Psychosocial aspects of loneliness
PARASCHAKIS A.
Psychiatrist, Psychiatric Hospital of Attica, Dafni, Athens

Much has been written about the phenomenon of loneliness. Feeling lonely is a universally lived experience that is significant to health and quality of life. Loneliness is understood as a complex dimension in our lives and it can be experienced at many levels. The deep dimension of loneliness can entail suffering that is possibly so intolerable that it may turn towards becoming an illness.

Despite the plethora of theoretical information concerning loneliness, the phenomenon lacks a clear, consensual definition. In this review, we examine the existing body of theoretical knowledge regarding the phenomenon of living lonely. We focus, in particular, on loneliness as a crucial marker of social relationship deficits and contend that loneliness should command clinicians' attention in its own right, not just as an adjunct to the treatment of other problems such as depression.

Community-based studies have identified a variety of risk factors for loneliness/isolation, including widowhood, no (surviving) children, living alone, deteriorating health, and life events (eg, loss and bereavement). Older women report more loneliness than male peers. Loneliness is an area of concern related to the well being of older women because it is a cause of emotional distress and is linked to a variety of health problems in older individuals. Life changes, including widowhood and relocation, are associated with increased vulnerability to loneliness. Having a confidant has been identified as a protective factor for loneliness. Social isolation predicts morbidity and mortality from cardiovascular disease, and other causes. The mechanisms by which the social world impacts on health are poorly understood, in part because of lack of specificity in the conceptualization and operationalization of relevant aspects of social relationships and physiological processes. It seems that loneliness is a social factor of importance in three pre-disease pathways: health behaviors, excessive stress reactivity, and inadequate or inefficient physiological repair and maintenance processes. Empirical evidence of autonomic, endocrine, and immune functioning suggests that the physiological effects of loneliness unfold over a relatively long time period. Tobacco and alcohol abuse is also particularly high among persons living alone. Loneliness, often accompanied by the appearance of depressive reactions or of depression, increases the likelihood of cigarette smoking.

More than half of people with severe mental illness are lonely, the subjective state associated with social isolation and lack of desired relationships. Their loneliness is related to impaired ability to make and keep friends, lack of opportunities to participate in social activities, and stigma associated with mental illness that creates barriers between them and their communities. Treatment for people with severe mental illness often fails to include social network interventions that have the potential to decrease loneliness.

Group therapy is a well-known therapeutic approach that exploits all the benefits social involvement has to offer in treating patients suffering from torturing loneliness. It is very effective in improving well-being and quality of life of both psychiatric patients and patients with severe somatic diseases (i.e cancer).

The therapist should be careful when treating patients suffering from loneliness. He should firmly encourage them to find and preserve relations with other people too. He has to make clear to them that the therapeutic relation has a specific purpose, unique characteristics, and is not a model for other type of social contacts. He should also be aware of the process of idealization of the therapeutic relation that a lot of these patients perform.

Nowadays, if one wants to create new relations, he will have to do it actively, trying to join other people in the achievement of a common goal. This is both energy and time consuming. Friends will not arrive outside one's door by simply moving a finger!

Loneliness may be understood as a structural dimension of existence. It is perhaps in the silent reflective loneliness that we paradoxically develop a greater understanding of the benefits of togetherness. Encephalos 2010, 47(1):37-42.

Key words: Loneliness, psychosocial, psychiatric disorders, psychotherapy.