In today’s technologically blessed world, face-to-face contact gets reduced, leading to decreased expression of emotions aiding to ‘virtual relationships’ that in turn adds to loneliness. Dr. Debanjan highlights that loneliness is an emerging epidemic but it can be tackled.

Need for longing and attachment is a basic premise of human existence. Be it with fellow humans, pets, plants or even inanimate objects: the sense of ‘belonging’ and need to ‘belong’ adds to our identity, giving our psyche the sense of completion and purpose. It can range from the proximity of siblings or parent-child dyad to the companionship of your pet or bond of a writer shared with his diary or that of the painter shared with the canvas. Various psychological theories, from the traditional Freudian principles to Beck’s cognitive proposition or humanistic ideas by Carl Rogers or Maslow, the basic need for longing to be with your loved ones has been a recurrent theme, which is deprived of, can lead to adverse psychological consequences, like loneliness.

All of us have felt lonely at some point or the other in our lives and we know that it is not a pleasant feeling. However, like hunger or thirst, in itself ‘loneliness’ is not of concern. Varying mood states, social circumstances or environmental situations can affect our proximity and interactions with our loved ones, leading us to feel ‘left out’ or ‘lonely’. If this state is constant or pervasive, neglected (as it often is) and not attended to (which is again most often, the case): it gives rise to serious mental health consequences. Ironically enough, in today’s technologically blessed world, face-to-face contact gets reduced, leading to decreased expression of emotions and aiding to ‘virtual relationships’ that in turn adds to the ‘inner loneliness’ that we feel. Irrespective of the ‘friendly environment’ or the background noise or the number of people around you, one can still feel silently ‘lonely’ and ‘empty’; be it in a noisy bar or a happening party or in an entertaining movie theatre, alike.

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Loneliness: Causes and effects

Loneliness stems from pervasive physical, social or emotional detachment of an individual from his/her surroundings and intimate bonds. Unfortunately, in our busy lives, we often neglect our loneliness and the offshoots of it. We try compensating it by virtual connections, addiction, over-working or other maladaptive practices. If chronic, this state can lead to negative patterns of thinking like ‘hopelessness’ (feeling that nothing is going to change), ‘worthlessness’ (feeling that one is not worthy enough to live) and finally ‘helplessness’ (feeling that no help can be sought for their situation): which can create negatively biased views about one’s self, environment and the future, with the mental state spiralling into depression and anxiety. Stress builds up and soon the ‘alienated’ person considers him/herself as unwanted, unloved and unproductive; further decreasing interaction and shying away from the relations, thus eventually being lonelier. This vicious cycle is tough to break.

Study done at the University of Surrey, England in 2009 states that the screen-time (total time devoted to any form of visual and digital media) is inversely proportional to self-satisfaction and quality of life. This is further aided by research done by Briggs and his team later in 2012 where they studied adolescents and young adults in Melbourne, concluding that the degree of ‘perceived loneliness’ is directly related to lack of effective ‘friendships’ and ‘close contacts’, decreased ‘face-to-face’ contact, substance abuse, difficult parenting, bullying and increased internet use.

Concerning further, the prevalence of loneliness is on the rise. Factor analysis of the National Mental Health Survey (NMHS) 2015-16 records 30 per cent of the Indian population feels ‘lonely’ most days of the week at some point or the other, whereas 65 per cent of these people suffer from at least one mental disorder or substance abuse problem. World Health Organisation (WHO) identifies loneliness as one of the common and preventable risk factors for depression. Decades of research in mood disorders have suggested loneliness as a potent risk factor for suicide. Based on research done by Sharma and Sudhir in 2016 at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, ‘self-perceived loneliness’ led to anxiety, anger and frustration with poor occupational performance in all age-groups, with an increase in the elderly and adolescents. Further, it was identified as the 6^th most important risk factor for depression and suicide in young adults.

Loneliness: Mental and Physical Health

Research clearly states that depression and loneliness are intricately linked. It can also increase the risk for generalized anxiety disorder, panic attack, schizophrenia, pregnancy-related and post-partum mental health complications. In children, it can lead to problems in learning, school refusal, inattention, selective mutism (unwillingness to speak in specific situations), conduct disorders with decreased academic and social performance. In adolescents, it’s a common trigger for violence, aggression, substance use problems and anti-social traits.

Loneliness has been a common ‘gateway’ factor for highly addictive substances like alcohol, cocaine and heroin. The risk of relatively ‘stronger’ street drugs like ketamine, LSD and GHB is higher. People also tend to retire to the digital world, increasing the risk of mobile overuse, online gaming and technology addiction. The Service for Healthy Use of Technology (SHUT) clinic, Department of Clinical Psychology at NIMHANS, Bangalore has worked extensively in this regard.

A group led by B. S. Sharma from the Tata Institute of Social Sciences (TISS), Mumbai in 2010 studied a large group of suicide attempters in the age group of 15-30 years with and without mental illness and concluded ‘loneliness’ as one of the leading risk factors. Supplementing that, a recent study done in 2017 by the Geriatric Unit of NIMHANS identifies ‘feeling lonely’ and ‘social isolation’ to double the risk of suicide and quadruple the risk of anxiety in old-age depression. The International Alzheimer’s Society recognizes chronic loneliness as a major factor contributing to a lack of stimulation, increasing the risk of dementia.

Feeling lonely leads to emotional ‘numbness’ which if persisting for long time, can affect the stress-handling organs of the body (adrenal glands, hypothalamus) releasing excessive cortisol (stress hormone) which gets dysregulated, causing persistent anxiety, hair fall, digestive and heart disorders, gastritis, high cholesterol and uric acid, as well as increased risk for diabetes and vulnerability to infections due to compromised immunity. Lack of sleep (chronic insomnia) is another important consequence.

Loneliness: The emerging epidemic and steps ahead

The concern of epidemic has usually been limited to the outbreak of infectious diseases in the community. Vital to understand is that loneliness is NOT an illness, but a state of mind. However, the chronic state of it is often neglected until late directly affecting the mental health. As mentioned before, this important ‘risk’ factor for adverse mental health is emerging as a silent ‘epidemic’ and will only rise in proportions in the years to come. However, it can be prevented and dealt with aptly.

The generic measures suggested are lifestyle modifications (daily scheduling, Yoga and exercise, physical activity, personal hobbies and activity involvement), indulging in spiritual or humanitarian activities, group or community work, pets, reminiscence of older memories and music. Also, loneliness mostly overlaps with depression and anxiety and thus, professional psychotherapy (a special form of counselling) helps.

A vital step in fighting our regular loneliness is receiving regular peer support and enjoying enough ‘personal time’. In the pursuit of materialistic pleasures, we chase apparent ‘happiness’, the quicksand of which quickly immerses us in habit-bound duties and responsibilities, thus isolating us from our ‘true selves’, hobbies and fantasies. It is important to cherish our activities, no matter how simple: we need to have ‘time to enjoy’ them. Identifying another ‘lonely’ peer or colleague is a challenge and enabling him/her to seek timely help. The reasons behind this are varied and often are amenable to the simplest of interventions. Finally, a major component of loneliness arises due to the fear of socialising and hence, adequate social skills and adaptive behaviour training have been scientifically proven to help healthy thinking and social behaviour. In this digitally driven society, human touch and interaction still has no replacement. Sharing a smile or a friendly handshake or a gentle encouraging pat on the back goes a long way in making your day better than an emoji or an elaborate text message.

Every epidemic needs to be arrested at the earliest stage and further outbreaks need to be prevented promptly. The concerning cloud of loneliness can only be cleared by a collective effort of awareness, understanding and seeking help.

In the words of Mother Teresa, “The human bond, in its true sense, has the capacity for miracles.”

(The author Dr Debanjan Banerjee is a Geriatric Psychiatrist at NIMHANS, Bengaluru and also a member of First Check, an award-winning fact-checking initiative of Health Analytics Asia. )