Loneliness and Social Isolation

August 3, 2018 – Volume 28, Issue 28
Do they pose a growing health epidemic? By Christina L. Lyons

Background

Weakening Ties

Americans in the early 1800s liked to create and join civic, social, business and religious groups that contributed to community life and political debate, French diplomat Alexis de Tocqueville said in his classic book, Democracy in America (1835). But he also said the nation's celebrated individualism could confine a citizen “entirely within the solitude of his own heart.”36 Since then, stories and theories about Americans’ social life have fluctuated between the two themes.

Throughout much of the 19th century, most Americans lived in rural towns like those de Tocqueville observed, where organizations such as the Grange, a fraternal group focused on agriculture, offered a business and social network for farmers and their families. Families typically were large and served as vital support networks for multiple generations. Married couples tended to have an average of seven children, at least one of whom typically remained at home to care for the aging parents.37

By the start of the 20th century, many Americans had begun to migrate to the cities. Fearing the demise of the traditional farm community, President Theodore Roosevelt created the Commission on Country Life, which reported to the Senate in 1909 about hardships, such as isolation, faced by farmers and especially their wives. The commission said social isolation and other problems of rural life were “beyond the reach of legislation.” But Roosevelt pushed, unsuccessfully, for the Department of Agriculture to be renamed the Department of Country Life and its focus expanded to help farmers improve social life in rural areas.38

As the 20th century progressed, rural residents increasingly moved to cities, particularly during World War I and World War II, when factory jobs were plentiful. The largest shift to urban life took place within “the span of a single generation,” said sociologist Louis Wirth in 1938, and was “accompanied by profound changes in virtually every phase of social life.”39

City residents often experienced tenuous and changing social relationships, Wirth said. Even those who joined small social groups found that membership frequently turned over.

Multigenerational households became less common and family sizes shrunk. By 1950 women had an average of just under three children. Meanwhile, improvements in sanitation, nutrition and medical care meant life expectancy rose, from under age 50 in 1900 to more than 65 by 1950.40

Runners of all ages hit the pavement on May 5, 2018 (AP Photo/The Porterville Recorder/Chieko Hara)  
Runners of all ages hit the pavement on May 5, 2018, at the 17th annual Rotary Cancer Run/Walk hosted by the Porterville Breakfast Rotary Club in East Porterville, Calif. The event raises funds to benefit cancer treatment in the community. As membership in such civic clubs declines, experts say Americans are losing a way to interact with people who might have different social or political views, potentially increasing their own isolation. (AP Photo/The Porterville Recorder/Chieko Hara)

By 1950 Americans had become less focused on family and more on how others like them behaved and the attitudes of their peers and the mass media, sociologist David Riesman wrote in his 1950 book The Lonely Crowd, a landmark study of middle-class America.

About 4 million Americans were living alone in 1950, a little less than 10 percent of households, up from 1 percent in 1850. Fischer and Michael Hout, a sociologist at the University of California, Berkeley, attributed the increase in part to greater economic security and help from Social Security and private pensions.

By 1960, Americans were moving to the suburbs, and the sense of solidarity that “everyone in town” belonged to a community began to fall away, sociologist Maurice Robert Stein wrote.41

Meanwhile, more than 500,000 Americans with mental illness were secluded in mental institutions, or “asylums,” which had been established in the 1800s, says Boston psychiatrist Sigel. But in the 1950s and '60s, psychoanalyst Frieda Fromm-Reichmann, author of a 1959 essay titled “On Loneliness,” argued that loneliness was at the core of nearly all mental illness and that trust and intimacy could cure many patients. Amid increasing concerns about poor medical practices in the asylums, many mental health advocates cited Fromm-Reichmann's theory in pushing for reform.42

In 1963, President John F. Kennedy pushed through Congress the Community Mental Health Centers Construction Act, which aimed to replace mental institutions with a system of subsidized, community-based outpatient mental health centers. The law did not succeed in emptying out all mental hospitals, however, said Gerald Grob, Rutgers University professor of the history of medicine. In 1960, 75 percent of the patients were unmarried, widowed or divorced — making it unlikely they could live in the community with families while undergoing outpatient treatment, he said.43

And those patients who did return to the community had mixed results. “I think it's from there that the issue of loneliness really started to emerge,” Sigel says. “We discharged people into the community where they were not welcome,” he adds, noting that many newly released patients were uncomfortable using public transportation or feared social contact.

What's more, some patients were elderly and suffering from dementia. Many were able to move into nursing homes with support from Medicare or Medicaid, health insurance programs for elderly Americans created by Congress in 1965. Between 1960 and 1976, the number of nursing homes grew by 140 percent.44

Meanwhile, Arizona real estate developer Del Webb developed the first “retirement community” for the elderly, in Sun City, a concept that would be copied throughout the United States. Many Baby Boomers moved to such communities when they reached retirement age in hopes of finding continued social and medical support as they aged.

The 1960s also marked a period of high levels of participation in political groups, churches, synagogues and civic associations in America. By 1965 Americans reported an increased confidence in their neighbors. The proportion that agreed that “most people can be trusted,” rose from 66 percent during and after World War II to 77 percent in 1964.45

In 1969, sociologists Daniel Bell and Virginia Held said “there is more participation than ever before in American society.” Even so, in a survey that same year, 26 percent of Americans reported they had felt “very lonely or remote from other people” during the previous few weeks.46

Raising Alarms

Despite such high community engagement in the 1960s, Brandeis University sociologist Philip Slater warned in his 1970 book, Pursuit of Loneliness: American Culture at the Breaking Point, that Americans were seeking more privacy but feeling “more and more alienated and lonely” when they achieved it.47

Journalist Vance Packard in 1972 said in many regions more than 35 percent of the population was moving each year, and a typical junior executive moved 15 times in 20 years. Such mobility, Packard said, was destroying the sense that one had a community to “share experience, to find assurance of emotional and other support, and to develop some enduring friendships.”48

A year later, University of Massachusetts sociologist Robert S. Weiss wrote in his book Loneliness that “severe loneliness appears to be almost as prevalent as colds during the winter.”49

Journalist Suzanne Gordon in Lonely in America blamed increasing loneliness on a rising divorce rate, the launch of a “singles” industry focused on dating and group activities for singles and a growing technological culture that kept residents watching televisions rather than socializing.50

In 1979, Lisa F. Berkman, a social epidemiologist at Harvard, and S. Leonard Syme, an epidemiology professor at University of California, Berkeley, published a study of 4,775 adults in Alameda County, Calif. They found that people who were not strongly connected with others — through marriage, friends or social groups, for instance — were three times as likely to die over a nine-year period as those with strong ties. The difference existed regardless of physical health, socioeconomic status, lifestyle or other factors.51

In the early 1980s, social psychologist Carin Rubenstein and psychologist Philip Shaver, a professor at the University of Colorado in Denver, analyzed different survey data and concluded that loneliness declines with age, a phenomenon they attributed to individuals’ changing self-esteem and self-awareness.52

At the time, many sociologists and psychologists blamed loneliness or isolation on the increasing “impersonality” of large urban settings, workers’ growing reliance on technology and increasing mobility and divorce. In April 1983, New York Times health editor Jane Brody declared loneliness a “national epidemic.”53

But not everyone agreed that urban life was weakening social networks. “Residents of large and small communities alike generally manage to sustain helpful and meaningful relations,” Berkeley's Fischer said in 1983. And city dwellers “are more likely to have friends that they pick and choose rather than friends they inherit by virtue of geography or kinship or even occupation,” he said.54

Still, several studies concluded that socially isolated or lonely people faced a higher risk of death. A 1984 study published in The New England Journal of Medicine found that among 2,320 male patients who had suffered heart attacks, those classified as socially isolated or suffering from life stress faced more than four times the risk of death than those with less stress and isolation.55

A UCLA study of men infected with HIV found that those who had not disclosed their sexual preference, fearing social rejection, developed AIDS and died an average of two to three years earlier than those who were not “in the closet.” UCLA's Cole theorized — and later proved with tests on HIV-infected blood — that an individual with a false identity and fear of social rejection had higher levels of stress hormones in the body, which caused tissues to swell, hiked blood pressure and weakened the immune system.56

In another study, University of Iowa psychologists Daniel W. Russell and Carolyn E. Cutrona found that college freshmen were lonelier than the elderly. And in a study with physician Robert Wallace, the two psychologists determined that loneliness among the elderly was a greater predictor than blood pressure of mortality and admission to a nursing home.57

By 1994, Steven Ruggles, then a University of Minnesota associate professor of history, concluded, based on U.S. Census data from 1850 to 1990, that the 19th-century tendency of extended families to live together and the nation's history of maintaining strong family ties had disappeared.58

Klinenberg, author of the 2002 book Heat Wave, found that during a heat wave in Chicago in July 1995, a lack of family and social support contributed to the deaths of hundreds of residents who, he said, “died alone, behind locked doors and sealed windows, out of contact with friends, family and neighbors, unassisted by public agencies or community groups.” The city began a public campaign to find living relatives for 170 unclaimed bodies — a third of which remained unclaimed when Klinenberg published his book.59

Meanwhile, as the number of home computers grew in the late 1980s and the internet rose to prominence in the '90s, sociologists saw the growing use of technology as a potential cause of social isolation or feelings of loneliness. By 1998, about 40 percent of all U.S. households had personal computers, about a third of which had internet access.

But while some researchers said the internet was causing people to become socially isolated, others said it enabled people to create more social relationships without the constraints of geography.60

New Research

Putnam's Bowling Alone returned the nation's focus in 2000 to dwindling civic engagement, which he called the erosion of “social capital.” Although the number of national nonprofit organizations had doubled between 1968 and 1997, few had mass memberships, he said. And the number of Americans who said they had “attended a public meeting on town or school affairs” in the previous year had fallen by more than a third — from 22 percent in 1973 to 13 percent in 1993.61

By 2000, about a quarter of American households consisted of one person, and only 14 percent of citizens lived in extended-family households. Birth rates had dropped to an average of 2.4 children per woman of childbearing age. Putnam said such statistics indicated the erosion of social capital, which he attributed to more women working outside of the home, greater mobility, a lower marriage rate and technological changes, such as the rise in the popularity of video games.62

In a 2000 book on the medical consequences of loneliness, psychologist James J. Lynch, of Towson, Md., wrote: “New Age cultural forces that disturb, disrupt and destroy human dialogue must be viewed with the same concern and alarm as has been brought to bear on other plagues, infectious diseases, viruses, bacteria and cancers.” Loneliness, particularly if it begins in childhood, is linked to premature death in all technologically advanced nations, he said.63

However, not all surveys during this period found negative results. By 2000, some reported that a majority of U.S. adults said they felt good about their communities and had a sense of belonging with their neighbors. Almost half of adults said they had at least a few friends in the neighborhood.64

Soon, more scientific studies explained the link between loneliness and physical illness. In a study published in Science in 2003, researchers using neuroimaging determined that the brain responds to the pain of social exclusion similarly to how it responds to physical pain. And in another study, Cole, Hawkley and Cacioppo found a connection between chronic loneliness and an elevated risk of inflammatory disease.65

Cacioppo compiled much of the research in his 2008 book Loneliness: Human Nature and the Need for Social Connection. At the time, he noted, about 20 percent of citizens said feeling isolated was “a major source of unhappiness in their lives.”66

But researchers increasingly debated how best to measure loneliness. In 2006, sociologists from the University of Arizona and Duke University found that the percentage of respondents to the General Social Survey, conducted periodically by NORC to track trends in American society, who said they had discussed “important matters” with no one in the previous six months had risen from 10 percent in 1985 to nearly 25 percent in 2004. But their conclusion drew heavy criticism. Fischer, for example, said the results likely were due to changes in survey procedures or technical errors.67

In 2009, a Pew Research Center survey indicated that the average size of Americans’ social networks had shrunk by a third since 1985, with 12 percent of Americans saying they had no one with whom they could discuss important matters. That year, U.S. Surgeon General Regina Benjamin issued a “call to action” to promote social networks in the community by creating sidewalks, parks and mass transit, and locating stores, schools and workplaces nearby.68

In 2014, Cacioppo and fellow researchers determined that the effect of loneliness — or perceived isolation — was an “evolutionary, heritable trait,” or that some individuals have a genetic predisposition to set certain standards for social connection and to feel lonely if those standards are not met. The researchers also found that loneliness both affects, and is affected by, depressive symptoms. But Cacioppo and other researchers concluded the only method that showed promise in reducing loneliness was talk therapy to help a patient end thoughts of low self-worth and to alter skewed ideas that others were untrustworthy.69

In 2016, as surgeon general, Murthy traveled the country and asked communities what issues were important to them. “What I heard time and time again was that people were in fact dealing with an epidemic of stress and loneliness,” he said. He urged health care providers and communities to address social factors — such as isolation — that affect public health.70

In 2017 Congress began taking some interest in tackling the issue of loneliness, especially among the elderly. At a Senate Special Committee on Aging hearing, Chair Susan Collins, R-Maine, said, “Just as we did when we made a national commitment to cut smoking rates in this country, we should explore approaches to reducing isolation and loneliness. Each has a real impact on the health and well-being of our seniors.”71

In addition, Sen. Mike Lee, R-Utah, began directing a multiyear research project, under the auspices of the Joint Economic Committee of Congress, to determine what societal changes might be causing a breakdown of community ties.

The so-called Social Capital Project's first report, released in May 2017, found that citizen participation had generally declined over time in community organizations — including family, churches, schools and civic associations.72

Go to top
Go to Current Situation

[36] Alexis de Tocqueville, “Chapter V: Of the Use Which the Americans Make of Public Association in Civil Life,” Democracy in America (1970 edition), pp. 99, 106–10.

[37] William Berry Lapham, Centennial History of Norway, Oxford County, Maine, 1786–1886 (1886), p. 218, https://tinyurl.com/y8u3p9hn. Also see Atul Gawande, Being Mortal (2014), p. 21.

[38] “Report of the Country Life Commission,” U.S. Senate, 1909, pp. 47, 6, https://tinyurl.com/ycmflvgu.

[39] Louis Wirth, “Urbanism as a Way of Life,” The American Journal of Sociology, July 1938, pp. 1–24, https://tinyurl.com/yazwewgp.

[40] Steven Ruggles, “The Transformation of American Family Structure,” American Historical Review, February 1994, pp. 102–103; Gawande, op. cit., pp. 22, 198; “Life expectancy in the USA, 1900–98,” Berkeley Demography, https://tinyurl.com/4kjakmd.

[41] Joseph Stromberg, “Eric Klinenberg on Going Solo,” Smithsonian Magazine, February 2012, https://tinyurl.com/ycvbshmq; Claude S. Fischer and Michael Hout, Century of Difference: How America Changed in the Last One Hundred Years (2006), p. 74. Maurice Robert Stein, The Eclipse of Community: An Interpretation of American Studies (1960), pp. 92, 329.

[42] Judith Shulevitz, “The Lethality of Loneliness,” The New Republic, May 13, 2013, https://tinyurl.com/zfwfz2y.

[43] John F. Kennedy, “Remarks on Proposed Measures to Combat Mental Illness and Mental Retardation,” The White House, Feb. 5, 1963, https://tinyurl.com/ybtsymea. Gerald N. Grob, “Public Policy and Mental Illnesses: Jimmy Carter's Presidential Commission on Mental Health,” The Milbank Quarterly, 2005, pp. 426–427.

[44] “The History of Nursing Homes,” Foundation Aiding the Elderly, undated, https://tinyurl.com/y8e6e8an.

[45] George H. Gallup, The Gallup Poll: Public Opinion 1936–1971. Putnam said, however, that the version of the “trust” question used in the 1940s, '50s, and '60s is not directly comparable to the one that became standard in later years.

[46] Daniel Bell and Virginia Held, “The Community Revolution,” The Public Interest (1969), p. 14; Norman M. Bradburn, The Structure of Psychological Well-Being (1969), https://tinyurl.com/ycq7fot2.

[47] Philip Slater, The Pursuit of Loneliness: American Culture at the Breaking Point (1970), p. 12, https://tinyurl.com/yaqlsp7u.

[48] Granville Hicks, “Rootless Americans,” The New York Times, Sept. 10, 1972, https://tinyurl.com/yahz864k.

[49] Robert Weiss, Loneliness: The Experience of Emotional and Social Isolation (1973), p. 1.

[50] Suzanne Gordon, Lonely in America (1976), p. 22.

[51] Lisa F. Berkman and S. Leonard Syme, “Social Networks, Host Resistance, and Mortality: A Nine-Year Follow-Up Study of Alameda County Residents,” American Journal of Epidemiology, February 1979, https://tinyurl.com/ybldcuws.

[52] Carin Rubenstein and Philip Shaver, In Search of Intimacy: Surprising New Conclusions from a Nationwide Survey on Loneliness and What to Do About It (1982), https://tinyurl.com/yckx9jk3.

[53] Jane E. Brody, “Personal Health,” The New York Times, April 6, 1983, https://tinyurl.com/yde6oegs.

[54] Linda Wolfe, “Friendship in the City,” New York Magazine, July 18, 1983, p. 22, https://tinyurl.com/yad7kcky.

[55] William Ruberman, Eve Weinblatt, Judith Goldberg and Banvir Chaudhary, “Psychosocial Influences on Mortality after Myocardial Infarction,” The New England Journal of Medicine, Aug. 30, 1984, https://tinyurl.com/yaoz659b.

[56] Judith Shulevitz, “The Lethality of Loneliness,” The New Republic, May 13, 2013, https://tinyurl.com/zfwfz2y.

[57] Martha Lear, “Body and Mind; The Pain of Loneliness,” The New York Times, Dec. 20, 1987, https://tinyurl.com/ycd9u3jt.

[58] Ruggles, op. cit., p. 104.

[59] “Dying Alone: An interview with Eric Klinenberg,” University of Chicago Press, 2002, https://tinyurl.com/ybx572fb; Eric Klinenberg, Heat Wave: A Social Autopsy of Disaster in Chicago (2002), p. 15.

[60] C. Stoll, Silicon Snake Oil (1995); Robert Kraut et al., “Internet Paradox: A Social Technology That Reduces Social Involvement and Psychological Well-Being?” American Psychologist, September 1998, p. 1018, https://tinyurl.com/n2p8rv6; J. E. Katz and P. Aspden, “A Nation of Strangers?” Communications of the ACM, 1997; and H. Rheingold, The Virtual Community: Homesteading on the electronic frontier (1993).

[61] Robert D. Putnam, “Bowling Alone: America's Declining Social Capital,” Journal of Democracy, January 1995, pp. 65–78.

[62] Fischer and Hout, pp. 57, 63, 64. Putnam, ibid.

[63] James Lynch, A Cry Unheard: New Insights into the Medical Consequences of Loneliness (2000), p. 1.

[64] Fischer and Hout, op. cit., pp. 164–165, 244.

[65] Naomi I. Eisenberger, Matthew D. Lieberman and Kipling D. Williams, “Does Rejection Hurt? An fMRI Study of Social Exclusion,” Science, Oct. 10, 2003, https://tinyurl.com/gspmca6; Steve W. Cole et al., “Social regulation of gene expression in human leukocytes,” Genome Biology, Sept. 13, 2007, https://tinyurl.com/y9wuznpa.

[66] John Cacioppo, Loneliness: Human Nature and the Need for Social Connection (2008), p. 5.

[67] Miller McPherson, Lynn Smith-Lovin and Matthew E. Brashears, “Social Isolation in America: Changes in Core Discussion Networks Over Two Decades,” American Sociological Review, 2006, vol. 71, p. 358; Fischer, Still Connected (2011), op. cit., p. 1.

[68] Keith Hampton et al., “Social Isolation and New Technology,” Pew Researcher Center, Nov. 4, 2009, https://tinyurl.com/k7xefem; “The Surgeon General's Call to Action to Promote Healthy Homes,” Office of the Surgeon General, 2009, p. 1, https://tinyurl.com/y7yp9c7m.

[69] John Cacioppo and Stephanie Cacioppo, “Loneliness is a modern epidemic in need of treatment,” New Scientist, Dec. 30, 2014, https://tinyurl.com/jlxfxf5; John T. Cacioppo, Stephanie Cacioppo and Dorret I. Boomsma, “Evolutionary Mechanisms for Loneliness,” Cognitive Emotion, Sept. 25, 2013, https://tinyurl.com/ydddr97y; John Cacioppo and Stephanie Cacioppo, “Social Relationships and Health: The Toxic Effects of perceived Social Isolation,” Social and Personality Psychology Compass, Feb. 1, 2014, https://tinyurl.com/y8a2n3od; Christopher M. Masi et al., “A Meta-Analysis of Interventions to Reduce Loneliness,” Personality and Social Psychology Review, Aug. 17, 2010, https://tinyurl.com/y8kw3bpg.

[70] Murthy, op. cit.; Steven Ross Johnson, “Surgeon general: Entire community needs to tackle social factors of health,” Modern Healthcare, Dec. 6, 2016, https://tinyurl.com/y8yf7y6d.

[71] Sen. Susan M. Collins, opening statement in earing on “Aging Without Community: Consequences of Isolation and Loneliness,” U.S. Senate Special Committee on Aging, April 27, 2017, https://tinyurl.com/yacjjb75.

[72] “What We Do Together: The State of Associational Life in America,” op. cit.



Document APA Citation
Lyons, C. L. (2018, August 3). Loneliness and Social Isolation. CQ researcher, 28, 657-680. Retrieved from http://library.cqpress.com/
Document ID: cqresrre2018080303
Document URL: http://library.cqpress.com/cqresearcher/cqresrre2018080303
ISSUE TRACKER for Related Reports
Stress
Aug. 03, 2018  Loneliness and Social Isolation
Feb. 12, 2010  Sleep Deprivation
Dec. 06, 2002  Homework Debate
Aug. 04, 1995  Job Stress
Jun. 23, 1995  Repetitive Stress Injuries
Aug. 14, 1992  Work, Family and Stress
Aug. 13, 1982  Pressures on Youth
Nov. 28, 1980  Stress Management
Jul. 15, 1970  Stress In Modern Life
BROWSE RELATED TOPICS:
Aging Issues
Elderly Health Issues
Employee Benefits
General International Relations
HIV and AIDS
Internet and Social Media
Marriage and Divorce
Medicaid and Medicare
Medicaid and Medicare
Mental Health
Nursing Homes and Long Term Care Facilities
READER COMMENTS
(0)
No comments on this report yet.
Comment on this Report