Loneliness: A Public Health Issue with Two Forms, Global Recognition, and Health Risks
Elvis Presley's 1973 comment on a sad song coincided with Robert S. Weiss's paper identifying emotional and social loneliness. This condition, now a major public health issue, has dedicated ministers in the UK and Japan, and a WHO commission. Professor Brian Lawlor advocates for its recognition in psychiatry due to its severe health risks, comparable to smoking, and its impact on mental health.
Elvis Presley famously described Hank Williams’s «I’m So Lonesome I Could Cry» as the saddest song he had ever heard during his January 14, 1973, Aloha from Hawaii concert. That same year, sociologist Robert S. Weiss’s paper, «Loneliness: The Experience of Emotional and Social Isolation,» identified two distinct forms of loneliness: emotional and social, both impacting health.
Emotional loneliness is the absence of a close confidante, often linked to the loss of a partner or deep emotional bond. It can lead to hyper-vigilance and reduced empathy, hindering new relationships. Social loneliness is the lack of a broader social network, causing feelings of marginalization, boredom, and exclusion. While both can coexist, emotional loneliness is considered more pernicious. Long-term loneliness is a significant health risk, comparable to smoking 10-15 cigarettes daily, exceeding hypertension and obesity.
Loneliness is now recognized as a major public health issue. The UK (2018) and Japan (2021) established dedicated ministers for loneliness, and Ireland added it to the mental health minister’s brief in 2019. The WHO formed a Commission on Social Connection in 2023. Professor Brian Lawlor of Trinity College Dublin advocates for loneliness to be considered a co-morbidity in mainstream psychiatry, not a mental disorder, due to its exacerbating effect on psychiatric conditions. He cites Kurt Vonnegut’s 1974 call to create stable communities to cure loneliness.
Lawlor’s own research in the early 1990s at St James’s Hospital, Dublin, revealed loneliness as a risk factor for depression. He recounts a patient with treatment-resistant depression whose condition improved after addressing her emotional loneliness following her husband’s death, involving family and community reconnection without medication. Risk factors for loneliness include widowhood, being a woman, mental illness, physical disability, caregiving, living alone, bereavement, poor social networks, and low socioeconomic status. Loneliness peaks at ages 30, 55-60, and 80, with 5-10% experiencing it to a significantly impairing degree.