Loneliness: An Epidemic

Social isolation isn’t just bad for your psyche. It’s linked to a host of ailments including heart disease, cancer, diabetes, depression and suicide. But is chronic loneliness a life sentence or is it possible to re-engage with society and find health and happiness?

A little over a year ago, Anne Cartledge fell in the lobby of her apartment building. It was a small misstep – her flip-flop hooked on a floor mat and down she went. She didn’t break any bones.

But in the next weeks, Cartledge felt a bit broken by what happened. She was badly bruised and developed recurrent cellulitis, a painful skin infection requiring antibiotics. The medications to treat it upset her stomach.

Back and forth she went to the Rockyview General Hospital for weeks, relying on taxis to get there – an extravagance for her already tight budget. She struggled to learn how to shower with an intravenous site on her arm.

“That’s when I felt the loneliest,” she says. “I was injured and I was alone.”

Cartledge never imagined she would wind up lonely. She raised three daughters, trained as a social worker, owned a dog. She’s outgoing and articulate, funny and engaging. These are things that ought to buffer against loneliness.

But, at 67, she is lonely – and in that, she isn’t alone. Around the world, loneliness is emerging as a public-health problem, contributing to depression and anxiety and to coronary heart disease and stroke. It’s associated with a 26-per cent increased risk in premature death.

Loneliness cuts across all ages and socioeconomic groups, affecting people who live alone but also those who don’t. Millionaires, celebrities, senior citizens, teens – no one is immune.

An American study released this spring showed the high rates of loneliness, with nearly half of the 20,000 survey respondents saying they sometimes or always felt alone or left out and one in four said they rarely or never feel as though there are people who really understand them. And, it was the youngest generation surveyed, those aged 18 to 22, who felt the loneliest.

No similar study exists for Canada, but experts say loneliness is hurting Canadians at unprecedented levels. “We are experiencing an epidemic of loneliness and isolation,” says Lisa Androulidakis, executive lead, Centre of Excellence for Peer Support and Recovery at the Calgary branch of the Canadian Mental Health Association.

Smaller studies show loneliness is prevalent in certain groups across Canada: a 2016 survey found two-thirds of university students felt lonely in the last year; for Canadians aged 75 and older not living in an institution, almost one in six has no close friends they can confide in or call on for help.

Humans have never been so technologically connected, but we have less social contact than in the past, according to data from Statistics Canada. Consider your interactions over a day in Calgary, a growing metropolis with a population of more than 1.4 million. We can connect superficially with more people than ever before in the course of a day: strangers in the Plus 15 walkways, people at spin class, a person (if, indeed, it is a person) on the end of one of the more than 300 million active Twitter accounts.

But some experts suggest the quality of our social relationships is eroding. In modern, industrialized cities, we often live far away from extended family. We’re more likely to live alone, to not have children. We email, text, tweet, Facebook but we don’t talk to strangers. We bank online and order coffee by app and buy groceries from Amazon to be deposited outside our front doors. We live in homes with closed garages and fenced yards, especially in Calgary.

“It’s like people’s homes have swallowed them up,” says Annastasia Stevens, the Calgary Seniors’ Resource Society volunteer services manager, comparing life in the city of Calgary to the small towns where she grew up. “They don’t know their neighbours. They aren’t out on the street; they aren’t interacting.”

Cartledge lives by herself in a subsidized one-bedroom apartment in the southeast neighbourhood of Fairview. She’s estranged from her two surviving kids. Her dog, a bichon mix named Belle, passed away about five years ago. Cartledge, who suffers from severe arthritis and fibromyalgia, didn’t feel up to the task of acquiring and caring for a new pet.

Most, if not all, of the tenants in her building receive financial support to live there. For some, it’s their first home after living on the streets. They tend to keep to themselves. So does Cartledge.

“Being lonely and isolated makes people more agoraphobic. It’s much easier to be that way,” she explains.

There are stories about loneliness from every pocket of the city, covering all age, socioeconomic and ethnic groups in each quadrant and neighbourhood.

At the Calgary Seniors’ Resource Society, Stevens spends her days finding volunteers to help isolated seniors throughout the city. The stories that Stevens hears about older citizens across Calgary astonish her, even after 13 years in her job. At Christmas, a young volunteer delivered a gift to a retired professor, the first present he had received in years. One man, distressed by the death of his cat, secretly buried it in his backyard. He refused to leave its body when it came time for him to move. “Loneliness is a huge problem,” says Stevens.

Calgary’s urban sprawl might be a contributing factor, especially for the very poor, she adds. People who have ready access to transportation tend to have stronger social connections, even in the age of the Internet. “If people don’t have a lot of money and aren’t able to afford groceries on a weekly basis, they are unlikely to use what they have to participate in anything social, which leads to further social isolation and loneliness.”

There’s nothing to suggest that Calgary is a lonelier city than others, as there’s no study that compares loneliness city by city in Canada. The closest thing may be Canada’s General Social Survey (GSS), which queries Canadians on different themes like social networks and social engagement every five years. Compared to other Canadians, Albertans appear to be well-connected to friends and family: 60 per cent of Albertans have at least five close relatives and 54 per cent have five close friends. In both categories, we do better than the national average at 55 per cent and 51 per cent, respectively.

But loneliness isn’t something you can measure from social connections alone.

Toronto psychologist Ami Rokach surprised his colleagues in 1980 when he said he wanted to study loneliness. “They thought I was lonely myself, and so needed to study the subject,” recalls the York University professor.

But academic thinking on loneliness has changed dramatically in the last 38 years. It’s now studied by researchers in fields ranging from psychology to urban design. Loneliness is no longer considered “just a feeling,” says Rokach. “It is now considered an epidemic, and the proof of how seriously it is taken can be seen by the appointment of a minister of loneliness in Britain.” Rokach rattles off a list of descriptors for loneliness including crushing pain and “internal emotional storms.”

“If it is chronic, it can be severely depressing, and complex … We do not have nice or sweet kinds of loneliness. It is always painful,” he says.

Loneliness differs from social isolation, a problem easier to identify and easier to address, says Rokach. “Social isolation happens when a person doesn’t have enough people to interact with. Loneliness is the experience we endure when we feel that we are not important to others, that no one truly cares about us, that we do not have emotionally intimate relationships and when we do not succeed in getting out of that situation.”

Being alone isn’t a requirement for loneliness; loneliness happens at home, on a bus, at a party. Sometimes, the most painful loneliness occurs in an intimate relationship, says Rokach, “where we expect to be close to someone and we find out we don’t know the person we are sleeping with at night. And then we feel a terrible pain, the pangs of loneliness.”

Loneliness is not the same as depression but it’s a strong risk factor for depression, and vice-versa: depression exacerbates loneliness. They’re partners in crime, each goading the other on. Writer Andrew Solomon, whose book The Noonday Demon: An Atlas of Depression was a finalist for the Pulitzer Prize, calls depression “a disease of loneliness.” Solomon wrote in The Guardian in 2014 about the association of love, loneliness and depression: “Love – both expressed and received – is helpful, not because it ameliorates the symptoms of depression (it does not), but because it gives people evidence that life may be worth living if they can only get better. It gives them a place to admit to their illness, and admitting it is the first step toward resolving it.”

A 2015 study by American psychologists showed loneliness, social isolation and living alone were associated with a higher risk of early death – even more so than obesity. Down to the cellular level, we can see the effects. Loneliness leads to fight-or-flight stress responses, affecting the production of white blood cells. John T. Cacioppo, the psychologist who led the 2015 study, called loneliness “social pain,” a sensation humans developed to protect us from the harm of isolation.

Cacioppo died this spring after a diagnosis of cancer. His wife Stephanie Cacioppo, a brain researcher with whom he’d shared an office for the last seven years, wrote an email to the New York Times after his death, saying, “as John would say, and I agreed with him: ‘If you think about what our species would be like without loneliness, it would not be nearly as endearing a species. Loneliness, which compels us to bond with others, gives us what we call Humanity.’ ”

Loneliness becomes a serious concern when we suffer from it for extended periods, John Cacioppo wrote in his book Loneliness: Human Nature and the Need for Social Connection. Chronic loneliness doesn’t just affect our physical health but impedes our ability to make intelligent decisions about what is good for us.

Cacioppo once led an experiment in which some participants were told that no one wanted to work with them, setting them up to feel socially disconnected. Those participants ate twice as many cookies as those eaten by participants who had been told everyone wanted to work with them. It’s among the simplest of studies, but a telling one.

“This loss of executive function also helps explain the oft observed tendency of rejected lovers to do things they later regret,” he wrote.

Linh Bui, the program coordinator for the Greater Forest Lawn Community Connector Initiative, draws from her own experiences when she talks about how to address the loneliness of people in our communities.

Bui and her husband moved to Calgary from Vietnam in 2005 and lived in a secondary suite in the basement of a house in Forest Lawn. The family who lived above didn’t know them but “took us in as part of their family,” Bui says. For months, these neighbours were the closest friends the Buis had in Calgary. Acquaintances of the family helped them to buy a car – a terrible second-hand one that kept breaking down, but a car, nonetheless.

Bui remains grateful to the people who helped in those first months. Now, she tries to do the same for other newcomers. She organized a “pay-it-forward” day in Forest Lawn to spread random acts of kindness. The community is often portrayed as a ghetto, she says, with high rates of crime and violence, which makes people leery of each other. She wants Forest Lawn to be a place where people feel comfortable talking to strangers, so Bui and volunteers handed out Tim Hortons gift cards and started conversations at bus stops with people they had never met before. “It’s so important that we build a sense of community,” says Bui.

She’d like to see more funding for programs that build community and support the socially isolated. “We see seniors who rarely go out. I also see it with single parents, especially single moms who have limited access to resources and limited time. I see it with newcomers or the immigrant population. Language barriers contribute to social isolation.”

Bui’s colleague Marichu Antonio, the executive director of the Ethno-Cultural Council of Calgary, says addressing loneliness in Calgary needs an approach that’s three-pronged: individual, community, systems. People can start by paying attention to their neighbours. Don’t overlook people whose accents or skin colour or socioeconomic situations are different than yours, she says. The Ethno-Cultural Council of Calgary where she works recently changed its name to Action Dignity – a move to reflect the organization’s belief that every human deserves to be treated with dignity.

Antonio talks about building a “culture of humility” in Calgary. “This is how we can build a welcoming community. If we are respectful of the cultures of others and we don’t see ourselves as the dominant culture, we can instill the culture of humility. That will, I think, spark the culture of kindness and caring among us.”

Dr. Nabeela Nathoo is a resident physician in neurology at the University of Alberta. While in medical school in Calgary, she and classmate Omar Damji created a program to call isolated seniors at home once a week, based on a similar initiative in the U.K. It was “eye-opening,” she says, to see how a simple intervention can help.

“Loneliness is a growing problem and if we don’t keep it at the forefront of our thoughts in health policy and planning and things like that, it will grow into being a bigger issue than it is now. It probably is one of those things that we can curb through trying to enhance people’s social interactions,” says Dr. Nathoo. “It’s something that truly does have an impact on people’s health and well-being overall. I hope that people take it more seriously than we have.”

From her Fairview apartment, Cartledge agrees.

When she found herself struggling with paperwork related to her pension, she reached out to the Calgary Seniors’ Resource Society. They paired her with Jon, a volunteer who took her grocery shopping. She made him laugh by tossing groceries into the cart. He taught her to text and nicknamed her “Shenanigans.”

His friendship changed her life.

“Through him coming into my life, I was able to open up – a lot. I saw a lot of attributes that I had that came to the foreground and he encouraged them,” says Cartledge. She has since become an advocate for better housing policies for low-income Calgarians, arguing that a person’s income can worsen their loneliness.

To make her case, she wrote a poem about aging in isolation, something she wouldn’t have had the courage to do last summer:

“Not one person, cares enough to come and ask,
And this old body and mind cannot, will not,
venture out there anymore.”

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