It's hard to sit down and discuss the data on loneliness without feeling just a little bit sad. Loneliness, something we've all felt at some point or another, is one of those human emotions that can easily become more than just a 'feeling'; it can become a state of being, with its own set of bodily dysfunctions to go with it. Loneliness is almost physical; we ache.
Loneliness was defined as the want of intimacy by psychoanalyst Frieda Fromm-Reichmann in her essay On Loneliness published in 1950. This essay was considered a founding piece of writing when researchers started delving into loneliness, and her definition, loose as it is, has remained true. Naturally this definition has been debated a thousand times over, since nobody can really agree on precisely what loneliness is or isn't; the feeling can exist when one is surrounded by people, and be completely absent when one is physically completely alone, even for extended periods.
Defining lonely has been hard. It's so subjective. This is why Fromm-Reichmann's definition rings so true - feeling connected, being intimate, is the one thing we humans can agree we need, even if sometimes it hurts us. Sometimes, paradoxically, it can hurt more to be lonely than to stay in a bad situation. This just goes to show - along with all the other evidence - just how critical our fellow humans are for our survival.
Loneliness research is now far more advanced, and more often now we are finding what we all knew to be true, but didn't know how to prove it: being lonely can not only make you sick, but it can kill you.
Loneliness as an adaptive mechanism
When we lived in tribes, we needed each other to survive - food, care, all the work that goes into shelter and hunting and cooking and sewing. The set of skills we bring to the table, each of us. If we are banished (for bad behaviour, illness), death would soon have found us, alone, weak. The lone creature is the first to be picked off.
We are designed to stick together, and the feeling that keeps us seeking each other out is not only the pleasure we feel at connection, but the strong desire to avert loneliness because it is so unpleasant. John Cacioppo, a psychologist who specialises in loneliness, believes we are built to find life unpleasant outside of our trusted networks of friends and family. His experiments show what we sort of already knew - stress, one result of loneliness, can cause disease if left unchecked.
In his university campus study, students who showed symptoms of distress (which included high cortisol and subsequent poor sleep) were those who didn't like the fact that they hadn't made any close friends. Stress makes us sick, not loneliness per se. Feeling like a loose thread can be blissful freedom some days, but simply terrifying other days. Our sense of being ok in the world is utterly flexible.
Rejection and loneliness cause genetic disturbances and make us weird
Monkey studies have offered us clues into how being rejected can impact our genetics, and the results show that these genetic changes make us weirder and weirder the longer the rejection goes on. We can end up angry, bitter, insecure and moody, and loneliness often leads to depression, anxiety, and paranoia. Luckily, these experiments show that even the most neglected of monkey can regain some of its genetic normalcy with the love of a good foster parent. It's not terminal.
The first control group - coming out of the closet with HIV
The HIV and AIDS epidemic in the 1980s gave researchers a unique natural experiment into the social element of disease progression, and how feeling isolated - rejected, in effect - could make us die faster.
In the mid/late 1980s, UCLA labs got their hands on a long-term study of gay men who had enrolled without knowing their HIV status. Half tested positive, with a third of those consenting to the more in-depth study, which included thorough questioning regarding their social and emotional support structures, amongst many other topics. By 1993, a third of the positive group had AIDS, with just over a quarter dead.
The first things the researchers put side-by-side with death were socioeconomic status and levels of support, finding - to their surprise - that being poor or lacking social support did not result in worse outcomes. Unsurprisingly (and incidentally to this discussion), it was found that being in mourning (as many gay men were at that time) weakens our immune system.
One of the researchers in that lab, Steven Cole, discovered that the most striking difference in outcomes, and the best predictor of death, was whether a gay man was in the closet or out, with closeted gay men having the worst outcomes. This, Cole determined, was due to the high stress levels encountered on a daily basis by a person trying to hide their true selves from most of the world and feeling completely disconnected most of the time. Closeted gay men died an average of three years earlier than non-closeted gay men. Hiding is by its very nature a lonely activity.
So what was the culprit? Norepinephrine, a stress hormone. When AIDS-infected white blood cells are bathed in norepinephrine, the virus replicated itself three to ten times faster than non-dosed cells.
One study found that the feeling of loneliness increases your risk of death by 26 per cent, but that on top of that, if you lacked social connection (being socially isolated) or lived alone, the risk of death increased to 29 and 32 per cent respectively.
Can life insurers do anything to help the lonely?
The lonely are invisible, and their suffering is done in silence. Life insurers can help by adding in social questioning to their health programs, to ensure the risks of loneliness aren't creeping up on their clients, the invisible sword that can hasten death and disease. Loneliness is part of the mental illness that pervades our society that nobody really wants to talk about.
Mental health is being given much more air time than ever before, particularly in risk circles. Risk insurers are in a good position to ensure the psychological health of their clients is taken into as much consideration as their physical when evaluating risk, considering the numbers are so damning.
What about the risk for insurers?
The risks are clear - being lonely causes early death and disease. If we're talking purely in bottom-line dollars and cents, keeping people connected should be on insurers' lists of client support tasks along with lowering BMI and keeping cholesterol in check.
The older you are, the more likely loneliness is to affect you, but unfortunately the less likely you are to be insured (and have a health program to enjoy). Loneliness can be exacerbated by feeling disconnected at any age - more and more children are suffering health conditions that affect their psychological well-being at younger ages (ADHD, autism spectrum disorders, depression, anxiety), which can lead to isolation and social rejection, which naturally turns into loneliness, and often quite quickly.
We need interventions
As our baby boomers age, our elderly friends are at greater risk than ever of loneliness. We all know the old lady who talks our ear off at the mailbox any chance she gets, or the man who seems compelled to tell story after story at the post office counter, line behind him or not.
We need to address our need to be part of a group and consider it a requirement of good health. We need to belong.
"Treatments" for loneliness also need to address the underlying social anxiety many lonely people feel. The solution to loneliness is belonging, but our culture values the individual, and this is our net loss - the group, our tribe.
It can be easy to be repulsed by someone else's need, particularly that of people we don't know very well. We don't have the energy to give to others, despite the fact that a little bit of effort in connecting goes a long way.
Loneliness is everyone's problem.