10. High Emotions: Loneliness

This weekend was Easter, and Good Friday is in part a ‘celebration’ of loneliness and fear. For the social animal, few experiences are as crippling as loneliness, and when a human being feels isolated, when it feels that all its comrades are against it, disagreeing and discouraging, the hairless ape cannot help but question all that it is.

Just as the early followers of Jesus doubtless hit their low points during these days, truly grasping the loneliness of the people I’ve met has been one of the hardest things I’ve experienced both on this placement and throughout all of medical school. I’ve coped by pretending to be David Attenborough, conducting an impartial examination exploring how humans meet the challenges of surviving in the most desperate habitats in society, seeking the wonder of nature, to stave off the horror of man.


I think of capital in a similar way to power — follow this link for a far more interesting and better presented discussion on this topic, and skip to the end of my numbered points to eventually get back to loneliness.

1. What is capital? A black box name for stuff you can have and use to get other stuff. Usually you don’t want it for its own sake, but because of the power it gives you to get other stuff. Economic capital is money and wealth — an individual owns it, and can use it. Social capital is the esteem of other people — celebrities have lots of social capital, and as a result people listen to what they say and pay attention to them. It’s not the same as fame — your friends will listen to what you say, because you have ‘social capital’ with them, whereas you don’t with strangers on the street who can be pretty hard to stop and have a conversation with. Political capital is a combination of lots of these sorts of things, so individual politicians curry favour with groups of people, which they can use to try and make political changes. For example, Obama used a lot of the political capital of his presidency to make ObamaCare happen — it meant there were other things he couldn’t do, but there was a limit to the power he had in the form of political capital that he could use to make things happen as President and get other people to support him in it.

2. What do people want capital for? You can use capital to get other stuff. Within economics, capital often refers to machinery and that kind of thing — you use machines to produce things like electronics. Having more machines means you can make more mobile phones, and thus get richer. You don’t want the machinery because it’s nice to look at usually, you want it because it’s useful for other stuff in a very general way — you can retool machines to make slightly different things, you can use the voice people listen to to say lots of different things. But the thing is, you can also exchange between types of capital. Someone who has a lot of money but a terrible personality may have fewer friends, but they often have more friends than someone without any money — the simplest example might be that they buy expensive presents which makes their personality easier to bear.

3. Who gets capital? The other side of the coin is that people with a lot of money, or any kind of capital, also tend to have more of other kinds of capital for two important social reasons: firstly people respect people who have made money both for the achievement of making money and because they want money and to be like them. Secondly, capital begets capital: you can make machines to make more machines, you can use your voice to talk about things people are interested in, which makes more people listen to you. The powerful, who have lots of capital and can already do lots of things, are more likely to become more powerful because they can do things that makes them more powerful. Monopolies are a good, albeit extreme example of this; if you are desperate to bake a cake, and only one person sells sugar, you either pay whatever that person wants to charge, or you bake some kind of shit raw, vegan, unprocessed, sugar free cake. Most people will pay for sugar if they can, and the person who sells all the sugar will make a lot of money — a lot more money than if they were competing with another sugar seller, as they would have to charge a lower price to sell the same amount of sugar. Instead, they get richer, and have more money. They could then use all this money for example to buy all the newspapers in the country. This wouldn’t just give them a lot more money from a new business — newspapers have social and political capital. They can influence what people think and hear, and as a result what we do in society and how politics is conducted. Rupert Murdoch is one such powerful person, although there’s nothing sweet about him; despite differences in editorial style, all his newspapers are ultimately answerable to him in content, opinion and political leaning, and so amplify his voice enormously.

The key take away is that different types of capital can be exchanged and rich people tend to get richer. Rich societies also tend to get richer, big companies in general continue to grow. Poor people tend to get richer too, but at a slower rate.

Why does this affect the lonely and the homeless? Quite simply, if you’re on the down and out in terms of money, you’re more likely to lose relationships too. Stress might cause tension between you and those close to you. If you downsize your house, you might move away from people who can love and support you. You might try to plug the gaps in your financial capital with social capital — for example, if you find yourself homeless, you might sleep on someone’s sofa for a while. They aren’t going to let you sleep there forever though; if they have to kick you out, that might be the end of your relationship. You’re out of money, and you just used up all your social capital, too. You might bounce from sofa to sofa; you might also be drinking and taking drugs to cope with the stress, making your old friends less willing to take you in, help you, and remain your friends — they’ve gotta look after themselves too, after all. Rough sleeping is a desperate situation, and most people will do nearly anything to avoid it — by the time they end up on the streets, they’ve probably used up every resource they’ve got. Your friends are much more likely to be able to help you than strangers, but they aren’t likely to pay for your drug habits, so you even if you’ve still got them, you might not want to ask them for help that you might not think you need.

In hospital, homeless people are often desperate to get TV cards and will pay what little they have to watch a show or a film. They often have no visitors, they are some of the most isolated and lonely people in the whole building. The friends they have may struggle to make the trip into hospital and to navigate the structures of wards and departments, or they may be too chaotic to organise such a journey. TV is voices and an illusion of company, a parasocial relationship with people. The absence of social capital leads to the expenditure of economic capital, because the communities homeless people live in just aren’t strong enough to support them in this kind of time.

Communities are beautiful things. Whole networks of people sharing social resources with each other; anything from friendship to information. If you’re embedded in a strong community, they buoy you up when you start going under, finding you a spare room to live in for a while, or if you’re on the streets, pointing out the new soup kitchens or useful services. If you’re sleeping rough, of if you’ve moved to a new area because house prices and rent in London were too high, what kind of community do you think you’ll be in? The kind that has spare rooms, or the kind that knows the local drug dealers? The kind with friends and links right the way across the city, or an insular community of 5/6 strangers to the city? We’re part of one of the economically wealthiest, healthiest societies that have ever existed, but the new epidemics are isolation, loneliness, stress, anxiety, and they hit those at the bottom hardest.

While this placement has already provided experiences that will likely stay with me my whole career, last Thursday affected me more than anything else I have seen in medical school. I went on a home visit with the GP to see a man who wasn’t homeless, but could still be described as vulnerable. The GP suspected psychosis; the day before, he had an extended conversation with the patient through his letterbox. Standing outside this patient’s flat waiting for him to answer the door, the GP pointed out masking tape hanging off the letterbox. The patient may have tried to tape the letterbox shut in paranoia, and a sensation that having openings into his flat left him vulnerable.

However, when the patient opened the door, we were faced with a kindly and effusive man holding a cloth to his face. It later transpired he had a dental abscess, and the cloth was cooling the infection and swelling, to make it more bearable. He lead us into a darkened corridor; on either side of the corridor were glimpses of seemingly empty rooms, where even less light was able to perforate heavy, unstirring shadows. He took us to a living room, olive sofa and armchairs unflattered by the light filtered through a plastic covering on the only window. Various tables in the room were laid out carefully like a workshop, one table covered in stacks of sticky stars and lottery tickets, a wall with pliers and screwdrivers still in packets arranged as though for sale. Everything seemed to have an arcane purpose; most mysterious to me was the old catalogue, looking like papyrus pulled from an ancient tomb. Clearly the items laid out on shrivelled yellow pages were no longer for sale, the company perhaps long bust, and yet this book was kept, not used as a paperweight or scrap or any other reason I could imagine.

This patient was new to the GP, but not to the area; he had lived in this flat with his brother for some time, he explained. However, his brother had cared for him until recently, due to a debilitating agoraphobia and also apparent learning difficulties. The darkness was because of his eyesight — the light gave him headaches and made him feel unwell — and he betrayed no signs of acute psychosis. Agoraphobia was his biggest problem, and he was unable to spend any time outside. So his brother did the shopping, provided an income, did some work, organised all of their affairs. That left the patient with a lot of time to himself; however, he was unable to use a computer properly, and I wonder if he was able to read. The brother had made several USB drives full of videos for him that he was able to choose from and watch, to spend his time and have some choice in his life.

However, several weeks earlier, the brother dropped dead while walking outside. The patient told us “I know he wasn’t coming back, when someone came and knocked on the door. I knew something was wrong that day, that that was what they were going to tell me.” He didn’t betray any sadness while telling us this, he didn’t once suggest that he missed his recently deceased brother. He spoke of fear, more often, and helplessness. He told us how, straight away, he realised he would have to fend for himself. He left the flat; he headed towards the shop he could see from his flat. He didn’t make it half way. He just knew he was going to fail. He turned back, and returned to the flat, where he had no phone he could use and no way of contacting anyone. For two days, he ate the sweets that were the only food left in the apartment. And he feared starvation, and he considered whether he would die too.

He was found. Other services had been in touch, the coroner about his brother, mental health workers perhaps referred by the coroner. He had been in contact with family, his mother who lived in London and his cousin who was in another part of Manchester. His cousin had been coming recently, once a week, to do an online food shop. At some point, he was going to teach the patient how to do it, but for now, the patient was able to simply pick out what he wanted while his cousin organised it for him. When his mother came for the funeral, she was going to leave him some cash so that he would be able to pay for taxis and the like if he urgently had to leave the house. Until now, he had money in the bank but no way to access it. He couldn’t leave the house to get to a cash machine.

This man was totally dependent on others. He was reliant on the social capital family provided for someone to come and do his shopping for him; the civil capital that citizenship provided for some basic benefits that allowed him to survive. But in truth, he didn’t have a lot. He didn’t have the mental faculties to look after himself, and he didn’t have friends in the area. He had lived in the flat for 17 years, and barely ever left it. Not once a week, not once a month. There was a record at the practice from 5 years ago of him having attended once.

Communities are beautiful things. Whole networks of people sharing social resources with each other; anything from friendship to information. Families look after their own, communities look after their own, and to a greater or lesser extent, society looks after its own, even when sharing time or information with people who need it is tough or expensive.

One final point: this post may seem a direct contradiction of what I wrote in 9., of how there is a community in between addresses, that for some people is worth staying for. That’s deliberate; describing the lives of people is always, always complex and contradictory, and there are a lot of different experiences of people who find themselves without a home to call their own. Some socialites find an avid community to call their own, and others may struggle to gain a friend all their lives.