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11 December 2019

How loneliness became an epidemic

Social isolation is a growing modern phenomenon. But can we treat it as a disease?

By Sophie McBain

I named my eldest daughter after my maternal grandmother, my Oma, my closest confidante growing up. Among the many qualities Oma and I shared was a visceral hatred of being alone. Now that I have small children I have started for the first time to crave aloneness, a respite from pawing hands and insistent demands, the luxury of being able to complete a thought uninterrupted. But any longer than a few hours in my own company and I start to feel restless and depressed.

When I turned 11 my grandfather, who seemed perfectly fit and healthy but had spent his whole life convinced he would die young, insisted on moving out of his house and into a practical three-bed flat. The flat was in a modern tower block, one of the tallest buildings in the southern Dutch town of Tilburg and consequently a local suicide spot. Despite efforts to heighten security, the jumpers kept coming. Oma saw one of them pass by her kitchen window as he plummeted to his death in the car park. Sometimes Opa threatened to jump off the roof too.

Opa’s behaviour grew increasingly err-atic. He was so lucid at times that it seemed like he was goofing around, playing at being a confused, forgetful old man, but a diagnosis of Alzheimer’s confirmed our fears. Oma’s two children and six grandchildren lived overseas, and few of her old friends lived within walking distance. But she was the kind of person who makes friends easily. If she didn’t have other plans she’d walk to her local café to drink two cups of coffee while watching the world go by, exchanging gossip and pleasantries with everyone who passed. Eventually, though, Opa grew so senile that she scarcely dared to leave him.

In 2011, Opa moved into a nursing home. I called Oma on the day of the move, knowing she’d be devastated. She had never lived alone before. She told me she had a sore throat and was going to bed early. I said I’d call the next day and for some reason, probably because I was young and selfish and found it all too painful to think about, I didn’t. Instead, I received a call from my mum a few days later to say Oma was in hospital. By the time I flew in to see her she could no longer breathe unaided. I leant in close to try to understand her questions, chatted nervously about the things we’d do together once she was better, and gave her a manicure because she was upset by her messy nails. She died soon after. Officially she died of pneumonia, but I can’t shake the feeling she died of loneliness, too.

It has become common in recent years to speak about loneliness in medical terms. Newspaper headlines describe an “epidemic” of loneliness in the UK, the so-called “loneliness capital of Europe”. According to the Campaign to End Loneliness, a British charity, over nine million people in the UK say they are always or often lonely. Loneliness is often discussed as a public health issue: being lonely is said to be as bad for one’s health as smoking 15 cigarettes a day.

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“During my years caring for patients the most common pathology I saw was not heart disease or diabetes, it was loneliness,” the former US surgeon general Vivek Murthy wrote in 2017. Last year the Economist’s 1843 magazine suggested that loneliness could be the “leprosy of the 21st century”. Scientists have even started investigating the possibility of developing anti-loneliness drugs. One University of Chicago study is exploring whether the hormone pregnenolone can reduce the heightened social anxiety that can perpetuate loneliness.

The study is being conducted by Stephanie Cacioppo, the widow and former research partner of John Cacioppo, a social neuroscientist who in 2008 co-authored, with William Patrick, Loneliness: Human Nature and the Need for Social Connection. The book outlined his research into how loneliness damages our physical and mental health. It argued humans are hard-wired to seek connection and that our modern way of living – in single households, as part of fragmented, transient communities – is at odds with our evolutionary inheritance. Just as physical pain prompts us to avoid physical harm, the social pain caused by loneliness protected our forebears from becoming dangerously isolated. Loneliness is meant to be a temporary discomfort, not a chronic one.

The stress of severe loneliness wreaks havoc on our bodies, it dampens our immune response, damages cardiovascular health, distorts our cognitive abilities, makes us depressed and impulsive, less likely to eat healthily and more likely to abuse drugs or alcohol. Cacioppo argued that chronic loneliness is also tragically self-perpetuating. Loneliness makes people defensive and socially awkward, either too eager to please or too quick to lash out. Loneliness begets loneliness, not just for individuals but across communities: one person’s inability to form social connections leaves another person feeling more isolated, and so loneliness can spread like flu.

We don’t have a word for the opposite of loneliness, a linguistic observation that is often held up as evidence of its emotional complexity. But Cacioppo didn’t think of things this way. For him the opposite of loneliness is the same as the opposite of thirst or the opposite of pain – normality.


In her expansive, sometimes lyrical new book A Biography of Loneliness (Oxford University Press, 320pp, £20) the cultural historian Fay Bound Alberti cautions against viewing loneliness as primarily a biomedical issue. She is wary of the moral panic surrounding loneliness, and the “knee-jerk, political soundbites” this invites. The way we talk about loneliness can make it sound like a historical inevitability, a universal condition rather than the product of socio-economic and political choices. Bound Alberti, whose previous books have explored the cultural and emotional history of the heart and the human body, explains that by charting the history of loneliness she hopes to expose the power dynamics that have shaped its naturalisation. “All emotions are political,” she argues, “none is so political as loneliness.”

According to Bound Alberti, the modern concept of loneliness, as an emotional state distinct from physical solitude, did not emerge until the 1800s. The birth of loneliness can be linked to major demographic, economic and spiritual shifts: the industrial revolution and the mass migration from agrarian, face-to-face communities to big cities, rising individualism and declining belief in an omnipresent, paternalistic God.

In recent decades the number of people who complain of loneliness has skyrocketed. Bound Alberti identifies and examines a number of trends that have played a role in this. She explores the loneliness of widowhood and singledom in a culture that still upholds the romantic ideal of a “soul mate”; the loneliness of young people – among the loneliest groups in Britain – who are finding that social media connections and online community are poor substitutes for the richness and reciprocity of real-life community; the loneliness of the old and infirm; the loneliness of the poor; the loneliness of the homeless and of refugees. She writes too of the transient loneliness that can feel painful but can also be beneficial, a source of creativity or of personal growth.

It is not coincidental that loneliness is often closely associated with poverty. Bound Alberti’s writing is most impassioned when she discusses how neoliberal politics – laissez-faire government, economic austerity, competitive individualism and the consumerist message that we can buy our way out of spiritual discontent – has created the conditions for widespread loneliness. The wealthy can be lonely too, but they are less affected by the government’s swingeing funding cuts to community centres and libraries, council housing and social care.

In 2018 the UK appointed its first loneliness minister. The role was established to implement recommendations by the Jo Cox Commission on Loneliness, which was formed in memory of the murdered Labour MP – an active proponent of policies to tackle loneliness. Writing in the New Yorker Rebecca Mead observed that like Brexit, the loneliness plan is “based on fantasy: in the case of Brexit, that a lost sovereignty can be regained without social cost; in the case of the Loneliness Ministry, that a rupture in the social fabric can be repaired on the cheap”. The government is like the deluded office manager who hopes that a Christmas party and a few team-building exercises can counteract a toxic work environment.

Three quarters of GPs report that one to five patients a day come to their surgery because they are feeling lonely. The government’s loneliness strategy suggests doctors should ramp up “social prescribing” by referring patients to local community groups and activities. As Bound Alberti observes, if they are to have any impact such initiatives need to take into account people’s variability. Not every lonely old person is just waiting for an invitation to a local bridge night or the bingo. There are no easy fixes: how much of loneliness among the elderly is a product of political alarm at the economic burden of our ageing population, or our fetishisation of youth?

But more than this, the government’s approach illustrates how modern medicine is increasingly called upon to address a spiritual, perhaps even economic and political, malaise. We may not yet be ready to think of loneliness as an illness per se, but we’re starting to treat it as one, as an ailment requiring a prescription, as something pathological, as a costly public health issue.

The medicalisation of loneliness isn’t necessarily a bad thing: doing so for other emotions, such as fear and sadness, has paved the way for life-saving mental health treatments, from drugs to talking therapies, to help people suffering from anxiety or depression. But it also encourages the view that loneliness is the product of individual dysfunction, a “pathology”, rather than a normal reaction to one’s circumstances. It simultaneously absolves a person of responsibility for their loneliness (you’re ill!) and holds them responsible for their predicament (you’re ill!).

I’ve had a lot of time to think about the circumstances of Oma’s death, of what could have been done instead – why, oh why, did I not call her when I said I would? – and how much difference it would have made. Could a doctor, more alert to the physical and psychological toll of Oma’s isolation, have intervened earlier? Would therapy or anti-depressants or family support groups have helped? Would she one day have been a candidate for anti-loneliness drugs, perhaps to address her above-average need for social connection? It’s hard to imagine when her problems appeared external: the move, the suicides, Opa’s illness, the useless, far-flung relatives who adored her but did too little.

If loneliness is a public health issue then drawing conclusions from a single case study is irresponsible – there’s a risk of sounding like the person convinced that homeopathy cured them of cancer, or that a flu shot made them sick, despite all evidence to the contrary. But in addition to Bound Alberti’s sharp political analysis, one of the most powerful themes in her book is how varied loneliness is, how embedded it is in our lives, how extensively it evades generalisation. Maybe loneliness is a 21st-century epidemic, a modern illness requiring an urgent response, but it’s also so much more than that. There are so many ways to be lonely, so many paths to loneliness, that it seems absurd to imagine there’s a cure. 

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