By Richard Gunderman, MD, PhD
IU School of Medicine 

Loneliness plays a much larger role in human health and disease than many of us once supposed. In part because treating disease as a purely biological phenomenon tends to generate more revenue for hospitals, drug and device companies, and physicians, we often neglect its social dimensions. Yet now we are beginning to realize that medicine’s greatest pathologist, Rudolf Virchow, was right when he emphasized that medicine is less a biological science than a social science.

About one-third of adults over the age of 45 report feeling lonely, a number which tends to increase further with advancing age. Adolescents and young adults also have high rates of loneliness.  Loneliness is clearly dangerous. It increases all-cause premature mortality to about the same degree as smoking and obesity, with about a one-third increase in risk for heart attack and stroke, a 50% increase in dementia risk, and a two-thirds increase in the rate of hospitalization.

People at increased risk of loneliness include those with lower incomes, those with a history of a psychiatric disorder, victims of discrimination, those with chronic diseases, and those undergoing major life transitions, such as job loss, divorce, or the death of a loved one. 

Yet loneliness is present in all demographic categories, and it is important for physicians not to think of themselves as invincible in this regard. Physicians, too, can be lonely. 

A Harvard Business Review study suggested that physicians and lawyers are the loneliest workers in America, followed by those in engineering and science. In fact, loneliness appears to be positively correlated with educational attainment. It is quite possible that more educated people may expect more of themselves as individuals and, therefore, reach out less to others to share their concerns and vulnerabilities and build relationships. Perhaps they suppose that they should be self-sufficient.

Some might find the suggestion that loneliness is endemic in medicine hard to believe. How can a physician who spends hours daily in the company of patients, their family members, and other health professionals possibly experience loneliness?  Doctors’ offices and hospitals seem like bustling places – how could anyone ever feel lonely there?  Moreover, physicians do not seem to fit the demographic profile of loneliness.  For one thing, they tend to rank in upper-income groups.

Yet loneliness is not the same thing as being alone. Someone can be in a solitary setting yet not feel lonely, and someone else can feel profoundly lonely in the middle of a crowd. Loneliness is often defined as a keen sense of being alone and disconnected from others. People may be surrounded by others yet acutely conscious of lacking close or meaningful relationships or being distant from those with whom they share such relationships.

In some ways, loneliness can be normal, at least to the extent that nearly everyone has felt lonely at some point or another.  The novelist Thomas Wolfe wrote, “The whole conviction of my life now rests upon the belief that loneliness, far from being a rare and curious phenomenon, is the central and inevitable fact of human existence.”  Associated health problems tend to arise when people feel chronically lonely for weeks, months, or years on end.  

There is good reason to think that we as a culture are experiencing increasing loneliness. Americans are more likely than we once were to be single than to be married, to be childless than to be parents, and to work, eat, and live alone. Technology also plays a role. Radio, television, and the internet have made it possible for people to remain informed and entertained without coming into direct contact with other people. Moreover, we are a more mobile society, spending more time in unfamiliar settings.

One problem for physicians in assessing loneliness is the lack of objective metrics. We can measure a patient’s blood pressure or serum cholesterol, but to assess loneliness we must inquire into the patient’s subjective experience. And while there is no doubt that some may feign loneliness, the best approach is to take subjective assessments of loneliness at face value.  If someone reports that they are lonely, we should generally assume they truly are.

This makes detecting loneliness among physicians especially difficult.  Many physicians are loath to share their own difficulties, perhaps from a fear that others will think less of them. Others fear that admitting loneliness would mean that there is truly something wrong with them since they spend a good part of their days with other people.  Others may feel that their mission in life is to tend to the suffering of others, not draw attention to their own.

No one is truly self-sufficient, no matter how hard they have worked to achieve success in life.  The core of the problem may be the mistaken presumption that human health is a purely individual attribute. In fact, as Virchow reminds us, there is a profound social dimension to health, and only those physicians who appreciate our interdependence, need for connection, and the fulfillment that comes from fellowship can truly help themselves and one another.

What steps might we take to enhance friendship and community in medicine?  First, physicians need to take time to talk with and build relationships with others. To say that we are too busy to do so is like saying we lack time to be healthy. Second, we need to help build and sustain community, whether through civic or religious organizations, informal groups such as book clubs, or organized medicine. Finally, we need to be there for one another. Excellence lies less in what we extract than in what we share.