My patient and I both knew he was dying.
Not the long kind of dying that stretches on for months or years. He would die today. Maybe tomorrow. And if not tomorrow, the next day. Was there someone I should call? Someone he wanted to see?
Not a one, he told me. No immediate family. No close friends. He had a niece down South, maybe, but they hadn’t spoken in years.
For me, the sadness of his death was surpassed
only by the sadness of his solitude.
I wondered whether his isolation was a driving force of his premature death, not just an unhappy circumstance.
Every day I see variations at both the beginning and end of life: a young man abandoned by friends as he struggles with opioid addiction; an older woman getting by on tea and toast, living in filth, no longer able to clean her cluttered apartment.
In these moments, it seems the only thing worse than
suffering a serious illness is suffering it alone.
Social isolation is a growing epidemic — one that’s increasingly recognized as having dire physical, mental and emotional consequences.
Since the 1980s, the percentage of adults who say they’re lonely
has doubled from 20 percent to 40 percent.
About one-third of Americans older than 65 now live alone, and half of those over 85 do. People in poorer health — especially those with mood disorders like anxiety and depression — are more likely to feel lonely. Those without a college education are the least likely to have someone they can talk to about important personal matters.
A wave of new research suggests social separation is bad for us.
Individuals with less social connection have disrupted sleep patterns, altered immune systems, more inflammation and higher levels of stress hormones.
One recent study found that isolation increases the risk of heart disease by 29 percent and stroke by 32 percent.
Another analysis that pooled data from 70 studies and 3.4 million people found that socially isolated individuals had a 30 percent higher risk of dying in the next seven years.
Loneliness can accelerate cognitive decline in older adults, and isolated individuals are twice as likely to die prematurely as those with more robust social interactions. These effects start early: Socially isolated children have significantly poorer health 20 years later, even after controlling for other factors.
All told, loneliness is as important a risk factor for
early death as obesity and smoking.
The evidence on social isolation is clear. What to do about it is less so.
Loneliness is an especially tricky problem because accepting and declaring our loneliness carries profound stigma. Admitting we’re lonely can feel as if we’re admitting we’ve failed in life’s most fundamental domains: belonging, love, attachment. It attacks our basic instincts to save face, and makes it hard to ask for help.
Dhruv Khullar, M.D., M.P.P., is a resident physician at Massachusetts General Hospital and Harvard Medical School. Follow him on Twitter at @DhruvKhullar.