Loneliness as a Component of Psychiatric Disorders

Richard Booth, PhD

Disclosures

Medscape General Medicine. 2000;2(2) 

In This Article

The Problem of Definition

Loneliness is not an easy condition to define; it is much easier to describe. This definitional challenge emerges, in part, from the differential perspectives of those researching the problem. In all areas of science, including the psychological and other human sciences, nosology succeeds epistemology: that is, the method of naming a condition derives from the way one thinks about that condition. For example, some researchers argue that a considerable problem in loneliness is that lonely people have deficient social skills.[9] This argument suggests that certain individuals, lacking effective communication skills that provide meaningful interaction with others, find it difficult to feel connected to other people, and loneliness may ensue as a result. The clear focus of this approach is on identifying skill deficits and remediating them through some form of social skills training. A definition of loneliness from this perspective is likely to include a central concern with feeling alone, rejected, or alienated as a function of an inability to establish, maintain, and terminate relationships appropriately. On the other hand, other researchers consider that loneliness is related primarily to attachment difficulties stemming from insufficient bonding and love in childhood. They would define loneliness differently. At present, while a number of definitions for loneliness do exist, they are not necessarily consistent with one another.[10]

Regardless of a particular theorist's or researcher's definitional bias, a survey of the literature strongly suggests that loneliness is a multidimensional problem, involving not merely social skills deficits and dysfunctional attachment histories but also cognitive styles, attributional patterns, situational problems, unrealistic expectancies, and other factors. Any acceptable definition of loneliness would have to account for this multifactorial situation in a logically meaningful way. Even though it is now possible to construct a prototype or a "general case" of a lonely person, if there is no universally agreed-upon definition of loneliness, it is imperative that within-group variance be kept constantly in mind, particularly when attempting to identify loneliness accurately within a clinical setting. The literature suggests that, while general patterns may exist in lonely people, such people are far from identical; differential levels and varying types of loneliness must be considered when dealing with lonely people.[7,11]

Although loneliness has been defined in many ways, in the final analysis people appear to feel their loneliness, even though they may not fully understand it. Fundamentally, loneliness can be conceptualized as an aversive affective condition, accompanied by any number of possible problematic cognitions, life circumstances, problem-solving strategies, interactive patterns, and various other factors, depending on the individual. The subjective experience of loneliness, however, is at the heart of the matter, and is sometimes so intense that lonely people can think about little else. In addition, lonely people possess a deep sense of emptiness that they frequently describe quite accurately as loneliness. When asked if they are lonely, they often respond affirmatively. Moreover, if they are asked to respond on a paper-and-pencil psychological test about their loneliness, they frequently indicate, accurately, that they are lonely. It should be noted, that, while many correctly identify themselves as lonely, either verbally or in writing, some lonely people appear confused about what they are feeling and misidentify their affective condition. Weiss, attempting to describe just what it is that lonely people are feeling and expressing, poignantly suggests that lonely people's subjective experience of loneliness is very distressful and without redeeming features.[3] When people are truly lonely, they feel miserably unhappy, vacuous, and painfully hollow.

Even without a universal agreement about defining loneliness, a few words need to be said about what loneliness is not. Voluntary solitude, for example, is not synonymous with loneliness. Lonely people do not voluntarily enter into that emotional state; rather, they "find themselves" feeling sometimes desperately lonely for reasons even they may not fully understand. Voluntary solitude, on the other hand, can be a healthy alternative to interacting with the "noise" of the world and a respite from the constancy of dealing with the sometimes harrowing contingencies of modern life. Solitude may be sought for deep growth experiences such as meditation, visualization, listening to music, and other forms of "doing nothing."[12] Neither is being alone synonymous with loneliness: the data show that some lonely people have sufficient interactional networks and are, nonetheless, lonely because they are dissatisfied with those networks[11]; conversely it is well known that some people enjoy the state of aloneness, within which they might be very productive or creative, and these people are alone without being lonely.[13]

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