Surrounded by Others & Yet So Alone

Ms. Mathew:
A staggering 47 percent of adults in America are affected by loneliness, and at a time when Americans are social distancing amid the COVID-19 pandemic and with recent evidence linking loneliness to increased health risks like heart disease, stroke, and depression, addressing this new epidemic with our patients is now more important than ever. 

Coming to you from the ReachMD studios in Fort Washington, Pennsylvania, this is the ReachMD Book Club.  I’m Princy Mathew, and joining me is Dr. J.W. Freiberg, who also goes by Terry, to discuss his book titled Surrounded by Others and Yet So Alone, in which he studies chronic loneliness through the unique lens of a social psychologist. 

Terry, welcome to the program. 

Dr. Freiberg:
Well, thank you very much. 

Ms. Mathew:
So, Terry, in your book you’ve used storytelling in the way of 5 case studies to have us consider the complexity of human relationships.  Why did you decide to write in this way as opposed to academic prose? 

Dr. Freiberg:
Because everybody loves a story.  Children, adults, everybody will listen to a story, and I find it a very effective way to reach people’s emotions as well as their thoughts. 

Ms. Mathew:
And before we dig deeper, how do you define chronic loneliness? 

Dr. Freiberg:
Loneliness for me is a sensation, not an emotion.  It’s like hunger or thirst or fear.  It comes from the animal part of our brain, from the parietal lobe, so loneliness is something we get signaled, just as hunger or thirst, inadequate water, inadequate food, inadequate connection to others. 

Chronic, of course, is a different issue.  We all feel lonely from time to time.  We all get these signals of disconnection.  For chronically lonely people, it’s the world they live in.  There are people with no connections, which I studied in a prior book called Four Seasons of Loneliness, and then there are chronically lonely people who are around others but still subjectively feel lonely, and that’s what the new book, Surrounded by Others and Yet So Alone, is all about. 

Ms. Mathew:
Thank you for that, Terry.  You’ve described chronic loneliness just now as a sensation rather than an emotion.  As healthcare professionals, how could this transform the way we care for our patients who may be chronically lonely? 

Dr. Freiberg:
Well, I think there are some very powerful tools that we have to use.  Let’s start with the UCLA Loneliness Scale version 3.  It’s been around now for over 20 years, and it has a remarkable statistical significance in terms of both reliability and validity.  There’s just 20 questions.  Here’s a couple of samples.  “How often do you feel that you are in tune with the people around you?”  Another one is, “How often do you feel part of a group of friends?” 

So, when you answer these 20 questions on a scale 1 through 4—never, rarely, sometimes, and often—and when you add them up at the end, they quite cleverly give you an accurate picture of how well-connected you are to others in your life, whether you really have relationships that are working for you or not.  And if someone were to do that and find that they have an issue, they don’t have enough connections that they value and that nurture them, they can then turn to the Relational Assessment Chart. 

By chance it’s also 20 questions; that’s coincidental.  And when you put the name of relationships up top—Joe, Mary, Harry, your friends, your family, your workmates and so on—and then you go down the 20 questions, you answer questions on a scale of again 1 through 5.  Here are some samples.  “This person trusts me with his feelings,” or, “I can count on this person to help me out in an emergency,” or, “Despite our different roles, we treat each other as equals.”  So, when you go through these questions for each of your relationships that you want to score, you end up with an aggregate score that’s very accurate and a little disturbing sometimes because you find that sometimes the people you trust the most with your most private and important feelings are not the obvious people in your life.  It may be a workmate rather than your wife or husband.  It may be a sibling rather than a friend.  But you certainly end up with a very powerful and magnified assessment of each of your relationships that you put through this little questionnaire test. 

Ms. Mathew:
You know, Terry, especially since the advent of social media, it seems like we can always be connected with others.  So, how does technology figure into the loneliness epidemic? 

Dr. Freiberg:
Well, it’s a complex question and answer, as you might imagine.  Obviously, the media can be used in a healthy way that helps one stay connected, or one can bury oneself in the media and be lost from face-to-face connecting with others.  I think one of the powerful tools is the new media—Facetime, Zoom and their competitors—that allow visual representation to be present while there is oral communication, and this allows mirroring, this skill of reading the intentions and emotions in people they are speaking with.  So, one can use the media wisely or, as so many young people do, overuse them.  And, in fact, the Generation Z and the millennials, so that’s 18-year-olds through 38-year-olds, I believe, score the loneliest of any age group on the UCLA Loneliness Scale that I mentioned earlier. 

Ms. Mathew:
And continuing on with that theme, Terry, can you describe for us the 5 main modes of disconnection you identify in your book?  

Dr. Freiberg:
Sure.  I just took a look at law cases.  I’m also an attorney, and I was general counsel to mental health professionals in the city of Boston for 35 years, and they would call for legal consultation and tell me in the process about their patients, and these cases of chronically lonely people who were misconnected—so they were around other people—broke down into 5 groups:  obstructed connections, people who were too busy to do a good job of being a parent, being a child, being in a relationship with others; another one was one-way connections, people who get in a relationship for a very different reason than the other person; fraudulent connections, people whose relationships are based on fraudulent accountings of who they are… By the way, under this category, about 40% of current new couples have met each other on the internet, and about 45% of people who put their personal profile on these dating sites lie significantly and materially about who they are and what they believe, so there’s a lot of fraud at the basis of modern relationships that probably wasn’t there so much in the past.  Other relationships have the problem of being tenuous, being uncertain, unclear.  Obviously, the mental health positives of being in a relationship are based on one’s capacity to be confident that the relationship will carry on.  And finally, there’s a category of dangerous connections, spousal abuse being a classic example.  When you talk to a battered spouse and try and convince them to leave, they often won’t leave the relationship because it’s a type of connection.  It’s an unhealthy and dangerous type of connection, but for them a type of connection.  So those 5 modes of misconnecting with others, if you like, make up the backbone of the book, and I’ve written out a client case for each of them. 

Ms. Mathew:
For those just tuning in, you’re listening to the ReachMD Book Club.  I’m Princy Mathew, and today I’m speaking with Dr. J.W. Freiberg about his book Surrounded by Others and Yet So Alone. 

So, Terry, let’s shift gears and talk about how the COVID-19 pandemic may be impacting those with chronic loneliness.  What are some of your observations? 

Dr. Freiberg:
Well, I think the best way to answer that question is to take 3 age groups.  Let’s start with children.  Children are divided often from other children and often enough from grandparents, and tracing that through makes one worry, because the way in which children practice their relational skills, in making friends, in entering groups, in dealing with rejection from groups—remember high school?—or in identifying the local bully and dealing with him, this has to do with children’s free playtime, so that obviously has been greatly compromised.  And this doesn’t happen between siblings.  It’s non-sibling children free play where children work out their relational skillsets. 

If you look to middle-age people, the working people, there are a lot less relationships going on, and they have lost the closeness of physical contact, of the mirroring capacity that comes when they are near others, of touching others.  A loss of touch is going to have a big psychological effect, I think.  We are the kind of mammal that brush up against each other and enjoy hugging and touching.  It’s part of our animal nature, so that’s an issue. 

And then for older people, retired people, for grandparents, it’s an enormous gap, and I’ve been thinking lately about what grandparents supply.  Since we know parents supply children with the skillsets they will use to learn to value close relations with others, grandparents connect us to the history of our families.  It takes 2 points to define a line, and I think it takes 2 generations to define a lineage, so grandparents, I think, are greatly saddened by this distance from their grandchildren.  And one can only hope that the medical field is able to bring this disease under control soon enough where people can get back to being close to one another and touching with one another and dealing with one another in all 3 of these age groups. 

Ms. Mathew:
And just to bring all of this together, how can we lower our risk of becoming chronically lonely, especially during this current season of sheltering in place and social distancing due to the COVID-19 pandemic? 

Dr. Freiberg:
Well, I take a look at that in 3 ways, if you like:  relational due diligence, taking a good look at who our important relationships are and doing something about it; secondly, relational repair, maintenance like we do for our car, for example…  You have to call your cousins and your friends.  We’re much more divided off from our family and our childhood friends than throughout the entire history of human beings up to just a few generations ago.  We don’t grow up around our cousins very often these days.  In the past everyone always did, so picking up that phone or, better yet, one of the smartphones with their photo capacity and getting back in touch with your cousins, for example, is a way of strengthening that family lineage that you come from.  And thirdly and finally, relational creation, getting out there and meeting new people, joining the kind of groups where you’re likely to meet the kind of people that you can relate to and create relationships with, that obviously is more difficult to do while we’re locked at home, but hopefully that will be possible. 

Ms. Mathew:
Those are some great tips for us to keep in mind, not only for ourselves but also for our patients who may be struggling with loneliness during this time.  And with that I want to thank my guest, Dr. J.W. Freiberg, for joining me to discuss his book Surrounded by Others and Yet So Alone.  Terry, it was great having you on the program.  

Dr. Freiberg:
It was my pleasure indeed. 

Ms. Mathew:
I’m Princy Mathew.  To access this episode and others in the series, visit ReachMD.com/BookClub where you can Be Part of the Knowledge.  Thanks for listening.