By Karen Weintraub GLOBE CORRESPONDENT APRIL 24, 2015
By all rights, Betty Lewis should be a lonely woman.
Now nearly 90, her daughter, grandchildren, and great-grandchildren — whom she’s never met — all live in California. Her friends have died or moved to faraway nursing homes. Health problems mean she can’t get outside without help, and her vision troubles make reading a challenge.
But Lewis, of Brighton, involves herself in public lectures, continuing education classes, sales on eBay, and visits from friends and volunteers for Little Brothers-Friends of the Elderly.
“I’m an optimistic person,” said Lewis, who still laughs a lot and values her ability to put aside unpleasant thoughts. “I think that’s so important for anybody’s survival of a decent, non-unhappy life,” she said.
A growing body of evidence suggests that there could be health consequences for someone like Lewis if she dwelled on the negatives.
Chronic loneliness, it seems, is partly a matter of social isolation and partly a state of mind. Both can potentially drive ill health.
Lonely people over 65 run the same risk for early death as those who smoke or are at least 100 pounds overweight, according to a study published last month in the journal Perspectives on Psychological Science.
Although the exact mechanism isn’t clear, loneliness “activates a whole host of biological systems that appears to be harmful to people’s health,” said Bert Uchino, a professor of psychology at University of Utah, who was not involved in the new study.
A lonely person’s blood pressure tends to be higher and change more as they age; and they are more likely to have high levels of inflammation, which leads to even more health problems, Uchino said.
“Often mental health is a precursor or warning sign that physical health is in danger,” said Laura Kubzansky, a professor of social and behavioral sciences at Harvard’s T.H. Chan School of Public Health. Loneliness is “a really important aspect of people’s lives we should be paying attention to — but it’s not the kind of thing doctors typically ask about.”
Loneliness is particularly problematic among older people, said J. David Creswell, an associate professor of psychology at Carnegie Mellon University. They may have lost loved ones, or their social fabric may have frayed when they left the workforce or the neighborhood where they laid down roots.
Today’s older people are more alone than counterparts of 50 years ago, said Andrew Steptoe, a professor of psychology at University College London.
In the United Kingdom, for instance, more than one-third of people 65 and older live alone; 40 percent say that TV or pets are their main form of company; and 23 percent of men and 15 percent of women have contact with friends or family members less than once a month, Steptoe said.
Social structures that used to help people avoid loneliness in old age, like close extended families, neighborhood groups, and religious institutions aren’t as strong or as readily available as they used to be.
For those whose loneliness is a matter of social isolation the solution, while not necessarily simple, may be more straightforward. For them more human contact may be the solution.
There are others, however, for whom loneliness is harder to resolve as it is partly a function of personality and temperament.
These are people — whether socially isolated or not — who tend to be mistrustful of others, often negative, and feel threatened, said Steve Cole, a professor of Medicine and Psychiatry and Biobehavioral Sciences at the University of California, Los Angeles School of Medicine.
“When we think about loneliness, we think about it in a sad, dejected way — as a quiet emotion,” said Cole. But “this biology is the biology of threat.”
Such a chronically lonely temperament is relatively common, affecting roughly 15 percent to 20 percent of the population, he estimates.
It’s not clear how much of this is inborn, and how much is the result of loss or betrayal, particularly in childhood, Cole said.
Researchers used to think that the obvious answer to loneliness was simply more social activity — making friends, having hobbies, and getting out more, like Lewis does. For years, researchers studied such social activities and couldn’t understand why there were so many people who had some of these things in their lives but still reported persistent feelings of isolation.
But viewing loneliness for these individuals instead as temperament — a constant state of anxiety — suggests a different approach that has been proving more effective in early research.
After an eight-week program of mindfulness in Los Angeles, for instance, a small group of participants reported feeling less lonely and their genes were producing fewer inflammation-triggering proteins, said Creswell, who led the study, along with Cole.
Mindfulness, said Creswell, helps people view their loneliness as merely a fact, rather than something distressing.
“It’s not any type of cure-all,” Creswell said of mindfulness, “but it can be a really helpful tool.”
Loneliness research has helped highlight the problems, Kubzansky said. Now, people need to act on that knowledge and make a difference in the health of those who are lonely.
“This is something that does really matter and we should put it on the agenda,” she said. “We have a lot of smart people who can think about it, but it has to be on the agenda.”
Technology may make us feel more connected than ever — most people are just a call, text or tweet away.
But does this actually make us closer?
"Even as the quantity of our connections with other people is on the rise, the quality of our connections is often taking a turn for the worse," Kory Floyd, professor of communication at the University of Arizona, writes in his book, "The Loneliness Cure: Six Strategies for Finding Real Connections in Your Life" (Adams Media).
Our increasing tendency to communicate electronically has left many of us starved for affection. We're deprived of hugs, smiles and literal shoulders to cry on.
"It's easy to fall into patterns of pseudo-connection and quasi-intimacy that initially feel gratifying but ultimately leave us feeling less than satisfied," said Joseph B. Dilley, psychologist and author of "The Game Is Playing Your Kid: How to Unplug and Reconnect in the Digital Age" (Bascom Hill Publishing Group).
You may have 1,000 Facebook friends, but how many of them could you confide in about the worries that keep you up at night? Just because an old college friend likes a photo of your cat on Instagram doesn't mean he or she is down to listen to you complain about work or give you advice on how to care for your aging parents.
"We know the minute details of what we're doing moment to moment in the day, but that comes at the expense of being able to invest in each other in longer term and more intimate ways," Floyd said. And, he writes in his book, "We end up glorifying the trivial … while barely noticing the substantive and meaningful are missing."
People struggle to connect "emotionally and interpersonally" when so much of our communication happens in digital form, said Dr. Lisa Strohman, founder and director of the Technology Wellness Center in Scottsdale, Ariz. "(When) our communication is reduced to 140 characters, we lose patience and compassion to have in-depth emotional connections with others."
Illusion of safety can backfire
Technology of course has countless benefits, but when it comes to communication it can "become a crutch when used as the only form of social contact one has," said Erika Martinez, a clinical psychologist based in Miami. Some people may prefer interacting online or via text because they feel less vulnerable that way.
"Interacting in person scares some people because they're afraid of rejection, ridicule or judgment by others," Martinez said. "Online, you can just log off, and no one sees the hurt or discomfort you feel."
Those with social anxiety may feel more comfortable online because it allows them to present the best versions of themselves. They can deliberate over every word and make sure every photo is near-perfection. But logging on to the Internet, especially social media, to find companionship can backfire.
"People find themselves comparing their lives with others more and more, which can then create anxiety, depression and more intense feelings of loneliness," Strohman said. Seeing photos of friends hanging out together or learning about others' successes online can make us feel even lonelier or depressed.
Phones in hand
Smartphones are the ultimate adult pacifier. They allow us to get lost anytime, anywhere in pockets of the Internet, and they rescue us from ever being alone with our thoughts.
They can also cause people to feel alone when they're together.
Devoting tech-free time to the people you love is crucial, said Ben Michaelis, clinical psychologist and author of "Your Next Big Thing: Ten Small Steps to Get Moving and Get Happy" (Wolf Street Press). That means spending time with the people who matter most without using your phone for distraction.
"The deepest forms of connection are still face to face," Michaelis said. "We read each other's face and body language; we appreciate context and nuance in ways that flat communications that come through our computers and devices don't allow."
"The things that characterize our most substantial relationships — our ability to create those — are impeded when the majority of our conversation is done through text," Floyd said.
Several years ago, Floyd conducted a survey for skin-care products company Nivea on how Americans felt about affection and touch. The results showed that three in four adults agreed that "Americans are in a state of affection hunger." People also reported having more physical contact with their cellphones than other people.
We may reach for our phones when we really should be throwing our arms around loved ones. Sometimes it takes more than an emoji to cheer us up.
Even if we manage to put down our laptops, tablets and phones, we may still seek out technology to distract us from being truly together, focused on each other.
"Sitting on the couch at night watching TV or streaming Netflix while you sit next to your significant other is not quality time," Strohman said.
Primal need for affection
Humans are social creatures, so we don't just enjoy social interactions and relationships, we need them, Floyd said. When you are lonely, "you are missing something that is fundamentally necessary for your life."
"When people feel deprived of meaningful connection with others, they don't take care of themselves as well as they should," Floyd writes. Lonely people tend to exercise less, drink more, are more likely to smoke, and eat more of their daily calories as fat, Floyd explains in his book. They are also more likely to have sleep disorders, chronic pain or a weaker immune system.
So what can we do to not feel so alone? One of the best ways to invite more affection is to give more, Floyd said. Invite people over or to do activities with you, like going for a hike or out to dinner.
And when you do have the chance to spend time with someone, for goodness' sake, put down your phone.
Reconnecting on a personal level
We asked the experts we talked to for advice for feeling less lonely and more authentically connected to the people in our lives. Here is what they said:
Don't get trapped in the ease and convenience of online interactions. "Social skills are what suffer most when people socialize predominantly online," Martinez said.
Make a consistent effort to unplug, Strohman said. "Taking breaks, real breaks, not just for an hour or two, but for a day or week at a time, is critical in this regard," Michaelis added. Go out to dinner at a restaurant without TVs all over the walls, and leave your phones in the car, Dilley said.
Think broadly about what you consider affection to be. When you feel lonely, take an inventory of the ways you already receive affection. It may show you your situation isn't as bad as it appears at first glance, Floyd said. Affection can be verbal (saying, "I love you"), nonverbal (hugging, kissing, holding hands) or socially supportive (acknowledging someone's birthday or listening to a friend's problems).
Do something that forces eye contact. That doesn't mean watching TV together or playing video games. While those can be fine pastimes, cut technology out of the equation sometimes, Strohman said.