Patient Education - COVID-19 AND LONELINESS: CAN WE DO ANYTHING ABOUT IT?

A psychiatrist writes about the unique experience of loneliness during coronavirus and how to address it

It is quite amazing. Up to about six months ago, no one mentioned loneliness. Loneliness is known to have a significant stigma to it, and while untold number of people are lonely, temporarily or continuously, people did not dare to discuss it out loud. If I am lonely, that means that no one wants to be close to me. That means, simply, that I am not good enough. And in our couple culture, which adores successful people, I feel like a failure and am probably seen like that by others. I will, therefore, shut up so others do not see what a loser I am.

Hence, loneliness has become deeply stigmatized, and people simply do not talk about it.

However, it took the COVID pandemic to let the horse out of the stable. Loneliness has become a hot topic, a common complaint, and something that people openly discuss and wish to change.

Why the change? Nowadays, being lonely does not suggest our shortcomings as much as reality of COVID, which has forced individuals to be locked up at home.

To better understand loneliness and be able to address it effectively, certain concepts need to be clarified. Loneliness is not a feeling but rather an experience that has emotional and cognitive dimensions. Loneliness is painful and distressing and consequently we do not choose or enjoy being lonely. It is a subjective experience influenced by one’s personality, history and situational variables.

Hearing the word loneliness often conjures images of being alone. And while being alone can, indeed, promote loneliness, being in a crowd – for example on a bus or in a theater of even surrounded by a loving family – we can also experience loneliness which is even more painful. However, the most painful loneliness is the one we may experience in an intimate relationship which lost its zest, excitement and intimacy

Two kinds of loneliness

Loneliness is differentiated between reactive and essential.

• Reactive loneliness is that occasional loneliness that may be experienced when undergoing the loss of a significant person or various other losses, or a major disruption in life like moving to another city or country or separation from a loved one.
• Essential loneliness is intertwined into our personality, most probably as a result of infancy or childhood experiences with caretakers. Those people who are lonely at their core cannot simply stop it unless they undergo deep and lengthy psychotherapy. In my clinical practice, I have treated couples who experienced relational disharmony where, for example, the husband was showering his wife with love, caring and attention, and the woman still complained of experiencing loneliness, alienation and being unloved by the world.

5 Dimensions Of Loneliness

• The first and the most salient dimension is emotional distress, which we feel when lonely. The gnawing pain, hurt and anxiety, feeling as if our heart is breaking.
• Next are social inadequacy and alienation, which are experienced as the concern that we are not good enough for others to want out company, feeling inadequate, ignored and not valued.
• The third dimension is interpersonal isolation, marked by thinking that I am not loved by anyone, have no meaningful close or romantic relationship, and basically do not matter to anyone.
• Self-alienation is the fourth dimension. It focuses on experiencing my body as thought it is separate from my mind – a kind of a defense mechanism to prevent me from feeling the searing pain of loneliness.
• The last dimension is growth and discovery, which address the growth-promoting effects that this experience may have, the ability to realize that we may have more resources to cope with a difficult situation than we thought, a new appreciation of others and of interpersonal relationships, and a clearer understanding of ourselves and our world.

Concepts related to loneliness

These are concepts people often equate with loneliness but which differ in their cause or the experience they bring about.

• Loneliness anxiety. This is the anxiety one may feel just at the thought of the possibility of experiencing loneliness. It is akin to those who survived the Holocaust and experienced the depth of hunger that none of us will hopefully ever know. When they came out of the concentration camps and settled in the world, even in rich countries, they continued to horde food which they later needed to throw away as it rotted, but without which they would feel very anxious at the prospect that they may once again suffer the terrible hunger pangs that they experienced so many years ago. So the hording is not to prevent hunger but to reduce the anxiety about that possibility. Similarly, there are those who would become very busy, at work or the dating scene, just so they can reduce their anxiety about loneliness.
•  Depression. Are loneliness and depression the same? People frequently wonder about this. While it is true that a lengthy experience of loneliness may breed depression, it is possible for one to be depressed without being lonely. What really tells the difference is what we want when experiencing these. Generally, depressed individuals want to be left alone, and they may even push others away if they get too close to them. Lonely people yearn for the opposite; they yearn for the company and closeness of others. And so, these different experiences which bring about different behaviors.
• Solitude.  Being alone is a fact, a description of one’s geographical state. Some perceive it, almost automatically, as loneliness. But as we mentioned, it only describes our geographical position. Solitude occurs when we welcome that aloneness because we chose it to do what can be done alone, such as reflect, plan, walk in the woods, create, paint, write and sculpt. Many well-known literary creations were a result of the author’s solitude. Solitude is refreshing, providing us a respite from out fast-paced and demanding world, and is always welcomed by those who experience it.

Addressing loneliness in the era of COVID

Complaints about loneliness due to physical (rather than social) isolation are rampant. People wonder what they can do and how can they handle the forced social isolation. Clients who are seen for psychotherapy inquire about the best way to deal with the loneliness they experience.

The first step is for them to become aware of the difference between loneliness and solitude, and that being alone does not have to be construed as loneliness, for it could as easily be solitude. Earlier, I made a distinction between reactive and essential loneliness. Many who have been quite lonely prior to the COVID era, continued to experience loneliness during the forced physical isolation. These people will, unfortunately, continue to experience loneliness when the measures taken to fight COVID are be relaxed. That is part of their personality, and unless they engage in a lengthy individual psychotherapy, they may not be able to shake it on their own.

As humans, unlike what many may feel, we have control over how we survive and live through this unique period and what our days will look like. The problem arises for those under lockdown — they may feel helpless in this situation.

Learned helplessness

There is a story that poignantly illustrates what it means. In India, there was a farmer who got a small young elephant as a present. He loved the animal and played with it, but when he tended his fields, he tied the elephant to a large wooden pole that was planted in the soil. The elephant did not like being tied for the whole day and attempted with all its might to free itself. After several days and realizing that the pole is planted firmly in the ground and cannot be moved, the elephant gave up and just stood there the entire day waiting for the farmer to free it. As the years passed, the elephant grew and reached the size and strength that could easily unearth the wooden pole to which it was tied. However, the elephant had learned in its infancy that once tied to the pole, it cannot free itself, and even when it grew and strengthened, it never even tried to unearth the pole.

That is an excellent example of learned helplessness, which is what many may feel since being ordered to remain at home. They seem to believe there is nothing they can do about it, no way to control their days and social connections. That is clearly incorrect.

Taking back control

Humans can indeed control their days, their actions, their choices and their perception of the situation. Yes, it is true that during this period, individuals are not able to visit their children, grandchildren or elderly parents. However, living in the 21^st century, surrounded by technology, it is possible to connect with them even more intimately than when regular meetings take place. Intimacy is not closely linked to distance; it reflects our behavior and our ability to get closer to the ones we connect with.

Beyond that, visitations can take place within the limitations of standing six feet away from each other. It can be done as frequently as people wish to show our caring and connection. Instead of perceiving this period as one when we are forced to huddle at home and social connections are prohibited, there is a different way of viewing this period. Firstly, while physical connections are discouraged, social and intimate connections can flourish via the internet, phones, Facebook, etc. or by visiting our neighbors and loved ones without going into their homes and maintaining the required distance.

Not only did many take social connection for granted in pre-COVID days, they did not bother to remain connected simply because daily chores and responsibilities took over. Humanity is now going through a very special time that may not occur again during our lifetime. It seems that the world has stopped moving. Unlike what people got used to, the air is now clear, and people who yearn for social connection are kinder and greet each other. Being at home allows us to do various things we have wanted to do but did not have the time for.

It stands to reason that this period of isolation will not last much longer. It may be that while many cannot wait for life to once again be rushed and hectic, there are others who may not be prepared to return to the humdrum of “regular” life. It’s been quite good to take a breather, become more self-aware and get to ourselves and others better.

 Suggested reading :  Dr. Rokach’s book: The Psychological Journey To and From Loneliness