Charting loneliness

Loneliness is increasingly recognised as a public health issue, but to tackle it effectively we need to be able to accurately distinguish between the many forms it can take

Dr Kimberley Smith is a lecturer in health psychology at the University of Surrey

By Dr Kimberley Smith

@kimjsmith81

Social relationships are among the most important things we need in life; they are crucial to our wellbeing and our physical and mental health. Those people with larger social networks, more social support and high-quality relationships tend to have better health and wellbeing. However, when social relationships are deficient in some way, this can have a negative impact.

Loneliness is one metric of poorer social relationships that is receiving increasing attention. The late social neuroscientist and leading loneliness scholar John Cacioppo labelled it a “public health problem”.

Defining loneliness

Despite the amount of attention paid to loneliness, we still struggle to identify what it is, and it can be confused and conflated with similar constructs. This is concerning, as in order to help people to be less lonely we need to know what loneliness actually is. Yet many researchers have differing definitions.

Most definitions incorporate perceptions and evaluations of relationships. For instance:

• sociologist Peter Townsend defined loneliness as a perceived deprivation in social contact
• Louise Hawkley and John Cacioppo define it as perceived social isolation
• professor of public health Mima Cattan defines it as the unwelcome feeling that accompanies isolation.

The most commonly used definition is that of US social psychologists Daniel Perlman and Letitia Anne Peplau, who propose that loneliness is an unpleasant affective state that results from a discrepancy between the quality and quantity of relationships we perceive we have and the quality and quantity of relationships we want to have.

They suggest that most definitions of loneliness have the following in common:

• first, that loneliness relates to a perceived deficiency in social relationships
• second, that it is a subjective experience
• and finally, that the experience is aversive.

Further complicating matters, researchers have identified different types of loneliness. In his seminal work on the subject, American sociologist Robert Weiss suggested there were two main kinds:

• social loneliness, which is linked to a lack of a social network
• and emotional loneliness, which is linked to an absence of emotional attachment.

Furthermore, Dutch sociologist Jenny de Jong-Gierveld suggested that a differentiation can be made between:

• ‘situational loneliness’, when one becomes lonely in response to a situation or event
• and ‘chronic loneliness’, which can be thought of as a persistent state.

Many scholars believe it is chronic loneliness, rather than situational loneliness, that might be linked with many of the adverse health and wellbeing consequences that have captured the attention of the media and governments.

Meanwhile, US psychologist Clark Moustakas differentiated between types of loneliness by the affective impact they have on people: loneliness anxiety and existential loneliness. He suggested that the former was the negative affective experience that followed feeling ‘alienated’, whereas the latter was a normal part of the human experience that offered the opportunity for personal reflection and growth.

However, most current research persists in examining the link between loneliness and negative consequences, such as the link between loneliness and depression.

Loneliness and depression

Loneliness can be thought of as a phenomenon that has social roots but a psychological presentation. Negative emotions commonly associated with feeling lonely include feeling unloved, unwanted, worthless, helpless, desperate, panicked, hopeless, abandoned, vulnerable, rejected and depressed.

It therefore may not be surprising that there is an overlap between the presentation of loneliness and depression: up to 50% of people who are lonely also report that they feel depressed.

It is possible that loneliness may lead to depression — some point to the fundamental need we have for meaningful connections with others. However, other experts propose that people who are lonely are more likely to develop a negative view of themselves and the world, which can lead to depression.

On the other hand, depression may lead to loneliness: those who become depressed can isolate themselves from people around them, and hold more negative perceptions about their relationships. It is also possible that the relationship may exist because loneliness and depression share common risk factors such as social anxiety, attributional styles, attachment styles, low self-esteem and negative life events.

The relationship between loneliness and depression may be even more enmeshed than longitudinal studies suggest. Screening tools for symptoms of depression, such as the Center for Epidemiologic Studies Depression Scale, include items that ask people how lonely they feel. Thus, loneliness is sometimes measured as a possible symptom of depression.

However, identifying loneliness within oneself, and differentiating it from related affective states such as depression, can be difficult. It is possible that some people label themselves as lonely when they are actually depressed, and vice versa.

Despite the role of psychological processes in loneliness, many people persist in thinking of loneliness as the direct result of being alone or socially isolated. To unpick loneliness from related constructs it is worth using the typologies of phenomenologist Rubin Gotesky, who differentiates the subjective experience of loneliness from physical aloneness, solitude and being socially isolated.

Physical aloneness and solitude

Loneliness and being alone are often conflated as being the same; however, as we have seen, feeling lonely is not always due to being alone.

The difference between these states is articulated by people experiencing loneliness, as reflected in this quote from a research paper by social gerontologist Mary Pat Sullivan:

“It’s not being alone because you can be alone and not lonely… it’s when you feel your soul is alone.”

Gotesky differentiated between

• physical aloneness (a physical separation from others)
• and solitude (a state of being alone where one does not feel lonely or isolated).

Physical aloneness can be thought of as the objective form of being alone, whereas solitude represents being alone without distress.

Both states can also be differentiated from living alone, which many use as a proxy to define loneliness. While living alone can be a risk factor, not everyone who lives alone will feel lonely; in work undertaken by myself and Professor Christina Victor, we found a group of older adults who experienced all the risk factors for loneliness and lived alone, but were not lonely.

Loneliness, being alone and solitude continue to be confused for a number of reasons. Loneliness affects all of us at some point, and many of us will draw on our personal experiences when thinking about what loneliness means more broadly. The social narrative of loneliness is also focused around a person who is alone and the media, in discussing loneliness, use the terms alone, solitude and loneliness interchangeably.

Social isolation

Social isolation is commonly conflated with loneliness, but it is actually different. It is defined by some researchers as the objective state of being alone, whereas loneliness is the subjective state of being alone. Yet this definition is arguably too simplistic to capture what it means to be socially isolated. Some researchers define social isolation as a lack of meaningful contact and/or communication with family and the wider community. Social isolation is a risk factor for loneliness, but not all people who are socially isolated will feel lonely. Social gerontologist Lars Andersson and colleagues propose a fourfold typology of loneliness and social isolation: neither lonely nor isolated; lonely but not isolated; isolated but not lonely; and both lonely and socially isolated. In my work with Christina Victor, we showed that those people who were both lonely and socially isolated were more likely to have poorer health and psychological wellbeing. This indicates that, while loneliness and social isolation are distinct, their co-occurrence may have important implications.

Social isolation can lead to loneliness for some, but others find that it instead provides them with solitude. The extent to which social isolation results in negative impacts is probably influenced by the extent to which it is voluntary or involuntary. When people are involuntarily forced into social isolation, for example because of a serious health issue, this has more of a negative impact than when someone makes the deliberate choice to isolate themselves.

Complexity in loneliness

When thinking about what loneliness is, it is important to remember that every person is different; they will perceive and evaluate relationships differently and may respond in a range of ways. Furthermore, underlying causes of loneliness will differ from person to person, although various risk factors for loneliness have been identified. These can include individual factors, such as personality, self-identity and relationship with parents when growing up. Major life events and transitions, such as developing a health issue, retirement or bereavement, are all linked to a greater risk of experiencing loneliness.

In addition, social relationships can have an impact on loneliness, ranging from feeling as though we lack the quality of relationships that we desire through to issues such as bullying and discrimination. We need to bear in mind wider social and cultural influences; when we evaluate our social relationships, we do so in relation to our own social norms and the expectations we have of what makes a good-quality relationship. We can also identify broader social and structural factors that influence feelings of loneliness, such as household composition, where we live, financial difficulties, community engagement and access to transport.

There is no single risk factor that always leads to loneliness; many people experience several of the issues listed above and never become lonely. Psychological reactions to risk factors and underlying resilience and coping strategies have been identified as factors that can help protect against negative affectivity. For some, being lonely can be a transformative and overall positive experience, as it can act as a motivator to reach out and develop new social connections.

How do we tackle loneliness?

Many of the interventions that have been developed to help people feel less lonely are focused on increasing social network size and building connections with others. In short, many loneliness interventions focus on the idea that to help people feel less lonely we need to make sure they are not alone or isolated.

Yet as we have seen, loneliness is far more complex. It may not be surprising then to learn that a recent report from the What Works Centre for Wellbeing concluded that there is no evidence that any of the existing loneliness interventions actually work. Could part of the reason for this be that these interventions have been designed for physical aloneness or social isolation rather than loneliness? In order to intervene, it seems that we need to identify the type of loneliness that a person might be experiencing, and then tailor an intervention accordingly.

When looking to find a solution to loneliness, we need to think more about what loneliness is to that individual, rather than assuming that a one-size-fits-all approach will work for everyone in the same way.

This article first appeared in the RSA Journal — Issue 1 2019