Manasvi Khandelwal talks about the loneliness that has stayed with her for a few months now, ever since she moved to Atlanta, the United States, after her wedding. “My husband and I are in a very happy relationship,” she says. “But there is some sense of grief because we are so far away from family and friends,” says Ms. Khandelwal.
A few weeks ago, the U.S. surgeon general, Dr Vivek Murthy, in an 81-page report, called the loneliness that America was going through, an epidemic. “Widespread loneliness in the U.S. poses health risks as deadly as smoking up to 15 cigarettes daily, costing the health industry billions of dollars annually,” it said. In an Associated Press interview, he compared loneliness to hunger or thirst “a feeling the body sends us when something we need for survival is missing.” “Millions of people in America are struggling in the shadows, and that’s not right.”
But loneliness isn’t just an American phenomenon. In India, which calls itself a collectivist society, promoting interdependence and cooperation, with 1.4 billion people and a population density of 470 per sq km (America has a density of 36 people; the world 60 as per 2020 World Bank data), it doesn’t seem likely that people could be lonely. Yet, they are.
In a study ‘What causes loneliness among household heads: a study based in primary setting in Mumbai, India’, published last year in BMC Public Health, 7% of respondents often felt lonely, while 21% had sometimes felt lonely in the week preceding the study. Another study, ‘A review of loneliness in Indian youth’, published in 2020 in The International Journal of Indian Psychology, says that while reliable statistics on loneliness in an Indian context do not exist, there is enough anecdotal evidence to suggest that it is dangerously at our doorstep.
“We are not short of people (in India), but we are often short of the understanding that community and connection are what keeps you healthy and happy,” believes Bengaluru-based psychiatrist Dr. Roshan Jain, a de-addiction specialist working at Apollo Hospitals. “Loneliness has significantly gone up among Indians, and it is going to become a bigger problem.”
India, like the world
Sanjay Suri (name changed to protect identity), 40, a Mumbai-based entrepreneur, is a self-declared extrovert with a strong support system. But he grapples with the loneliness of not having a romantic partner, someone to go home to at the end of a long, hard day. “People tell me to meditate, read a book, find a hobby, volunteer, adopt a pet,” he says, listing the world’s band-aid ‘solutions’ to deep problems, which often discount the core reasons behind loneliness.
There are multiple facets to loneliness, points out Dr Alok Kulkarni, senior consultant psychiatrist at Manas Institute of Mental Health, Hubli, adding that these range from feeling empty and abandoned to the lack of perceived intimacy, the constant and unrelenting feeling of being alone and the inability to connect with people at a deeper level. “The emotional aspects of loneliness include sadness, melancholy, frustration, shame or desperation,” he says. “This may be accompanied by self-doubt, low self-esteem, and social anxiety.”
The loneliness of an ageing population has been studied in the west and acknowledged in India as well. With the dissolution of the joint family structure leaving the elderly isolated, the death of loved ones, dealing with children leaving home, retirement, and battling multiple health conditions, big life changes — some that come together — can bring on loneliness.
But it’s also hitting India’s considerable youth (15 to 29 years) population of 27.2% (figures recently released by the government’s National Statistical Office). Ironically, it’s major life changes because of which many younger adults report loneliness as the most painful part of their lives, says Preeti Singh, senior consultant, clinical psychology and psychotherapy, and the chief medical officer at Lissun, a Gurugram-headquartered mental health startup. “We are more global than ever, which makes us travel more physically across the world, towns, the cities,” says Ms. Singh, pointing out that people who move away from their roots, often struggle to adapt and fit in these newer, different cultures.
Khandelwal agrees. The sense of unbelonging and uncertainty, feeling stuck between worlds, exacerbates her sense of loneliness. Since she is on an H1-dependent visa she cannot take up a job and finds the uncertainty of being asked to leave the country anytime means she cannot invest in furniture or build a ‘real’ home. “I’m guessing this sense of loneliness comes from not being able to build anything, both professionally and personally,” she says.
Loss and loneliness
“Stressful life events like bereavement, break-ups, and immigration are associated with loneliness,” says Dr. Kulkarni. He adds that low social connectedness, inadequate support network, low sense of belonging and psychological vulnerability are other important factors.
Aparnaa Nagesh, 40, an independent art professional in Bengaluru still remembers the crippling loneliness she felt when lost her mother in June 2021 to COVID. “It felt like something out of a space odyssey movie, where I was just floating around. I was just so lost for almost a year,” remembers Ms. Nagesh.
In 2020 ‘A systematic review of loneliness in bereavement: Current research and future directions’ published in the journal Current Opinion in Psychology, concluded that “…loneliness is a core, perhaps even pivotal, experience associated with grief, one that is linked to some extreme difficulties in adjusting to the loss of a close person, one that merits development of targeted interventions.”
While Dr. Kulkarni does suggest some common-sensical preliminary measures such as reaching out to family and friends, joining local groups of classes, volunteering, spending time outdoors and exercising, he is univocally clear about reaching out to a mental health professional. Ms. Nagesh, who has also struggled with depression, has worked with two therapists, and says she has benfited. “I think especially if you live alone and have trauma and grief in your baggage it is important to get therapy,” she says.
Loss doesn’t necessarily mean a demise in the family; it could also be a significant life change. According to Dr. Jain, many older people, for instance, experience intense loneliness after they retire, or their children move away. Like Mumbai-based consultant Shalini Agarwal (name changed to protect privacy), in her 50s, whose life changed when her children left home, the older one during COVID. While Agarwal has a large family that is fairly connected, “I didn’t want to talk to people,” she recalls. Instead, she turned to the television, binge-watching series for hours on end. “I just wanted to distract myself,” says Agarwal.
Then there are long-term problems of which loneliness can form one part. “The LGBT community is increasingly feeling isolated and lonely due to lower social ties and lower levels of social integration,” says Dr. Kulkarni, adding that people who have experienced physical and or sexual abuse are likely to feel lonely, as are those who are already dealing with mental health problems such as substance misuse, depression, bipolar disorder, and dementia.
The nature of work
With the opening up of the job market to include freelance and gig work, people turn to the internet for connection and community. Mumbai-based artist Indu Harikumar, 43, was an early adapter to the internet, turning to it for both social connections and work. “I wouldn’t have thought of having some of the conversations offline, that I would have in an online space,” she says, adding that, “At some point, I forgot that I needed the physical connection,” she says, adding that this is something she is consciously working on changing by ensuring that she goes out every weekend. She has also stopped doing things like classes online, opting for in-person stuff instead. “I go for bachata classes twice a week now,” she says. “I cannot tell you how physical touch makes me feel so good about myself.”
The omnipresence of the internet, which often creates a reality more potent than the natural world, means that people turn to it for many things: to forge communities, work smarter, find love, acquire new objects, entertain, or connect with loved ones many continents away. And yet, as multiple studies have proved, over and over again, there is a strong correlation between high internet use and loneliness. A meta-analysis of 26 articles, with a sample size of 16,496 subjects, titled ‘Association between internet addiction and loneliness across the world’ published in SSM Population Health in 2021, found “a moderate positive association” between internet addiction and loneliness.
There’s also the push for entrepreneurship in a job-short market and a society that glorifies it. Karen Martin, 26, the founder of Alkemi Media in Bengaluru, says, “I am a solopreneur. I feel like I am alone on an island,” she says, pointing out that few people, even her close friends and family, truly understand what she is trying to achieve.
Over time, loneliness can end up impacting both mental and physical health. “Loneliness is associated with many psychiatric disorders, such as depression, sleep disorders, personality disorders, and Alzheimer’s disease,” says Dr. Kulkarni, adding that chronic loneliness can also turn on genes that cause inflammation. It is also associated with diabetes, rheumatoid arthritis, lupus, coronary heart disease, hypertension, obesity, and cancer. In short, it portends poorer health outcomes, he adds.
He firmly believes that loneliness is something that needs to be tackled at a social and policy level. “Steps to tackle loneliness in the elderly include social skills training, fostering community support groups, creating age-friendly communities, and framing policies that address marginalisation and discrimination,” he says. He also believes that it is important to promote inclusive behaviour, ensure that the youth have access to better facilities for education, promote school mental health, make mental wellbeing a priority, and design mental health training modules for teachers as part of psychological first aid.
Ms. Singh concurs. “It is high time that the policy-makers make a difference, the magnitude of the problem is fairly immense,” she says, adding that the United Kingdom has recognised this and created a Ministry of Loneliness to tackle the issue. “Let’s learn from them,” she adds.
Together: Loneliness, Health and What Happens When We Find Connection by Vivek H Murthy
The Lonely City by Olivia Laing
Human Nature and the Need for Social Connection by John T Cacioppo and William Patrick
Lost Connections: Uncovering the Real Causes of Depression and the Unexpected Solutions by Johann Hari
If you are struggling with loneliness, reach out to findahelpline.com/in/topics/loneliness, thelivelovelaughfoundation.org/helpline or icallhelpline.org/.