The Republicans’ controversial effort to repeal the perhaps optimistically named Affordable Care Act because of rising premiums may be fatally stalled. But there are other ways to rein in health care costs that have been almost entirely overlooked. Making a serious effort to reduce loneliness could make a real difference.
Lonely people put heavy demands on our health care system. Loneliness impairs immune response and makes people more likely to develop serious medical problems like heart disease and stroke.
According to one meta-analysis, loneliness increases the risk of early death as much as smoking or being 100 pounds overweight. The risk is highest in people younger than 65. But lonely people don’t go to doctors just for medical care. They’re also dying for social contact.
Although loneliness is now recognized as a major public health problem, there hasn’t been much discussion about how to address it.
As a clinician who treats mental health issues caused by loneliness, I’ve come to believe that we can’t develop effective interventions for loneliness without first understanding what causes it.
More Than Social Isolation
Although isolation is an important risk factor, having company doesn’t always prevent loneliness—and being alone doesn’t always cause it.
Someone in a bad marriage may feel lonely in the presence of a distant or rejecting spouse, for example. Loneliness is the experience of being not alone, but without the other in a way that feels meaningful. What matters is the internal experience.
Some people are content on their own. As the British psychoanalyst Donald Winnicott explained, people like this never actually feel alone internally.
What protects them is the early experience of having what he called “a good-enough mother.” A good-enough mother isn’t perfect, but she cares deeply for her child and values them for who they are. Wherever these contented souls go, they carry with them an ongoing sense of the mother’s caring and attentive presence.
But many people are not that lucky. It’s well-known that people who were abused as children are at higher risk of getting into abusive relationships as adults. Similarly, people who suffered from emotional neglect as children have a high risk of reliving that experience as well. They felt lonely and uncared for as children, and they feel that way as adults too.
Chronic loneliness can be the aftermath of early emotional neglect. This kind of neglect is often invisible to others. A child may grow up in a family where everything seems normal on the outside, but still feel lonely if he can’t get the love and attention he needs from his mother to thrive.
We fall into old patterns because they’re familiar, and perhaps as a way of showing loyalty to parents who were once everything to us.
Fathers are very important too, of course; they can mitigate or worsen the effect of mothers in this regard. But since mothers are usually the primary caretakers, particularly of very young children, they usually have the greatest effect when it comes to providing a buffer from loneliness or leaving children vulnerable to it.
A depressed, withdrawn mother is not likely to be emotionally available to her child, even if she goes through the motions of doing what’s needed. Sometimes a mother may feel so depressed and deadened herself that she deadens the relationship with her child, as described by the French psychoanalyst Andre Green.
In other cases, the mother may be distant and rejecting—or so oblivious to her child’s thoughts and feelings, and so out of touch with who he is, that she leaves the child feeling stranded emotionally, and alone.
Anyone who tried to get close to his mother as a child and failed may well feel hopeless about developing close relationships later in life. Sometimes hopelessness has a neurological basis: Severe early neglect impedes the development of neurons responsible for optimism.
Lessons Learned From Neglect Can Harm For Decades
Sadly, people who suffered from emotional neglect as children may also act in such a way as to make the expectation of loneliness a self-fulfilling prophecy.
Children who feel uncared for generally blame themselves. As adults, they may hang back from others because of a lingering sense of shame about feeling unwanted, or because they feel they don’t deserve to be loved.