Loneliness study
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It can make you sick, destroy your sleep, raise your blood pressure, and shorten your life. Loneliness isn't just a momentary pang—it's a chronic emotional ache that affects up to 15 percent of us. So who are all the lonely people, and where do they all come from? Answers are finally on the way, now that loneliness is beginning to get the research attention it deserves. O reports on what one expert called "the Antarctica of the soul."
Lonely people tell themselves that it could always be worse. "Being alone is not the most awful thing in the world," says a character in Zoë Heller's novel What Was She Thinking?: "You make out to-do lists—reorganise linen cupboard, learn two sonnets. You dole out little treats to yourself—slices of ice cream cake, concerts at Wigmore Hall. And then, every once in a while, you wake up...and think, 'I cannot do this anymore. I cannot pull myself together again and spend the next 15 hours of wakefulness fending off the fact of my own misery.'"

Yet they do, the lonely people—they pull themselves together. They fend off the fact of their own misery and trundle forward, carrying its granite load, hour by hour, job by job, year by year. They walk down the streets, grazing knuckles against buildings just to confirm, despite how unwelcome and unnoticed they may feel, that they do indeed exist. They remain rooted to the front seat of the minivan, trying to figure out how to get from the drive to the house without shattering in front of the children or the husband or the indefatigably chirpy couple across the street. They sit, recently divorced, carefully groomed, and warily hopeful, for hours on a Saturday afternoon in the park.

They are exhausted by their separateness. They are strung out by their worry over it. And they are legion. It's estimated that ten to 15 percent of the population is chronically lonely—some 29 to 45 million people. But researchers are discovering more and more about the socially isolated, especially the effects of loneliness on their health, and this work is changing the way we look at those who chronically feel alone and cut off.

Keep reading: What researchers have discovered about loneliness
Take the quiz:
Determine your loneliness quotient
How to help: 9 ways to to help a lonely friend

As late as 1969, loneliness wasn't even mentioned in most psychiatric textbooks. When Robert Weiss, PhD, then an associate professor in the department of psychiatry at Harvard Medical School, began examining the topic in the early 1970s, he found that a quarter of those surveyed in a representative sample of Americans admitted to feeling lonely within the preceding few weeks. At the time, as Weiss noted in his landmark book, Loneliness: The Experience of Emotional and Social Isolation, the subject was "much more often commented on by songwriters than by social scientists."

Picking up where the Beatles left off, Weiss began to study the condition. Now professor emeritus of the department of sociology at the University of Massachusetts, Boston, he says his interest in loneliness was a by-product of research on marriage. He spent more than a year attending Parents Without Partners meetings, talking to people whose relationships had ended. "Very early, I learned that loneliness was an issue for these people," he says. It didn't seem to matter that the parents were in a support group, with people they clearly cared about and who cared for them, says Weiss, remembering one woman who told him, "I get together with my friends and we talk about how lonely we are." Eventually setting aside his marriage research, Weiss tried to pin down the many ways in which loneliness manifests itself, to quantify and rank the varieties, like some kind of lepidopterist of the lonely.

But it's a stickier business than hunting butterflies, this kind of cataloging, because there are not 11 kinds of loneliness or even 1,011. There are millions of iterations—those Parents Without Partners who caught Weiss's attention, for starters. There are the people who are physically separated from friends or family, and the brittle, acutely self-conscious, solitary guests, willing themselves to walk through the door of a party in full swing. Or the men and women who feel, despite their social obligations, work interactions, and all-around busyness, as if they're miles away from the people in their lives.

Others are caught in the less obvious and almost illogical loneliness that can exist between two people in love; the kind that marks out the exact limits of intimacy and the deep disappointment that surfaces when you've finally found someone...and still you feel alone. Some people are set upon by the particularly virulent form that occurs when they're sleeping next to somebody who doesn't really want to be there, and they realize how aggressively a person can prohibit closeness, even when he isn't conscious. Or the inverse predicament, the despair of the long-single that poet Marge Piercy traces as: "Every day alone whittles me. / I go to bed unmated and wake with a vulture perched on my chest." Or the utter bereftness of the widow who, each night in the minutes between taking out her hearing aid and the Halcion kicking in, falters in her stoic acceptance and rails at the Almighty to get a move on and reunite her with her deceased husband. 

It goes on and on—each lonely person confined to his lonely little mental specimen jar. How could you possibly study them all? But Weiss realized that he didn't have to collect each and every type; the disparate states could be classified into two categories that would help researchers chart the problem.
One he described as emotional isolation, the "response to the absence of...a close, indeed intimate, attachment" (what the rest of us call a partner). The second, social isolation, he explains with an image: "It's like a child home sick from school: Everybody else goes off, the neighborhood is suddenly empty, there's nobody to do anything with." People suffering from this kind of loneliness lack a sense of community—a healthy network of friends, acquaintances, or coworkers. Weiss says, "Theirs is a problem of maintaining a sense of being meaningful or mattering to other people."

Building on Weiss's work, several researchers around the country compiled diagnostic questionnaires. In the late 1970s, a team at UCLA put an ad in the school newspaper that said, basically, "Calling All the Lonely People." Daniel Russell, PhD, then a doctoral student at UCLA, says that many students, campus employees, and others showed up. "We gave them the early version of our scale, and as you would expect, these people were pretty damn lonely." But glancing around the room, the researchers also realized, as Russell says, "Hey, these people didn't look so weird."

Up until this point, scant as the research was, most of it was predicated on the idea that the lonely were somehow different, and by different, researchers meant uglier, stupider, less well educated, stubbornly reclusive, throwing pity parties for themselves in a corner. But the observable normalcy of the people in Russell's group made his team reconsider. "We got interested in understanding how loneliness was different from being alone," says Russell, now associate dean for research and graduate education at Iowa State University. They knew that loneliness isn't a numbers game; it yields only to specific kinds of connections. Russell's team began to believe that loneliness had to do with an individual's expectations. If someone feels she needs one dear friend, two go-to-the-movies pals, and a spouse, and she is missing some of those relationships, she's likely to be lonely. A person with next to no acquaintances who wants to spend a lot of time in solitary pursuits may not feel despondent at all.

"I was interested in the consequences of loneliness, particularly if it's prolonged," Russell says. But before he or anyone could move much further, they had to find a way to quantify the experience of loneliness. The UCLA scale developed by Russell and his group was a little more accurate than questionnaires developed at other universities. The test succeeds in part because it takes into account the effects of the wish for "social desirability," which is what researchers call the impulse of certain people in any sample to cast themselves in a more attractive light. "Owning up to being lonely is often viewed as saying there's something seriously wrong with you," Russell says. The researchers knew that some of their participants would never admit to feelings of loneliness. As a result, not one of the 20 questions on the UCLA scale, which was first published in 1978, includes the word lonely.

Take a version of the loneliness quiz.

With a workable, verifiable measurement, research on the topic took off. Russell (who had moved to Iowa by then) and his team discovered that older people were less likely to report being lonely. He and researchers at other institutions also began to systematically dispel the social doofus stereotype: The lonely, it turns out, are as intelligent and as physically attractive as happily connected people. Their incomes are comparable to those of the nonlonely. Their levels of education, their average body mass index, their diets, and their rates of seat belt use—all are virtually indistinguishable from those of their fellow citizens. They even have as many roommates as anyone else.

If lonely people are impossible to pick out at 20 paces, though, they can be distinguished from socially connected people up close. They carry their unhappiness with them, and they often display, as Weiss describes it, "all the stigmata of loneliness: they're drawn, tense, restless, inattentive." They're less trusting of others, their self-esteem is usually in the cellar, and they're less inclined to ask for help—qualities that reinforce a sense of their solo-ness.
While some researchers were trying to get into the mind-set of the lonely, others were trying to get into their brains. One of them was John Cacioppo, PhD, currently a professor at the University of Chicago's department of psychology. "When I became interested in the topic in 1994, loneliness was thought to be a gnawing, chronic disease with no redeeming qualities," says Cacioppo, quoting Weiss on the subject. "As a neuroscientist, that didn't make sense to me. Everything has evolved for a purpose, or it doesn't stick around."

The way Cacioppo sees it, loneliness is what propelled the solitary Neolithic hunter-gatherer back into the fold, where the group shares its meager supplies and survives, while his impervious buddy carries on only to die high in the Italian Alps and be discovered as a subzero mummy by 20th-century hikers. The implication of this theory is that loneliness is handed down, and with the help of the Netherlands Twin Register Study, Cacioppo estimates that, unlike eye color (100 percent inheritable), loneliness is only 48 percent inheritable. Cacioppo likens it to a pain threshold: If you're born with a low social-pain threshold but raised in a caring and supportive environment and taught techniques for managing your discomfort, you might never become lonely. Alternatively, if you're continually bruised throughout your formative years, no matter what your genetic setting, you might plunge into lonely episodes repeatedly.

Cacioppo knew epidemiologic evidence showed that social isolation is comparable to sedentary lifestyles, poor diet, and high blood pressure as a cause of morbidity and mortality, but he didn't know why. In the past 12 years, he's done a number of studies on physiological differences between the lonely and nonlonely, paying close attention to two groups—college students and 50- to 68-year-old Chicago adults. His team's findings on stress and perceived stress pointed out some interesting differences between the socially isolated and the socially connected.

For example, lonely and nonlonely young adults were faced with approximately the same number of negative and positive life events, but the nonlonely group coped better with stressors. (In the older group, the lonely had slightly more negative life experiences.) To the lonely, the same irritation felt like a bigger hassle than it did to the nonlonely, while a happy coincidence wouldn't lift their spirits as much as it would the nonlonely. Cacioppo's team also did a brain-imaging study with the young adults, and the preliminary results suggest physiological reasons for the different outlooks. Researchers scanned lonely and nonlonely people while certain images flashed before them. When the nonlonely looked at positive pictures of people (happy, smiling folk), they showed greater activation in the reward center of the brain than when viewing an equally positive photo of an object (a cake). A lonely person, however, showed no difference in that part of the brain, suggesting that he intuitively associates connecting with others as a less rewarding experience than the nonlonely do.

Faced with negative pictures, the nonlonely person didn't react differently to an object (a dirty toilet) and a person (a battered woman). But the lonely did; they showed a much stronger response in the threat surveillance part of the brain to the negative picture of a person than to the object. The finding indicates that when a lonely person has a negative interaction, or even sees a negative interaction, he'll feel more threatened than the average person.

"Lonely individuals want to connect with other people," Cacioppo theorizes, "but they also expect to be ultimately rejected or negatively evaluated. So they engage in self-protective behavior." That preemptive defensiveness can elicit the very responses they fear most: Studies out of the University of Minnesota, in which people were given information about a stranger they were about to meet, demonstrated that our assumptions affect our interactions. For instance, if the subjects were told the stranger was aggressive—even if he wasn't—they would pick up on certain cues, ignoring others, and their behavior would unknowingly evoke aggressive behavior from the stranger, reinforcing their initial suppositions.
is even more striking: 13 to one.

Along with this defensive sensitivity, the lonely tend to remember more social cues about encounters, according to studies at Northwestern University. This could be a vestige of being alone on a Neolithic plain, where a solitary person would be ever vigilant for danger. But today this capacity for hyperobservation coupled with their tendency to negatively interpret information guarantees that the lonely retain more "proof" of others' retreat, which not only confirms their view of being alone in an unfriendly world but informs their future behavior, further transforming them into the tense and anxious people Weiss first observed some 30 years ago.

"We're much more social architects of our world than we realize," says Cacioppo. "This fear of being rejected means the lonely don't open up. They also tend to select relationships badly. They're looking for the quick fix. With anybody." But easy friendships aren't always the most satisfying. The lonely stay in these substandard relationships to protect themselves from complete isolation. They find themselves at offices or cocktail parties, over-40 softball games or continuing ed courses, and because there are people in their lives, they often don't ever realize that the lack of intimate connection in their relationships reinforces a sense of not being understood or cared for in a significant way.

This kind of disconnection is, not surprisingly, often inescapably bound up with depression and results in a terrible feedback loop—the lonelier people feel, the more morose they become, leading to less and less social effort, which calls down more unhappiness on their head. But as intertwined as loneliness and depression are, researchers have discovered that they are not the same thing. As Russell explains it, "Depressed people are dissatisfied with everything in their life; lonely people are dissatisfied with their relationships." Loneliness is a distinct condition—unfortunately, a condition that has been found to be a huge causal factor of depression. Cacioppo's research has shown that a lonely woman has an eight times greater likelihood of becoming depressed than one who's not. For men, the incidence
It's enough to make a person sick—and loneliness does. In the 1980s and '90s, Janice Kiecolt- Glaser, PhD, professor at Ohio State University College of Medicine, demonstrated that lonely individuals had poorer immune function than the nonlonely. In 1995 Cacioppo and his team started examining the effects of social isolation on an individual's circulatory system. Among the college students, both the lonely and nonlonely had similar blood pressure levels. But when Cacioppo and his researchers looked closer, they discovered that the measure of the constriction of the blood vessels, the total peripheral resistance (TPR), differed in the two groups. Whenever Cacioppo tested them, the lonely college students had higher TPR, a sign of stress.

Both groups were young, which means their physiological resilience tended to be pretty high—the heart is working fine and the body's many systems are compensating for the increased TPR in the lonely. But in older adults, increased TPR contributes to high blood pressure. "That led us to hypothesize that as the students grew older, we'd see higher blood pressure," says Cacioppo.

Cacioppo has not done a longitudinal study with those 20-somethings, but his older group, currently in the last year of a five-year Chicago Health, Aging, and Social Relations Study (CHASRS), has reached the typical age for arterial stiffening. He and his team have discovered an association between loneliness and high blood pressure. Normal systolic blood pressure is less than 120 mmHg (millimeters of mercury, the standard unit of measurement). Looking at the CHASRS participants, Cacioppo says, "we found that as they get older, there's approximately a .7 mmHg increase a year per what's called standard deviation of loneliness." That doesn't sound like much, but let's assume at age 20 you have normal blood pressure. If you're chronically lonely, by the time you're 50, using Cacioppo's rate of increase, you could be hypertensive. And by the time you're 65, you could be seriously hypertensive, with an even greater risk of heart attack and stroke.

Cacioppo's team thinks one of the reasons for increased TPR might have to do with something they'd noticed while studying the restorative process of sleep among college students in the '90s. "We found that lonely people sleep less efficiently and complain about more daytime dysfunction and sleepiness," says Cacioppo. "We found it in the young adults and in the older adults. So this process that detoxifies isn't there."

As in the other studies, his team has taken into account age, gender, ethnicity, income, education, marital status, family history, level of physical activity, depressive symptomatology, social support—and this association of poor restorative process and increased TPR appears only in the lonely. In the older adults, Cacioppo found a link between poor restorative process and high blood pressure. It will take more years of study to prove that loneliness is the cause, but the association is compelling. Richard Suzman, PhD, of the National Institute on Aging, a government agency that has helped fund Cacioppo's research, wrote in an e-mail that the findings "suggest that we will pay more attention to the experience in the future, including testing whether interventions to reduce the experience of loneliness also reduce blood pressure in a cost-effective manner."

Cacioppo, Russell, Weiss, and Suzman are not aware of anyone specifically looking into how to lower blood pressure by reducing loneliness. Part of the difficulty, Cacioppo notes, is that since the increase in blood pressure is so incredibly subtle, it takes decades to see the results of chronic loneliness in hypertensive blood pressure. Another complication is accounting for the 50 percent of people who are lonely one year but not the next (though many become so again). Researchers are still trying to identify more definitively what the predictors of loneliness are—and what possible interventions might be helpful.

Teasing out answers would be an enormously tricky undertaking, but there are significant reasons why it might be important to try: Census information suggests that by 2010, 31 million people will be living alone, up from 18 million 25 years ago. And remember Daniel Russell's older generation of Iowans—those over 65 who were less lonely than younger people? Researchers thought that could be the result of wisdom or lowered expectations or desire for the peace and quiet of retirement, but Russell is finding that as boomers move into their retirement years, they are reporting higher levels of loneliness than the group measured in the 1980s. Maybe those who weathered the Great Depression were more grateful for what they had—a house, grandchildren, Social Security—than today's soon-to-be seniors? If the Greatest Generation was indeed a one-off, an aberration, followed by the boomers, and since people are marrying later and an increasing number of households are being headed by single parents, the number of lonely could shoot up.

So what is the solution for the person who's mired in what Weiss calls the Antarctica of the soul and who now has to worry about colds, depression, or a stroke on top of the regular misery of feeling too alone?

"If you understand where that feeling comes from," says Cacioppo, "and what its determinants are—that some are in your head, some are from unrealistic expectations, some are a result of how you've interacted with people—then you can make a change." Some of the grief, obviously, also comes from events outside a person's control (a relocation to a new city, the death of a spouse, etc.), but Cacioppo is saying that the lonely do play a part in the equation. The last thing socially isolated people want to hear is that their loneliness might be self-inflicted; yet if their despair is in some way their own doing, then it is within their means to reduce it.

The experts all say getting out of the house is a good first step, if only to stop the self-hating marination that so often takes place at home. Human contact—even a pleasant exchange with a store clerk—can soften the harsh pitch of an uninterrupted day. Since self-esteem tends to be lower for the lonely, anything that will boost self-image is worth a shot (a trainer, a personal shopper, speech lessons, purple contact lenses). Cacioppo suggests getting involved with a charity. Although lonely people can't simply will themselves to see the world as a hospitable place, they can make adjustments based on the awareness of their faulty, tending-to-negative vision. If they know, for instance, that their brains are wired to come up with the worst possible interpretation of cocktail party interactions, then maybe they decide never to go to a social function without a friend to provide a reality check, a home base, a mid-party buck-up.

Before lonely people even attempt to launch themselves into a social gathering, Russell advises lining up their expectations to see what exactly they're hoping for. Are they looking for a partner? Are they married but feeling alone in the community? Are they new mothers with a million single friends but no one who can tell them what a nasal syringe is for?

To meet new people to fill some of these slots, Jacqueline Olds, MD, recommends joining organized groups. She insists the group must revolve around a project—not a passive event, like a lecture series—because having work in common gives participants something to do and talk about. People need to pick something they are interested in, says Olds, an associate clinical professor of psychiatry at Harvard Medical School, because they'll need enthusiasm for the subject to carry them through the awkward early times. And there will be awkward early times—many more of them than you'd imagine.

"People often expect a connection to be made quicker than it can be," says Olds, who cowrote Overcoming Loneliness in Everyday Life with her husband, Richard Schwartz, MD, and Harriet Webster. "But you have to give it six months at the minimum." She's not saying that overextended men and women have to add something else to their schedules; in fact, she thinks part of the problem of loneliness in the 21st-century can be traced to the 19th. "Basically, our society emphasizes rugged individualism," says Olds. "On the frontier, people had to be enormously self-sufficient, but now we've taken that a little too far. We try not to lean on people. We go through a lot of trouble to hire someone to do our own little chores." We solve the problem but not our lack of connection. We don't ask for help with our trash barrels, and we don't borrow the cup of sugar from the house next door because we don't want to be in someone's debt. By not asking the favor, Olds says, we lose the opportunity to meet someone new—and it's in the colliding with many someone-news that a person eventually finds the sustaining and fulfilling connections that she was missing.

Olds acknowledges that knocking on a new neighbor's door or getting involved in a group can be difficult for some people. "They're so depleted by their loneliness that they're not the least bit welcoming in conversation or their facial expressions," she says. "One client looked standoffish because she was trying not to come off as weak or desperate." But it's okay to be weak, Olds says. We all need help with the trash barrels, the copy machine, or the ever perilous warrior III pose in yoga class. Olds encourages clients to ask for aid when they need it and also to offer it: to run a neighbor's errand, shake the toner cartridge, or help that poor klutzy yogi on the next mat. Olds reminds clients that while they're doing all this, they also need to be aware of body language—essentially to muster as many optimistic and hopeful gestures as possible to avoid Weiss's stigmata of the lonely: the nervousness, the crossed arms, the worried frown, the impulse to withdraw. The lonely can't force people to like them, but they can at least be aware of the habits that cause others to avoid or overlook them.

Take the person who sits quietly through the PTA meeting and volunteers to address envelopes at home. She could turn the task into a group project by joining a committee that meets weekly or inviting other volunteers to come over to address the envelopes each month. She may not find a soul mate, but the regular, counted-on envelope meetings will eventually create a conversational thread she can pick up every month. She can then turn to other regular encounters, no matter how small, using them as opportunities to throw out other skeins. She could become a regular at a coffee shop, ask the local librarian for recommendations, or strike up a conversation with fellow gym members. Many lonely people discount the effect of being greeted by name in several different environments. Feeling untethered, they hope to find one solid rope to cling to: If they're single, they search for a spouse; if they're new to a neighborhood, a best friend. But those companions are exceedingly hard to find. In their absence, a lonely person might have to anchor herself to the planet one little thread at a time.

John Cacioppo argues that, evolutionarily speaking, loneliness is an elegant solution to the millennia-long drive to see what's over the next Alp. "It isn't a death sentence or a life sentence—it's a signal," he says, "a signal that makes us human." Loneliness is the prompt that makes us come together, each of us sharing what we have, welcoming others to the fire or the cache of Junior Mints smuggled into the movie theater, creating a social fabric.

Lonely people who are cut off from any sense of community, who can see only what they don't have and want so desperately, might find it impossible to imagine their despair as a helpful genetic reminder. So they have to rely on possibly the only heartening characteristic of loneliness, acknowledged by each of the experts—that even the prospect of a connection can banish loneliness in an instant. If the socially isolated will listen to the prompt, if they're able to get up and get out, and if they can take hope in small daily interactions, they will make a connection and crawl out from under the howlingly empty feeling. The reprieve may not last forever—loneliness is pernicious—but it will last long enough for them to pull themselves together again and spend the next 15 hours of wakefulness tending to the prospect of their own happiness.
Take the quiz: Determine your loneliness quotient
How to help: 9 ways to to help a lonely friend


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