychiatry. Too sick to get out much and fearful of being “found out.”
Psychiatry IS alienation and drugs. Those are its 2 components.
The drugs aren’t really about helping people survive Ramesh. About keeping them docile and childish so they’re easy to control.
There is something disturbing about viewing “loneliness” as a health problem, rather than a consequence of our loss of community and our hypercompetitive social and economic system. It feels like we’re removing any chance of confronting what is really going on for people and setting the expectation that no one should feel lonely and anyone who does is “defective” in some way.
…or the expectation that everyone is lonely (and unhappy), and if they aren’t they must have something wrong with them.
Hmmm, I don’t think I’ve ever heard anyone take that position with me… I agree, it would be just as wrong to expect everyone to be unhappy as to expect them to be happy – people have a right to feel whatever they want to feel. It’s just that psychiatry has put such a focus on erasing any “negative” feelings, the message seems to be that everyone should be at least mildly pleased with the current state of affairs no matter what kind of indignities or stresses they might experience.
Suffering can be part of life, and chemical relief can easily create anther problem.
That’s for sure!
…this man thought everyone should hug
..but people objected.
There is some truth in it.In my experience the stigma and the taboo of mental health,the sedative effects of the drugs and repeated loss of jobs,economic crisis,and the resultant early death of all family members and inability to secure a new job,loss of house and property,divorce and debt,dependance on others,the extended period of time spent in a rehabilitation center with more adverse drug effects all makes you feel that you are a victim of this health industry.You lose your confidence in doing anything.I am overqualified for the job that I’am seeking but it just isn’t being given to me.Every Tom,Dick and Harry is getting it.
And when you realize that your crime is that you are suffering from a health condition to which you did not contribute anything by means of bad lifestyle or drug abuse,you do not want to be in the company of anyone who are messing up with other people’s resources but who still don’t stand to lose anything.
All of this also results in increased social anxiety when you are out there in the open.
People still try to pull your strings by bullying you,or abusing you physically and sexually.e.g.frotteurism in the public transport buses or pulling you out of your seat.You can’t go out for a walk to improve your health because of gait problems resulting from the drugs as also musculoskeletal issues like sciatica and root/cord compression and grade 1 diastolic function resulting from psychotropic drug induced obesity and hypertension which can leave you breathless at times.This has also been the cause for some injuries.Very profuse sweating,again due to the drugs also forces you to stay indoors.Such profuse sweating is accompanied by heating up of the body so much that you feel you are residing in the Sahara desert and not in a tropical region.
To sum up,you feel you have been excommunicated from the society,very systematically.Lonlieness was imposed upon you.It was not something that I choose.
Since psychiatry services are ignored and is practically non-existent to the fullest measure in our country,I think social rejection is the single most important factor in the etiology of loneliness.The private hospitals and the govt health workers including the psychiatrists working in psychiatry are responsible for this cause.Their population falls far below the required numbers.The health ministry is also not interested in it.The social rejection is almost global.It affects every sphere of life like occupation,housing and accomodation,economics,access to health care and legal system,education etc.Every imaginable social service is denied to us.The basic right of a citizen also is denied.If this was not the case,the other factors would not have become overwhelmingly important requiring professional level intervention.
Other factors mentioned in the article with which I could identify were lack of intimacy,lack of emotional relations,situational and cultural factors,social information processing issues,self blame,avoidant attachment and characteristics of early care givers
I went through a period of loneliness. For certain, isolation was the cause. I am very outgoing and not shy. Shyness was not a cause of the isolation. Fact was, barely anyone spoke to me for a period of about two years. Psych had wrecked my reputation, causing others to shy away. I was thought of by others as violent, paranoid, psychotic, whatever. Yes I saw this in their social media posts. They also called me “toxic.” One ex-friend wrote that I was “no longer a person.” I DID notice the way others who considered me “mentally ill” pushed me away by insisting on “email only” or “Facebook only” relationships. If I dared point this out to the person and suggested talking on the phone or maybe even getting together, the person would refuse or make excuses. The excuse-making was very noticeable.
Later, when people started talking to me, with much hesitation, some of my over-therapized friends were methodical in their methods of deliberately distancing themselves. When I finally twisted their arms tightly enough I might get a phone call, but many routinely cut phone conversations off after ten minutes or some other set time, often the same amount of time per conversation. That was noticeable in the way they insisted on ending conversations no matter what the content was. I had other friends who cut a conversation off if I ever strayed onto the topic of psych abuse.
It was ironic that I had been through this awful experience and not one person was willing to let me talk about it. I was silenced as soon as I brought it up. My natural tendency was to continue to do so. This is what trauma will do to you. You will continue to pull the conversation toward the subject of the harm because you NEED to talk about it!
Thankfully, that period of extreme social isolation is over now. I have friends at work and other places as well where I have been able to find really nice people, and I have been communicating with my family, too. Because my life is now enriched by real friendships, I don’t at all mind spending my holidays alone. I get the day off so I celebrate by working on the book I am writing. This makes me very happy indeed!
No other illness isolates you from the society and from people with whom you related well.This illness takes away everything from you.It’s not the illness per se,but the lack of our social institutions to resolve the issues in psychiatry despite being clearly evident.Just imagine what would be the fate of patients with physical or life style based illness,if they got no doctors,no medicines,no preventive approach,no 5 star hospitals,no sophisticated surgical procedures,no insurance,no diet plan,no exercise plan,no expensive investigations,no medical tourism,no paid-leave,no work place support,no job reservation of jobs (handicapped people),no cutting edge research,no effective medicines,no subsidized medicines,no medicolegal support…..They too will become isolated and crippled like us,no doubt about it.
The attitude of people to ignore the needs of psychiatry patients is the cause for all of their problems including loneliness.The govt. does not have the will power to improve the situation of such patients.They are only interested the cardio,nephro,neuro,gen medicine,gastro,uro….sort of specialities.Nothing wrong in that,so long as the needs of psychiatry patients are also met with,on par with them.
My suggestion would be to invest money and work force in preventive and curative psychiatry,creating awareness amongst the general public about psychiatry,integrate psychiatry with other specialities since it requires a multidisciplinary approach and there should be a public health approach for psychiatry.
Psychiatry patients who are educated and well informed about their condition must canvas to upgrade the existing level of psychiatry services.Nobody else will do it because of conflict of interests.
I have just read your posting of Dec 21 2018 on Loneliness and would like to suggest an aspect that I have failed, as yet, to find explored in itself.
Regarding the factor of “cognitive discrepancy” or perhaps even lack-of-Shared-Reality I do not see explicit mention of the situation of non-pathological factors such as super-normal intellectual function (more than 2 sigma and especially around 3) and its consequences. I observe that 2 sigma is a turning point for social ease. From there on I find the eccentrics, the neurotics, even the cranks and the aliens that often FEEL ILL but are not.
We acknowledge stages in Theory of Mind in the animal Kingdom and in child development – and see that discrepancies in these stages between individuals inhibits a satisfactory access or expression between them. Theory of Mind development evolves with gain in intellectual function/elaboration – and I suggest, does not cease in its potential to continue to evolve beyond the statistical norm of “adulthood”. For some persons it does; and these then find themselves absent companionship in their view of their of the world – have a private and isolating “Umwelt” – or feeling of dissociation.
Imagine living in a world mostly composed of, and run by, 4th graders. Such a situation would understandably cause a person to feel ill and lonely. But if 4th graders were the norm – and “adults” too rare to hardly encounter one another then the Worldview Norm of 4th graderishness would be what’s in the literature – the norm of studies. The “adult” then attempts to adapt and function in a 4th grade world and needs must adopt and meet its motives and expectations. The stress of this adjustment may very well be “un-assignable” – and its symptoms be regarded as pathological in origin.
From my long-ago reading of Frankl; in the face of existential adversity, meaning and satisfaction in life depend on 1) identifying the persecutor and 2) sharing that experience with others. Might I suggest developments in this direction? Loneliness is a state of mind (is independent of mere bodily company and superficial interaction (distraction).
I have stoically avoided the relief found in drugs and suicide somehow – but suffer – and hope to carve a way out for others and for myself.
The writer lost me with the phrase “mental health.”
Psychiatry is the cause of my loneliness. If I had not been stupid and gullible enough to see a shrink back in 1992 I would be a much happier woman today with a family, friends, and career.
Today I have nothing. Broke–living on gov. assistance with relatives and in occasional HUD slums. So sick I hurt all over and can barely leave my room most days. Never married. Will never have kids.
I owe it all to trusting my shrink and “meds compliance.” 😛
I hate my life. Psychiatry can talk to my hand!