The surprising health risk factor deadlier than obesity

Emily Dickinson described the quiet devastation of loneliness as “the horror not to be surveyed.” But modern researchers are surveying it and increasingly view it as a public health issue. And for good reason. Mounting evidence links loneliness to physical illness and cognitive decline. In fact, as a predictor of early death, loneliness eclipses obesity, according to a powerful recent study reviewed in The New York Times.

In the U.S., about one in three people over 65, and half of people over 85, live alone. As a result, 46 percent of people over age 60 experience loneliness.

According to neuroscientists, feelings of loneliness and depression stem from the same area of the brain. And like depression, loneliness acts like an aversive impulse (motivating actions to reverse it) similar to hunger, thirst or pain.

Evidence also links chronic loneliness with increased levels of cortisol, a major stress hormone. (Along with Dr. Ken Seaton, I proposed that cortisol is also an “aging hormone” in a scientific paper almost 20 years ago.) Evidence also links loneliness with increased blood pressure. And it may even impair the immune system in fighting infections. (That’s the cortisol connection.)

Loneliness takes a physical toll on older adults

Dr. Carla Perissinotto, a geriatrician at University of California, San Francisco, led a 2012 study that analyzed the relations between key measures of health and self-reported feelings of loneliness among 1,604 people over 60. Forty-three percent of the participants reported loneliness. They also had higher rates of declining mobility, difficulty in performing routine daily tasks, and increased death rates over a six-year period.

In another analysis, researchers pooled data from 23 studies, including data on 181,006 men and women 18 and older. These participants experienced 4,628 coronary heart events (heart attacks) and 3,002 strokes during follow-up periods ranging from three to 21 years. The researchers found that social isolation and loneliness increased risk of heart disease by 29 percent and stroke by 32 percent.

Growing sense of loneliness in America

In my view, it seems loneliness has been growing in America for decades.

Nearly 20 years ago, I remember picking up a public policy journal called the Wilson Quarterly and reading the lead article entitled, “Fifty years of the lonely crowd.” The article was a retrospective on the seminal book The Lonely Crowd by David Riesman, who was then celebrating his 89th birthday.

Riesman was born in 1909, in a town house just around the corner from where I was living in Philadelphia at the time, nearly 80 years later. (I made a little homage to the house, which still stands in a historic district of the city.) Riesman’s father had been a prominent member of the clinical faculty at my alma mater, the University of Pennsylvania School of Medicine. He also wrote books on the history of medicine.

Riesman began writing The Lonely Crowd in the late 1940s. And it started as an analysis of the sources of political apathy. But by the time it was published in 1950, it had expanded into an ambitious study of American life. By the 1960s and 1970s, the striking title — The Lonely Crowd — had become a catchphrase to describe what was happening in American society.

Riesman’s editor came up with the book’s title at the last minute. (Editors often are the ones who find great titles for good writing.) Of course, the ivory tower academics dismissed the book, perhaps because of its short and effective title. But the general public read it avidly.

Amazingly, the words “lonely crowd” never actually appear in the book, but they somehow seemed to summarize the ambivalence experienced by a generation of middle-class Americans at the time. It also captured the essence of the crony capitalist, bureaucratized, sanitized, suburbanized, and homogenized society that began coming into full flower after the end of WWII. (Probably the worst long-lasting legacy of World Wars I and II in the U.S. was the massive expansion of big government, bureaucracy, taxation, and the crony capitalist “government-industrial complex” warned about by Dwight D. Eisenhower of that era.)

After a history of self-reliance, individualism, independence, and liberty, America was turning into a nation of anxious and overly governed empty suits. Thus, the booming, post-WW II population started to become a teeming, homogenous throng. But as individuals, many Americans felt alone, devoid of purpose, despondent, and empty of meaning.

The 1998 Wilson Quarterly article argued that readers largely misunderstood this modern classic during the decades of its greatest popularity. They claimed its analysis of American society is more relevant at the beginning of the 21st century than it was in the mid-20th century, when it was published.

In my view, The Lonely Crowd may best be seen today in the tradition of John Stuart Mill, Ralph Waldo Emerson, Alexis de Tocqueville, and Herman Melville, whose central writings revolve around the fate of individuality in the age of the manufactured mass world.

Riesman’s book concludes: “the enormous potentialities for diversity in nature’s bounty and men’s capacity to differentiate their experience can become valued by the individual himself, so that he will not be tempted and coerced into adjustment…The idea that men are created free and equal is both true and misleading: men are created different; they lose their social freedom and their individual autonomy in seeking to become like each other.”

One can make an argument that increases in chronic diseases and disability parallel the rise in loneliness in our society. Without a doubt, spending time with loved ones and in social settings benefits your health. So aim to make good on that promise “to get together soon” with the neighbor you see out walking. Join a club. Strike up a conversation at the bookstore. Above all, keep your friends close and your family closer, as we advised in a recent Dispatch. You’ll feel better physically and mentally for the effort.


“Researchers Confront an Epidemic of Loneliness,” The New York Times ( 9/5/2016