Only the Lonely

Podcast Transcript

Host: 00:00
From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm Jon Earle. My guest today is Dr. Louise Hawkley. She's a senior research scientist at NORC, a research institution at the University of Chicago. Dr. Hawkley studies the impact of loneliness and social isolation on health and well-being, especially for older adults. I wanted to have her on because, let's face it, it's been a lonely year, and loneliness was already widespread in our society. Few people know more about it than Dr. Hawkley—how loneliness comes on, how it perpetuates itself, and which interventions are actually proven to help chronically lonely people. So whether you're lonely or know somebody who struggles to connect, I think you'll find something useful in here.

Host: 00:45
Dr. Hawkley, welcome to Road to Resilience.

Dr. Hawkley: 00:47
Thank you very much, a pleasure to be here.

Host: 00:50
I want to start out with sort of an odd question, because loneliness is such a common feeling. Everybody knows what it feels like to feel lonely. And yet you, as somebody who studies it formally, have a special understanding of loneliness, a more specific one. So let's start at the very beginning. What to you, Dr. Hawkley, is loneliness?

Dr. Hawkley: 01:08

Well, the first thing is what it is not. It is not being alone, and that is a common first misperception—that being isolated like we have been during the pandemic means that we're necessarily lonely. It certainly increases the risk of feeling lonely, but it is not synonymous. So what is loneliness? Definitionally we can say it's a mismatch between what we expect or want from the relationships we have and what we're actually getting from those relationships. Sometimes that's purely quantity, like, I need to have more people and I can't find more people, or more typically it's—I have people but they're not satisfying me. It's like eating a meal of celery or something. You know it's just not cutting the mustard. So the quality of the relationship matters a lot.

Host: 01:59
Reading about loneliness, I've come to see it as you and Dr. Cacioppo and others have called it a signal. What is it a signal of? Why loneliness? What is the purpose of loneliness?

Dr. Hawkley: 02:11
We think of loneliness as equivalent to a hunger signal. It's signaling that we need to reach out and eat, socially, whatever it is that we need. It's a biological signal and it's part of who we are. It's a motivational impulse in our brain that's very adaptive. How we survive as humans is we survive best with others.

Host: 02:39
What is the working number that's in your head for how many people struggle with loneliness in America?

Dr. Hawkley: 02:45
My figures are most current regarding older adults, and typically the figures range from about 20 percent to 40 percent. In the National Social Life, Health and Aging Project, which is a nationally representative sample of older adults that we've been chronicling since 2005, I think the most recent estimate for people who are feeling lonely—and I don't mean chronically lonely—but at a given point in time is about 25 percent. For younger adults it looks to be higher. I have some questions about the kinds of samples that have been used to make these estimates, but I can pretty safely state that they do have higher rates of loneliness.

Host: 03:28
Younger people, we're talking approximately?

Dr. Hawkley: 03:30
We're talking about what I think now is called "emerging adulthood," like 18 and up, as old as 30 or 35.

Host: 03:40
Loneliness is bad for our health. It's bad for our mental health and it's bad for our body. How so? Break that down for us.

Dr. Hawkley: 03:48
When we talk about loneliness being bad for us, we have to think about it in a temporal way, too. Transient loneliness is not uncommon, not necessarily bad; that's the signal we were talking about. It's when you can't get out of the loop, when that signal isn't reaching you or you're not able to act on it, whatever the reason may be, that's when you start seeing effects, at least that's the way we've been viewing the data we have to date. So the effects go, if you're talking about physical health, start at the top and go on down. People who are chronically lonely are more at risk for dementia, for various types of cognitive decline. Let's see, what's next? Cardiovascular systems. So these are people who are more likely to develop hypertension, cardiovascular disease, whether that's heart failure, stroke, angina, various types of cardiovascular diseases. If you go down a little further, you go to the hypothalamic pituitary adrenocortical axis, big name, it's just the system that manages and controls the body's stress response. And you see some dysregulation of people's control of that stress response. Related to that, we also see that people who are lonely, chronically lonely in particular, are more likely to show a great increase in the activation of pro-inflammatory genes, those that promote inflammation in the body, and deactivation of those genes that stall inflammation. Inflammation is good in the sense that it's normal and you need it for, let's say, recovering from poison ivy. In the body, it wreaks a whole different set of problems that contribute to a lot of the chronic diseases of aging.

Host: 05:50
Is it useful to think of it in evolutionary terms? Like, you're separated from the group and you have to be on guard and that sort of thing?

Dr. Hawkley: 05:58
The framework around which we think of loneliness is very much an evolutionary framework. If you think of loneliness as a signal like hunger, that it has a biological motivation, you have to ask—why is it there? Because it feels so terrible. But it's like hunger. Hunger doesn't feel good, but the point is it does the job, it gets you to eat. And so evolutionarily, we want people to be capable of feeling lonely, because that's what ensures that they will bind to a group, to other people, to their children, their spouse, whatever level you're talking about. At the same time, we don't want everybody to stick so close to each other that nobody gets out and sees what's happening on the other side of the tracks. We need explorers, we need people who can take a bit more pain of separation and get out and talk to other people, maybe collaborate with them, cooperate with them. This is how the big things in our civilization have happened and we've learned to cooperate to work together.

Host: 07:09
This gets to what to me a core insight on loneliness, which is the cycle of loneliness—how loneliness begets loneliness, how this signal, this alarm bell starts ringing, and if the loneliness is transient, the person is able to respond and feed the social hunger, but that doesn't always work.

Dr. Hawkley: 07:31
Right, so the cycle is a feedback loop, essentially. So when people feel lonely— and, again, you can take this back to evolutionary terms—it's this feeling that nobody's got my back, I'm on my own. That's a scary feeling and it makes you defensive. You've got to protect against assaults, and in the course of protecting yourself from potential hurt, damage, you may become more cautious in your interactions with others, you may put up barriers. And even if you have an interaction with other people, you may not be as forthright as you might be otherwise. That kind of behavior begets that kind of behavior. People sense whether they're being cut off in some sense, if a person isn't being forthright with them, and that makes them behave in perhaps a fashion that is less than desirable from the lonely person's perspective, they're not as friendly because they're trying to case the situation, too. What's going on here? What can I say? What can't I say? And by doing that, the lonely person essentially has affirmation that this is not a safe place, these people aren't doing for me, what I thought they would they're in fact kind of barricading themselves behind some kind of wall. And along with that come other emotions that are even contagious, I mean, you can feel pretty miserable and people around you may seem to look less happy than they are when they're interacting with others so then that makes you feel even more down. And the cognitive interpretations of all that—it's me, it's all about me, nobody likes me. Or you might go the other way and say, I'm being victimized. I don't know what's going on. At any rate, it does create a cycle of negative interactions that seem to become more negative and as that builds up, it just confirms this notion that nobody likes me, or nobody is what I need them to be, and it makes the loneliness stick around or get worse.

Host: 09:55
If I'm understanding you correctly, it's both an internal and external thing. The word contagion. Wow. Loneliness as a contagion. That if you are on high alert to threat, if you start to see the world as a dangerous place, if you start to interpret people's behaviors as being about you or somehow hostile to you, when they might be totally neutral or not about you at all. You start to behave in a certain way, and then people respond to you in a certain way—they're less likely to want to be around that suspicious defensive person. Is that right?

Dr. Hawkley: 10:27
Yeah and that plays right into interventions. You ready to go there?

Host: 10:35
I'm ready to go there if you're ready to go there.

Dr. Hawkley: 10:38
This belief that there is something to fear out there and that it's something about me, or maybe it's, "I'm being victimized," that is itself a problem that lends itself well to social cognitive intervention. So it's really ultimately in those cases training to reinterpret your surroundings, because you get into cycles of negative thinking too, especially about your social world. And this thinking backfires, I mean, it's not working for you it's just making things worse. So it's training to think of another reason why the person at the grocery store checkout didn't respond to your hello greeting. It's not you. Maybe she had a bad day. Maybe she's just got reamed out by her boss. Maybe she had a car accident before she came in. There's so many other interpretations you can give to others' behavior rather than think that they've got it in for you, or that there's something about you. So retraining on that front seems to do well in terms of getting people out of those damaging loops of loneliness.

Host: 11:54
You're talking about cognitive behavioral therapy, right?

Dr. Hawkley: 11:57
Very much like that, but it's very specific to social aspects of people's lives.

Host: 12:03
I see. And I should mention that this is a subject you've studied, right? You've studied interventions.

Dr. Hawkley: 12:08
Yeah, not that I'm an interventionist, but we have compared different types of interventions that have been attempted over the years, and that particular type of intervention in a study that we reported back about 10 years ago was the one that seemed to have the biggest effect. Other types of interventions were things like social contact, people who assume that the problem with loneliness is you don't have people to talk to, therefore I will give you people to talk to and we'll find you a group, or we'll find you some people to talk to on the phone and all will be well.

Host: 12:43
Didn't work so well?

Dr. Hawkley: 12:44
Not so much. It's true for some people, but getting back to the root of what loneliness is, it's not just contact, it's quality of interaction or quality of relationship. And if you're thrown together in a room with a bunch of other lonely people who you've never met before, you know, here you have all kinds of things working against you, you have loneliness, contagion, just magnified. You have no choice, which is a big part of loneliness is the sense that you don't have control that it's happening to you and not that you can change anything. So yeah, it's not a formula for a good intervention. Now, of course, if you don't have any contacts at all, which was a problem and an issue during the worst of the pandemic, especially in senior living facilities where people were essentially locked in their rooms, they could perhaps have virtual contact, but they had no control over any other contact they had. And that itself is lonely making, never mind the fact that they were isolated.

Host: 13:51
You mentioned that the intervention for loneliness can be very specific. What might it consist of? What are some of the specific thought patterns that a therapist would try to change?

Dr. Hawkley: 14:03
I don't know that I would talk about the therapist angle, that's not my domain, but if you look at types of interventions more generally—if somebody is feeling lonely because they are indeed isolated, let's say they're disabled, they can't leave the house and their family lives on the other side of the country and if they talk to them, it's maybe every two weeks or something like that and in between there's nothing meaningful in their social exchanges—all right there you have what I would argue is a need for something as better than nothing. And it is, in fact, Little Brothers Friends of the Elderly is an international program, but they have a number of chapters across the U.S. Their mission is to reduce loneliness and social isolation and their target population meets those criteria of having very infrequent meaningful interactions. Nothing wrong with that. I think for younger adults, and this is where there isn't a lot of data on this yet, but I would venture to say that there are a number of inroads that one could make both behaviorally and cognitively. This is where we could get into social media use. It's a funny thing, social media is heavily used by people who are very social, have a lot of activity, and it's heavily used by those who don't have a lot of social activity, but it's used very differently. And it's understanding how people are using it, and maybe there's something to be learned here from the older generation in the sense that the benefit of social media use is to supplement what you've already got, not to replace. So let's say you have really close friends and family members that have dissipated, they're all across the country. Well, having some access to them via social media is great, but to find a meaningful connection on social media is really a hit or miss thing. And oftentimes it's a big miss because social media might be used in a way that essentially highlights how lonely you are, this social comparison—what's everybody else doing and here's me. So, yeah, that's one inroad for tackling it.

Host: 16:35
What does this mean for the future of the younger generations who were born, like really born, onto screens and born into social media and who've known no other world? Are you worried about their future?

Dr. Hawkley: 16:49
I tend not to get worried, but I do think there's going to be a payoff of some kind. We have a granddaughter who was born into the pandemic, so we've gotten to know her through the screen, and she is amazingly good at recognizing that those things on the screen are actually people. She knows! That's great for us and for her, I think to some extent. I want to say it'll get worse before it gets better, but I say that within generation as well as across generations, because I'm optimistic that our social drive, that signal to connect will at some point kick in. We will recognize that this isn't doing it for me, something's not right here. Maybe it'll take until people have their own kids, or even after that. Maybe they see their own kids going down the sink hole of social media and realize, oh, that's the problem that I've been having. I don't know, but I feel like there will be the ultimate trumping of the human motivation to have this interpersonal, in-person contact that involves sight, smell, hearing, touch, all of those things that really bind us to each other.

Host: 18:18
I mean to use the food metaphor, it's the distinction between junk food and healthy food. And I think people have come to appreciate that distinction.

Dr. Hawkley: 18:28
Yeah. And I'm hoping that that appreciation will go on in future generations.

Host: 18:33
You touched on the pandemic a moment ago, it would seem to me to be the world's best and biggest loneliness experiment possible. What have you learned about loneliness from the pandemic?

Dr. Hawkley: 18:46
I think the biggest thing that I come away with is what a sea change there has been in society's appreciation for understanding of, willingness to talk about loneliness. This is not something that typically was given the time of day. Yes it was in broad strokes. Yeah, we have this epidemic with loneliness. But nobody really knew, what's loneliness? It's something that old people get because they're alone all the time. No, that's not what we're talking about. So the fact that people have, to varying degrees, been isolated or made themselves isolated, has I think generated a new appreciation for how much we need those people around us, those people in our network. And I think an appreciation that this is a universal experience and that we all must learn from each other. But the fact that it's universal gives us a grounding for talking about it in a way that is appreciated by all parties. We know what we mean, we all appreciate how important it is. If we can carry that forward, I think we have something very promising to look forward to. But we have to be intentional about it. It won't just happen.

Host: 20:05
Your late colleague, Dr. John Cacioppo, saw in the prevalence of loneliness in our society an indictment of our society. He wrote, "Western societies have demoted human gregariousness from a necessity to an incidental." Do you feel that way?

Dr. Hawkley: 20:24
Yes, and increasingly so in the current climate. I just feel like we're putting a lot of that gregariousness, that necessity, on the chopping block to maintain the tribes that we have artificially created around ourselves that separate us from other people, rather than those that bind us to other people. Tribes are good, but they need not be exclusive and it's crossing that boundary, being willing to talk to the other tribe, seeing commonalities. And it doesn't mean that those people have to become our closest buddies. This is where the notion of a weak ties comes in. Just being able to be friendly and civil in greeting somebody who you know has a very different political alignment than you do, but you can sincerely wish them well or tell them about the movie you saw the other day or whatever might be, a new restaurant in town. It's something that opens the door to connection.

Host: 21:33
It's so interesting that your mind went to polarization, because I was thinking about it in terms of economics and family structures and increasing numbers of Americans living alone. The way that we treat relocation in our economy, like, I'll just move. It'll be fine, we'll just move. Like, no problem.

Dr. Hawkley: 21:52
That's certainly part of it, but I think of the quality of relationships and what it takes to feel connected. Maybe the better way to think about this is the way I think about loneliness, which is it's a multifaceted concept. So when we look at dimensions of loneliness we see that there is something we call an intimate level, which basically corresponds to how connected you feel to a close other, typically a spouse, but it's basically a sense of self that is so comfortably embodied in and with another person that it becomes like a bigger self. That's an intimate connectedness. There's a relational connectedness that is more tied to close confidants. Just having people you can share things with, talk about important stuff. But there's also a third layer that I don't think gets enough attention, and it's the collective sense of connectedness or loneliness. Do you feel like you belong to a group that has meaning to you? To society? And you can think of people who are quite peripheralized from society, whether it's because of racial or ethnic status, or LGBTQ, or maybe it's age, whatever it might be, you can be made to feel like you belong, or you can be made to feel like you do not belong. That's lonely making. So when I think of polarization, I think that's what we're doing, we're hitting that collective aspect and excluding people from this larger social sphere in which we all inhabit.

Host: 23:40
I like that. There's something fundamentally important to the signal being sent that you belong in the biggest sense.

Dr. Hawkley: 23:47
Yes.

Host: 23:48
We did touch on emerging from loneliness. We talked a little bit about the interventions. I'm wondering, as people continue to emerge from COVID isolation, what might they do, especially the introverts, to do that in the right way? Like how can they begin to dip their toes back into a more "normal" social life?

Dr. Hawkley: 24:09
It's an interesting question and I think it doesn't hold only for introverts. I know many people who, even though it's only been a year plus, it's been a year plus! And the idea of resuming normal, what does that mean? And I think it's a time to be thoughtful about how one does this, and this is for everybody in that we took for granted the social contacts we had, the relationships we had, and we really didn't appreciate how important that larger immersion in that larger social context matters. This is our chance to be deliberate. Maybe what we did before wasn't all good, maybe we spent too much time not nurturing good relationships, maybe we spent it on frivolities, frivolous social stuff. But if we do take a little more time to think about it, we could hopefully be more deliberate about choosing to connect, choosing to connect across all levels with people close to us, with groups, with our society, not only for our own benefit, but including others, like, how do we connect others to this social sphere we inhabit?

Host: 25:31
I'm interested in what you would say to somebody who's listening to this who is lonely or is close to a lonely person. You know, sort of practical steps. What can a person do? Like where do you begin to break that cycle of loneliness?

Dr. Hawkley: 25:44
Yeah. I say that in a rather resigned tone of voice because I know this can be very difficult, especially in older adults. I hear this a lot from the children of older adults who wish for and try to direct their parent, or aunt, or grandparent, to some kind of social venue, and the person just obstinately refuses. Don't want to do that, don't want to go there. Partly because I think there is this resignation—this is who I am now, don't make me do this new thing, I don't want to go there. But in general I think this is a time for empathy. I think if there are opportunities to do intergenerational things, I've seen some interesting examples, even among people with cognitive impairment, where the child and the cognitively impaired older adult will go to a dance class together. It's fun, it gets the person out. It doesn't have to be in those kinds of settings. It can be volunteering, and there's a lot that has to be done to be careful, to match people with their volunteering opportunity. Again, choice plays a big role here, but if you can find, or at least help an older adult, or a friend, or a partner find a possible connecting point through a volunteering opportunity, I think that's a safe way to go. Because if they're in a place where their skills meet that group's needs, they won't get rejected. They'll be loved. So it's a profitable direction to go.

Host: 27:33
Why is that such a good one? I've heard volunteering mentioned before.

Dr. Hawkley: 27:36
Well part of it is that it gets you out of yourself. You're out there for other people. And maybe that can be part of the reason why older adults don't suffer as much from loneliness; they're not as worried about themselves as they are about their children and grandchildren. What can we do to make them feel good about where they are in life and to connect them, so volunteering—it's this nurturing aspect of the stages of life. So yeah I think of volunteering as much the same, you're doing for others.

Host: 28:12
That's so interesting. I've encountered this before, but it never ceases to amaze me that there's something about giving that begins to loosen, to thaw all this frozenness inside.

Dr. Hawkley: 28:24
The thing that also comes to mind is that giving generates giving, and I don't mean from the other person. The funny thing about giving is the act of giving to someone else kind of makes you feel obliged to give them more, right? So you continue to give, and that attitude—it's a pay it play it forward kind of thing. It does come back, but it breeds its own cycle of giving, of positivity.

Host: 28:56
I think that's a great place to kind of wrap it up because we've gone from a negative cycle to a positive one. This cycle of giving begets giving.

Dr. Hawkley: 29:04
Aren't we good?

Host: 29:06
This has been a pleasure, Louise. Thank you so much for taking the time to talk.

Dr. Hawkley: 29:09
My pleasure, too.

Host: 29:12
Dr. Louise Hawkley is a senior research scientist at NORC at the University of Chicago. That's all for this episode. If you enjoyed it, please rate and review us on Apple Podcasts, it helps other people find the show. Thanks. For more resilience tips, including transcripts and photos, visit our website, www.mountsinai.org/rtr as in "Road to Resilience." The podcast is a production of the Mount Sinai Health System in New York City. It's made by me, Jon Earle, Nicci Cheatham, Emma Stoneham, and our gregarious Executive Producer Lucia Lee. From all of us, thanks for listening and take care out there.