Even in normal times, loneliness takes a terrible toll on society's most vulnerable. Now with New Zealand under lockdown, we need to be even more mindful of the risks.
These are disorienting times. The benchmark for what's "normal" is shifting so rapidly it's dizzying to remember what we were all doing just a few weeks ago: popping around to our friends or relatives' homes, chatting to parents at the school gate, working surrounded by colleagues, meeting friends for coffee, playing sport, attending pub quizzes, going to the library. Who knows how long it will be before we can do these basic social activities again, or even if we will do them in the same way?
Now when I collapse on the couch for an hour of TV at the end of the day, I keep exclaiming at what already looks alien to my rapidly retrained eyes: "Oh my god, did they just shake hands!? Why are they standing so close together? I can't believe she just hugged her granddaughter!"
Depending on how long these measures are in place for, they have the potential to significantly and permanently alter our social norms for social interaction. And while they should hopefully protect us from the worst of the COVID-19 pandemic, without awareness and action they could also contribute to New Zealand's already significant loneliness problem.
In my role as deputy director of the Helen Clark Foundation, and with support from WSP New Zealand, I've been investigating the links between social isolation and loneliness and the risks disconnection poses to health and wellbeing. I'd like to share some of what I've learned.
What is loneliness?
Loneliness is one of those things that is hard to adequately express in words, but we all know it when we feel it. In general terms, it's a painful feeling that occurs when one's needs for meaningful connection are unmet, often experienced as a distressing longing for others.
There are at least three main types of loneliness, which can be loosely defined as: emotional loneliness, related to the lack or loss of an intimate other; social loneliness, feeling unconnected to a wider social network, such as friends, family, and neighbours; and finally existential loneliness, related to a feeling of lacking meaning and purpose in life.
Crucially, loneliness and being alone are not the same thing. Someone can live alone and rarely see others, but feel no loneliness, either because they value and enjoy solitude, or because they are able to maintain supportive relationships in other ways such as online or on the phone.
Similarly, someone can be constantly in the company of others but intensely lonely, such as a parent fully engaged with caring for children, but longing for the company of other adults, or an elderly person living communally in a care facility, but with only superficial relationships with carers and other residents.
Loneliness can occur at any time and is experienced differently depending on the person's needs and circumstances, though it does seem to be most prevalent during major life transitions such as leaving home for the first time, new parenthood, or retirement.
There is only a weak correlation between social isolation (not seeing others) and loneliness, so we don't necessarily need to fear becoming lonely just because we can't physically see or interact with people outside our bubbles. However, we still need to take care. The sudden loss of our usual social networks could put many of us at risk of developing feelings of social loneliness, and for many, loss of employment, uncertainty of income, and witnessing the distressing global impact of COVID-19 could lead to increasing feelings of existential loneliness over time.
While everyone will experience some loneliness during their life, both social isolation and loneliness are associated with various mental and physical health risks, particularly when they persist for a long time. Given that we could be in lockdown for many weeks or months, and that our patterns of social interaction could remain altered for some time after it is over, we need to be mindful of these risks.
What are the health risks of loneliness?
There is significant evidence that people who report feelings of loneliness are more likely to experience health problems later in life.
Physiologically, the research suggests loneliness accrues over time to accelerate the process of ageing, and that those who report consistent feelings of loneliness are more likely to experience cardiovascular disease, high blood pressure, high cholesterol, dementia, and hormonal imbalances.
Studies have found clear links between self-reported loneliness and increased morbidity and mortality, with some asserting chronic loneliness can reduce life expectancy to the same degree as smoking 15 cigarettes a day.
Furthermore, loneliness makes us more susceptible to infectious disease, because it can switch on or off the genes that regulate our immune systems. Given the current context, then, it is perhaps more important than ever to maintain meaningful connections with others.
Why loneliness has such a drastic impact on physical health is thought to be grounded in our evolution. Our ancient ancestors lived in tribal groups and would have relied greatly on those around them for survival.
Hence, to this day perceiving ourselves to be "separated from the group" can trigger an automatic threat response in the brain, which activates a state of physical hyper-arousal that is intended to help us manage immediate danger by making us more alert and poised for action. This is often known as the "fight, flight or freeze" response, and is not intended to be maintained for long periods due to the stress it places on our body, over-activating various physical systems and not allowing time for us to adequately rest and recover.
When we stay in this zone long-term, it can create hormonal imbalances, disrupt sleep duration and quality, and elevate feelings of panic and urgency, leaving us prone to anxiety and depression.
These mental and physiological health risks can also reinforce each other. For example, lack of sleep can exacerbate depression and weaken the immune system - and thereby create a cycle of deteriorating health and wellbeing that leads to a greater overall risk of illness or death.
It's remarkable just how much of an effect loneliness can have. As Louise Hawkley and John Cacioppo, two leading experts on this topic, have noted, "perhaps the most striking finding in this literature is the breadth of emotional and cognitive processes and outcomes that seem susceptible to the influence of loneliness".
Who is most at risk?
Loneliness can affect anyone at any time. However, as I've noted, it can be especially associated with going through major life transitions.
Like most public health concerns, loneliness has a strong correlation with poverty, with those living on low incomes or with high levels of material deprivation significantly more likely to report feelings of loneliness. This is likely because poverty creates barriers that can hinder the formation and maintenance of social relationships, firstly through the pervasive toxic stress that it creates, and secondly through the lack of access to resources like free time to socialise, and funds for travel and recreational activities.
This nasty effect works both ways: the subjective experience of loneliness is also worse for those with less access to material and social resources to buffer its negative effects, so those living with poverty are not only more likely to be lonely, but also to feel its impact more keenly.
Right now, for example, those with reliable access to high speed internet are likely to be feeling the impact of loneliness less than those who cannot easily jump on a Skype or Zoom call with their loved ones, and those living in warm, comfortable homes with access to plentiful food and resources like books and Netflix subscriptions may find it easier to cope with feelings of loneliness than those who cannot afford or access these things.
Age is also an important risk factor, with those at the younger and older ends of the spectrum most affected. International studies suggest a pattern: adolescents and young adults report high levels of loneliness. This tends to drop away through adulthood and mid-life, with those aged around 50 reporting the lowest levels of loneliness, but after age 75, it ramps up again. Both groups may be finding the present restrictions particularly challenging.
In 2017, some New Zealand researchers took a different approach and used data from the New Zealand Attitudes and Values Study to investigate how loneliness is experienced by New Zealanders, and whether differences in people's experience of loneliness were related to certain wellbeing outcomes.
They identified four categories or loneliness types, based on how people responded to the following statements: "I feel like an outsider" and "I know that people in my life value and accept me".
At one end of the spectrum, the "high loneliness" group both felt like outsiders and did not think the people in their lives valued and accepted them. This was a small group of about 6 percent, but they experienced significantly worse self-reported health and wellbeing than the other groups. The majority, 58 percent, of respondents fell into the "low loneliness" group, and they experienced the highest self-reported health and wellbeing compared to other groups.
Those who felt like outsiders, but nonetheless felt valued and accepted, had better well-being outcomes than those who were "superficially connected", a group of people that felt they belonged in society as a whole but didn't feel valued and respected by their contacts.
This suggests that the quality of social relationships may be more important than the quantity. Nevertheless, according to the report's lead author, Hannah Hawkins Elder, "we know that any level of social contact is better than none. This becomes even more relevant during the lockdown, when many of people's ordinary social interactions are denied to them".
How lonely were we before the pandemic?
You'll often hear talk of an "epidemic" of loneliness in the social media age, and of the global trend towards more single-person households. While there is a trend towards more single-person households, there doesn't actually seem to be a great deal of evidence that overall loneliness is increasing over time.
That doesn't mean it's not a significant problem though. In New Zealand's most recent General Social Survey, 36 percent of people over 15 reported feeling lonely at least some of the time, those most likely to report significant loneliness tend to belong to social groups which are already vulnerable. Other international studies have found up to 80 percent of those under 18 and 40 percent of adults report some level of loneliness.
How does the pandemic exacerbate these risks?
Not surprisingly, the solution to loneliness is greater social connection - not necessarily with a huge number of people, but meaningful, regular, and ideally in-person contact - which is obviously impossible right now.
While we can arrange virtual alternatives - phone calls, online meetings and shared virtual activities - for those already living minimally connected lives, there is now very little opportunity for the "incidental" social connections that they may have previously relied on: interactions with colleagues, fellow passengers on public transport, staff and customers in cafes and so on.
Even for those who can get online for planned connections with people they already know, this may prove taxing in ways that in-person connection is not.
Neuroscientist James Coan explained to New Yorker columnist Robin Wright that "the brain processes all manner of information more efficiently in the presence of other people, even if they are six feet away, than it does while alone, or while engaging with someone on a screen or a phone ... Videoconferencing can help, but it will require more work from the brain than physical presence would".
Planned virtual meetups also tend to be more purposeful and informal than simply spending time in the company of other people. There is benefit in simply being "together alone", for example working alongside colleagues at adjacent desks, or reading or crafting with others. While it is possible to arrange online ways to be together in this quiet way, it requires some effort and is unlikely to happen spontaneously.
And of course, these technological solutions are likely to be less available to those already at greater risk of loneliness, such as the elderly, ill, and those living in poverty.
Perhaps the greatest risk though is that this period of lockdown and isolation permanently changes our patterns of social interaction, so that by the time we get out of the current crisis, we're inadvertently hardwired to avoid physical connection with others.
As one leading loneliness researcher, Julianne Holt-Lunstad puts it in the same New Yorker article: "When we get out of a habit, it's hard to get back in. So, just like we're worried about an economic recession, we should worry about a social recession--a continued pattern of distancing socially, beyond the immediate pandemic, that will have broader societal effects, particularly for the vulnerable."
Are there any potential upsides?
During the immediate crisis, many of us are of course already acutely aware of the current risk of loneliness and disconnection and taking proactive steps to mitigate it by purposefully reaching out to others. Anecdotally, I've seen many people report that they are spending more time reaching out to friends and loved ones than ever before. While time-zones are still an issue, international borders feel less meaningful when we're all stuck at home, and people also seem to be making time to catch up with faraway friends and relatives. This time in enforced isolation has the potential to prompt many of us to consciously value our relationships and social interactions much more than we did before.
For some who have already felt the sting of exclusion, there are definite upsides to the new status quo.
As disability rights activist and wheelchair user Erin Gough posted recently on Facebook: "A week into lockdown. Enjoying the strange access it's created and the lift of a mental load I didn't know I was carrying. No longer do I have to worry about whether the venue of an event I've been invited to is accessible (everything happening at the moment live-streamed!), about daily commute stress (I now make a 2m trip from my bed to my desk) or not being able to visit friends' houses (we can Zoom whether across the road or across the world). No FOMO. Pants optional. Let's keep some of this going, even when we don't have to, eh?"
What can we do about it?
Even before the pandemic, loneliness was a significant health and social issue in New Zealand and around the world. While it's not a lens we often view policy challenges through, the sheer breadth of its physiological and emotional impact on people's health and wellbeing means it is worth focusing on. If we can help people to feel less lonely, many other benefits will follow.
The lockdown could not only limit our social interactions while it's in place, but for a long-time afterwards, so the challenge to meaningfully tackle loneliness has become more urgent than ever. While it can be difficult to craft effective policy responses to the subjective lived experiences of individuals, it's worth putting the effort in to get this right.
All over the world, individuals and communities are pulling together virtually to help each other get through this challenging time. Governments should move to support these communal efforts and build on our current hyper-awareness of the risks of social isolation by developing comprehensive strategies to tackle loneliness both in the immediate crisis, and as we move out of it.