What is Loneliness?

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Dr Sandro: You know, we should really kind of think about what we can do to build these meaningful social connections in young people who are seemingly embedded, in our institutions, but may not feel connected. They may not feel like someone's got their back. How do we, kind of make them feel included and part of a network that's meaningful to them?

Dr Sandro: Hello and a big welcome to In Good Health. I'm your host, Dr. Sandro, and I'm a medical doctor, public health expert and foodie. Our special guest today is Dr Michelle Lim. Michelle is a senior lecturer in clinical psychology and leads the Social Health and Wellbeing Laboratory at Swinburne University of Technology.

Dr Sandro: Her main interest is focused on how loneliness can negatively impact social functioning, as well as the negative impacts to our mental health, such as anxiety, depression and paranoia. Michelle is also the scientific chief adviser to ending loneliness together, a national Australia Network, made up of universities and industry partners. In this episode, we'll be chatting with Michelle about the differences between feeling lonely and being alone, and what meaningful connections actually mean.

Dr Sandro: Well, thank you very much for joining us. It's great to see you again.

Dr Michelle: Lovely to see you Sandro.

Dr Sandro: I want to start so; 2021 it's been well to say a crazy ride the last 18 months would be an understatement. But one of the things that's really been affected is our ability to stay connected. And while we've pivoted digital, the style and types of connections have changed so profoundly. So how common is loneliness in Australia now?

Dr Michelle: What we do know is about one in four Australians will report very problematic levels of loneliness, or high distressing levels of loneliness.

Dr Michelle: There's an additional issue about whether, is it that we experience distressing levels of loneliness and therefore it has a negative impact on our health? Or, is it that we experience these sorts of distressing levels of loneliness in a much more enduring chronic way and a more persistent way?

Dr Michelle: So that kind of research is still fairly new. We don't really have a good understanding of what we call enduring loneliness. We would imagine that similar to other kinds of health conditions, the more chronic or more enduring the experience, can actually lead to poorer health outcomes as well.

Dr Sandro: You mentioned before that, you know, loneliness is associated with a bunch of chronic diseases. Do we know which way the relationship flows? Is it that your loneliness increases your chance of these diseases or that somehow, like with mental illness, that these diseases can also exacerbate or make us feel feelings of loneliness?

Dr Michelle: That’s a good question. So, for mental health conditions, we know that loneliness predicts higher levels of depression, anxiety and paranoia. But what predicts loneliness back is actually a high level of social anxiety. So, if you fear having social interactions with others, if you feel like you're being negatively evaluated or judged, you're more likely to also feel lonely six months down the line.

Dr Michelle: So, there's a really strange reciprocal relationship between loneliness and social anxiety disorder or social anxiety symptoms, with cardiometabolic diseases, for example...

Dr Sandro: Like heart disease.

Dr Michelle: Yeah, that's right. Less is known, but what we do see from the epidemiological data sets, both international and national data sets, is that if you are lonely, you're more likely to report poorer heart health. About four years down the line and type two diabetes as well. But not cancer so is very specific.

Dr Sandro: So increased loneliness is associated with heart disease and diabetes.

Dr Michelle: That's right. Yeah.

Dr Sandro: And do we know why?

Dr Michelle: Well, a lot of the theories around that in previous research from Professor Cassopolis’s work in University of Chicago is really looking at brain processes of ‘if someone feels lonely’ e.g. when we feel like someone doesn't have our back, when we feel disconnected, we do process information about the social world very differently.

Dr Michelle: We navigate the world very differently. We're definitely more stressed out. And, you know, the accumulation of actually navigating these sorts of social situations continuously could actually lead to poorer health down the track.

Dr Sandro: Right. So, it could be through loneliness affecting our sort of anxiety, or levels of stress, physiological stress.

Dr Michelle: That's right. And there's even research that looks at blood pressure regulation, and also ability to kind of fight off infections.

Dr Sandro: Immune

Dr Michelle: Yeah, exactly. All those things are actually lowered or poorer if one feels lonely. So, there's really, I think this really kind of, there’s evidence really that, you know, feeling lonely itself is a very stressful response, is almost like a social stressor that we're going through. But we don't talk about enough.

Dr Michelle: You know, I think there's a problem with loneliness is that in our society or at least in Australian society, when we say the word lonely, it comes with a very negative connotation like there’s actually something wrong with you when in fact, it's something that's triggered as an almost a mechanism for you to do something different. But yet we kind of put that layer of stigma on it. So, if most people who do feel lonely will neglect it, ignore it, think it will go away. And if it doesn't go away, it actually can lead to poorer health outcomes.

Dr Sandro: And is all loneliness abnormal, like should we expect to feel a certain amount of loneliness in our lives or in our weeks?

Dr Michelle: Sandro, I think you and I probably would admit, at some point, we all do feel lonely, especially when you have, very strong relationships and strong networks. We can all feel lonely at some point, whether you feel persistently lonely or not is a whole other issue.

Dr Michelle: There are people who might feel lonely but are able to actually get out of these cycles of loneliness because they have the social resources. They are able to have the skills and the motivation to actually get out and actually do something different with their relationships and their networks, and other people who can't because of other reasons, as simple as even things like mobility, finances. We know that loneliness has a strong relationship with people who might report lower socioeconomic status, for example.

Dr Sandro: Income.

Dr Michelle: Exactly.

Dr Sandro: And so that's likely to be the ability to almost afford to access the social connection rather than some sort of inherent difference in the individual because of their income.

Dr Michelle: Look, I think that being a clinical psychologist, I had a very narrow view of what drove loneliness before. And it's very much in a in a psychological point of view, it's very much a cognitive bias, which is largely driven by that.

Dr Sandro: When you say cognitive bias sorry, what do you mean?

Dr Michelle: So, I guess this about a way of thinking that might not stem in reality. So it might be that we think, you know, oh that person didn’t look at me so they must not like me and don't want to connect with me or, they might not want to be friends of me. But in fact, that actually becomes a thought and a belief and...

Dr Sandro: Self-fulfilling.

Dr Michelle: Exactly. So, I might then look down and not smile at you in the morning. And, you know, that kind of then creates a barrier to connection.

Dr Michelle: And loneliness is largely driven by that. But at the same time, there's so many other factors that go on with that and systemic factors. And, you know, even from the environment that we are working under, you know, even urban design and the way we construct our offices actually facilitate or inhibit social interactions.

Dr Michelle: So, we need to have those social interactions in order to build those meaningful social relationships. We need resources. We need finances to be able to build relationships and to invest. So, it's not just an issue that is caused by what we call a thinking error or cognitive bias, but it is more than that. It is a very systemic issue. It's got many predictors.

Dr Sandro: So, what would you say? So, what when we look at the evidence, what would be the main drivers or risk factors for loneliness?

Dr Michelle: I think the biggest factor that we really need to focus on is poor health, you know, the fact that it leads to poorer mental health, but also poorer physical health. One of the things that people don't realise is that really the impact on poorer physical health outcomes, even for young people.

Dr Michelle: We always assume that young people are healthy and physically fine, but we know that loneliness and early markers of cardiometabolic disease, for example, occurs very early as late as late adolescence, that we can see escalate in aging, for example, in someone who's lonely, even at a young adulthood stage.

Dr Michelle: So, you know, that has massive implications for young people's health. You know, we don't actually think about addressing someone's loneliness because of physical health. But in fact, actually we just need to address loneliness because of health reasons.

Dr Sandro: We've all experienced loneliness at some point in our lives. It's part of being human. But a new global survey from Ipsos has shown that loneliness is on the rise worldwide. In fact, the survey reported two in five people became lonely during the second half of 2020. In Australia, according to the Australian Loneliness Report from 2018, one in four people feel lonely. So what's driving our loneliness? And is this different from being alone? Michelle is here to help us answer these very questions.

Dr Sandro: So, there's a lot of confusion around the terminology in this space. There's alone, lonely, you know isolation and then connection and meaningful social connection. In terms of alone vs lonely, are they the same thing?

Dr Michelle: So being alone is very much more equivalent to being socially isolated. So actually, that's really kind of refers to being physically alone.

Dr Sandro: Physically OK.

Dr Michelle: That's right. Whereas lonely, you could be alone in a crowd. You could be alone in a marriage, alone within a family unit, that you don't feel that people understand you, or that you have that meaningful social connection. You don't feel like there are people that you can turn to, to talk to when you really need that.

Dr Sandro: So, tell me about meaningful social connection. What is that?

Dr Michelle: So meaningful social connection is when you feel like someone's got your back. You know, when you feel like they understand you, you're speaking the same language. And it doesn't have to always be emotional. Sometimes it could be an instrumental kind of relationship.

Dr Michelle: But a lot of people might have a category of who is more meaningful than others. So, it might not be a just a dichotomous thing. You might be, you know, something on a continuum. One thing that's really important is to understand that not all relationships that you have, have to be meaningful. It's OK to have a variety...

Dr Sandro: A few meaningless friends.

Dr Michelle: Exactly. There are people that, you know, might come in and out your life for different reasons. And that's OK. I think that for a lot of young people, they feel like they need to have a very strong, meaningful social connection all the time.

Dr Michelle: But when, in fact, that's a lot of pressure. And as we age, we know that our relationships change. So, there's a lot of research, for example, that says that, you know, for young people, they favour quantity of relationships, but that kind of drops off as you get older, and the quality then becomes a lot more important.

Dr Michelle: So, you might have fewer friends, but they're a lot deeper. And it could be a reflection of our transitions in life, you know, perhaps having less time to invest or perhaps placing less value in the particular kinds of friendships and kind of moving towards more complex, but more meaningful relationships where you can really invest.

Dr Sandro: So how many meaningful friendships, you know, would the average person have in their 20s or 30s? I mean, I imagine everyone's listening in thinking, oh, God, have I got enough? Have I got too many, like what's a ballpark of like what's normal?

Dr Michelle: I think that that's a good question. But it really depends on the person's social needs, because as you would imagine, social needs are quite complex. I imagine actually between you and I; we have very different social needs. I don't need...

Dr Sandro: You have thousands...

Dr Michelle: No, no I think it might be the other way around. I don't you know, I'm also an introvert, so it doesn't really help. So, it's, you know, someone who's introverted is quite happy in their own space.

Dr Sandro: But it's probably at, what, a handful? A few handfuls. We're not talking hundreds. And I think that's something that it's important to kind of call out, because a lot of people do. I remember working as a doctor, people would say, you know, almost they should have more friends.

Dr Sandro: Like it was a sense of shame for not having very many close friends and very often actually just talking about kind of. Well, actually, that's very normal to have only a few very close friends that you catch up with. And particularly as you get older, as you say, as life gets busier. So, you know, we're probably talking, what, a couple of handfuls not a couple of hundred.

Dr Michelle: Or thousands.

Dr Sandro: Yeah. Like a thousand Facebook friends.

Dr Michelle: Yeah. The other thing is to think about our friendships in a much more flexible way, like we have friends for different needs. You know, you might speak to friend A about this subject, but, you know, not for something else.

Dr Michelle: You know, actually if we have that slight diversity and complexity in our social network, that could really help us. And again, you know, it's not to ensure as well that we adjust our expectations of friendships are. I think a lot of people think that, oh, you know, I've been friends with this person since primary school.

Dr Michelle: You know, I have to maintain that friendship and hold on to it when in fact, these relationships do get disconnected and then sometimes get back and it's OK, and it's OK to have relationships that come and go. You know, and I think this idea of we have to be friends, we have to do this and it has to be this way. It has to be exactly equal, has to be we have to meet up. That's a lot of pressure. And it's not always consistent of life and reality. And that friends in your life that might disconnect from you for no fault of your own.

Dr Michelle: It's just that it's something that happened to them and happened in their life. It's got nothing to do with you. And that's OK as well. And we can have those flexible beliefs about what friendship is. And you know, divert our attention to the ones that feel good for us. That's really important.

Dr Sandro: I've noticed also a lot of people over Covid have, there's been almost a sense of guilt about friendships, about I should have been a better friend, I should have stayed in in closer contact. I mean, how have you, is that something that you've seen in the literature or heard of, you know, even personally, I mean.

Dr Sandro: You know, obviously our friendships have been affected in all sorts of different ways. And what I've been hearing a lot from my friends lately is almost, kind of a lot of apologies for them not perceiving that they have been very good friends for, you know, catching up as often as they want. I mean, how do you navigate, you know, giving yourself the authority to just be the friend that you are, as opposed to kind of judging constantly or even worrying about the quality of the connection you're providing or the connection that you're getting?

Dr Michelle: Yeah, look, I think that's a very good question. And this you know, it's about the individual and how they can navigate that space, because sometimes, especially during Covid, as you would know, lots of people are stressed out. Covid fatigue from all the news, a lot of them are really just trying to cope. So how much can we give our friends in terms of quality is also questionable? You know, I think it does affect our relationships.

Dr Michelle: But I think one thing that's really important is we also know that we're incredibly resilient. We can pick up friendships and actually nurture those ones. And sometimes they don't always have to happen face to face, as you would know. But its that more consistent contact, even if it's brief, that might be more important than this one big party that you're going to have and invest, you know, eight hours on a big trip. You know, perhaps it's more that kind of more housekeeping things that we have to do all the time. That can be done even in a Covid safe environment.

Dr Sandro: But I think that's really helpful, though, to reflect on, because sometimes I think social connection, whether you have it, whether you don't and how much you give it and how much you get can almost be a source of guilt in our in our modern lives.

Dr Sandro: And I think particularly as you get older, you know, and life gets busier, friends and family and work and everything else, all of the things we're trying to balance alongside each other. And so, I think giving yourself or understanding that, first of all, friendships will change and evolve over time, and sometimes they'll be stronger and take more of your time and sometimes they won't. And also that they won't be the same across all your friendships. And I think also acknowledging that there's no kind of perfect friendship, that social connection could come in different forms and still be really meaningful.

Dr Michelle: And it's important for the person who might feel that way, to also reflect that their needs change. You know, it's not always about the friendships, they might need something different, and that's OK. It's again, moving through different life transitions.

Dr Michelle: And it's a very common experience that people often talk about as being a new parent for example. You know, their social needs have changed, or their social resources have changed. And so how do they kind of maintain the existing friendships that they had now as a new parent, because they're in a completely different phase of their life and some friends may understand what parenthood is about and others may not. And so, they have to pivot and do a little and they might find new networks that might actually support their new phase in life.

Dr Sandro: And you probably also developing some pretty deep social connections with a little guy or girl in your life, too.

Dr Michelle: That's right.

Dr Sandro: What's, what are some tips or some advice for listeners in terms of maintaining or even restarting, reigniting a sense of social connection after Covid  ?

Dr Michelle: I think it's really important, first of all, to acknowledge that all of our social connections would have been, would have suffered at some point during Covid, even if you have a very strong network before, you might feel that you have a lot to catch up on. OK. And it's really important for us to acknowledge it's a bit of a social challenge, we’re out of our social routines. But that doesn't mean that we can't reinitiate those ones or revisit those ones or even build new relationships.

Dr Michelle: And if things are a little bit too hard, perhaps kind of taking them in chunks and little steps as opposed to big expectations and big move gestures and movements to kind of make things right. So, I think an example that I gave before was, you know, instead of kind of having this expectation that you have to throw a big party, or, you know, kind of make a big gesture that you care about someone.

Dr Michelle: It's more those little things and checking in and making the effort. Even if you say, for example, if you typically text make the effort to call, you know, it's just that simple modification that can kind of help you get back into feeling more comfortable initiating some of these friendships again. Some people may also have an increase in social anxiety because they have a lack of exposure during Covid. Again, if that's the case, it's something for you to kind of take things very slowly and to kind of take things in chunks.

Dr Michelle: And, you know, you may not feel comfortable right away socialising. And that's OK. So, kind of breaking it down to little steps of how you can get back to how you might have felt in the pre Covid time.

Dr Sandro: I wanted to ask a question about culture and its influence, because from my own experience, I lived in Denmark, the US and Australia, and I was recently reflecting on making friends in those different countries. And I remember in America, everyone is your friend straight away, particularly as an Australian.

Dr Sandro: They love the accent. And you’re suddenly invited to barbecues and all sorts of stuff. But I noticed that when I left America, the relationships were fairly superficial, and we quickly lost tie apart from friends on Facebook or whatever.

Dr Sandro: Whereas Denmark, it was interesting. It was very different. It took ages to become part of the social circles, to develop friendships. But the friendships that I developed with Danes, they're like lifelong. I could not see my Danish friends, two, in particular for a decade. And it's almost like family. So how much does culture play into how we develop social connection, how quickly and how deeply and how long lasting that social connection is?

Dr Michelle: Yeah, that's a very good question. And I do think that it plays quite a critical role when in fact, a role that we overlook or perhaps not really understand very well. And you know, it really depends on your network and your ability and also, I think perhaps even the network that you make, you know. And so just like you, I've lived in America, but I've lived in the Midwest, and there's a very different culture in the Midwest to the East Coast. Everyone's your friend, but they're also your friends for a very long time, you know.

Dr Michelle: And, you know, it's been 10 years since I lived there, but it's still quite constant contact. But if I were to live in the East Coast, you know, people are a lot more transient for example even within that country.

Dr Michelle: So perhaps my friendships may not be as enjoyable. I don't know. It’s unusual just even looking at within country - cultures are quite different. And I have very much heard about the Danes and the close friendship networks. And those are the value that they place on family and friends. You know, I think it's much higher than most other countries that I know of.

Dr Sandro: Yeah. They talked about it being related to the fact that the winters are so long that, you know, the people you choose, you have to spend a lot of time with. So, you choose them wisely.

Dr Michelle: You better like them!

Dr Sandro: Yeah. You better like them if you’re going to spend 20 hours a day for six months of the year. Whereas, you know, countries where that wasn't the case. Well, I'm not sure maybe that’s your next study Michelle, spend a lot of time in Scandinavia. I'll come with you for that one.

Dr Michelle: Yes, please

Dr Sandro: Tell me about the social media. I mean, I have to ask the question. So, it probably surprises a lot of people, particularly maybe older people looking at younger generations, maybe younger generations themselves. You know, we have 20,000 friends on social media, or we are followed by a few thousand people, or we have 6000, you know, connections on LinkedIn, and yet loneliness is skyrocketing. Make sense of that for me.

Dr Michelle: So, I think it's very easy for us to kind of link an associate that social media could be one of the root causes. I don’t think we have enough research that would directly show a prediction. So sometimes we need years or at least a decade of data to really kind of link those two variables together.

Dr Michelle: What we do know from the literature is that it's really about the way you might use it. So, there's a difference between using social media to meet someone new that you've never met before, versus using social media to maintain the ones that you've already met face to face.

Dr Michelle: So, there's a big difference. And different generations use social media differently as well. ,I think the older people tend to kind of think that, you know, it's social media or these increased use within young people networks, might be one of the causes of feeling lonely.

Dr Michelle: But it's also what they know. That's, you know, a lot of them have happened to be exposed to it. So, I think that with every generation, we tend to kind of pinpoint I try to go, oh, you know, it must be this, you know, and because of the accelerated use of this, and that's what's driving loneliness.

Dr Michelle: But I think we need to take a pause and also think about how these sorts of tools can be used to connect people and also to help them gain more social confidence so that they can actually bring those skills into face-to-face reality.

Dr Michelle: And there are a lot of people who do that in Melbourne, for example, there are a lot of people who say have a shared interest. I don't know. They love dogs of particular breed of dogs. And what I noticed is that they wouldn't know each other otherwise, but then they would then, you know, have puppy play dates or something like that and then actually bring this online friendship into Face-To-Face settings. So that's one way that social media can be used for good. You know, so it's for us to really kind of link the two.

Dr Michelle: I think we need kind of years of research for that. But also, I can see how it can benefit a lot of people who might feel lonely as well, and using that space to meet new people in a kind of less confronting way and then bring that friendship into real life.

Dr Sandro: But even if we don't know if social media use is driving loneliness, and that's a big question and that's something that you're looking at. How is it that we are in a world that has never been so connected and yet loneliness rates of loneliness are increasing?

Dr Sandro: I mean, what is it about the level of social connection or the type of connection that we get from being digitally connected, liking something, looking at a photo, you know, that is different from the connection we get in real life. Is it different or is it just it? Do we not know? I mean, how can we be so globally and locally interconnected and yet lonely?

Dr Michelle: Very good question. I don't know. But again, loneliness is one of those things that might be a consequence of a multitude of different things, including our values, including by society. And they might have started to shift their values and even systems like, you know, workplace culture, for example, you know, we're really expected to come into work and spend a lot of time just on tasks and not necessarily encouraged always to kind of socialise with colleagues, you know, little systems like that that kind of discourage us from actually developing more meaningful social connection. Even things like, you know, our values, to strive to be the best at everything we do that that means something's got to give.

Dr Michelle: You know, we don't have as much time for friends or family or to just spend more time doing leisurely things that we might otherwise engage socially. You know, so such minute new little things and expectations and pressures in society might actually cause us to shift less attention to things that are actually really important for our health and wellbeing.

Dr Sandro: Going back to the concept of meaningful social connection. We’re you know, globally connected with we're on multiple platforms. People are on Twitter. People are able to get access to information all day, every day. Is it the fact that it's not meaningful social connection? That is the kind of huge disconnect between the amount of information and kind of interaction that is occurring. And yet. The high and increasing rates of loneliness?

Dr Michelle: Yeah. That's the definition about what's meaningful to you. You know, because what might be meaningful to you might not be meaningful to me. So, it's about our ability to ask ourselves what would actually satisfy our own social needs and what's meaningful.

Dr Michelle: For some people, they would say actually having these brief interactions with people, is enough for me, that's enough. I don't know. And that might be meaningful for me compared to someone else who might say, no, I really like that one-on-one chat, that coffee that time, you know, reflecting on how have you been?

Dr Michelle: Like actually that focus is meaningful to me, compared to the kind of more brief interactions I might have with you. So, I think the question is what's actually meaningful to that person and are their behaviours and actions, actually meeting those social needs for them?

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Dr Sandro: So, Michelle I’ve got a couple of questions here from our audience, so question from Jack, what are the long-term impacts of loneliness, even short periods of loneliness? Can it create trauma, can it create some sort of long-lasting trauma? So, is there a permanent impact even from short periods of loneliness on our health?

Dr Michelle: So, because loneliness by definition is a subjective feeling. Again, this could be quite nuanced and could differ from individual to individual. What I would say is that if you feel lonely and distressed, it's really important for us to kind of see as a signal to do something different before the health impacts actually do set in.

Dr Michelle: Because when we actually are in a long stay of stress, that's actually when it's problematic. So even if it's brief for you in someone who might feel lonely in a kind of a short sharp bout of loneliness, that is actually not a good state for them.

Dr Michelle: So, it's really important and it might cause things like trauma. So, it's really important for them to kind of seek the help and not see loneliness as a signal like the failed or they've done something wrong. It's actually a signal for them to kind of seek that help.

Dr Sandro: This one's from Tessa. I find it really difficult to be alone by myself, even for short periods. What are some things that I can do to feel more comfortable with being alone?

Dr Michelle: Good question. I think it might be understanding and building the tolerance to be by yourself and understanding that being by yourself and in your own space doesn't mean that you are losing a connection somewhere. Sometimes is that connection with yourself, that's really important and kind of using that time as a time of reflection.

Dr Michelle: And it's OK. And not to be too hard on themselves. If they can't do it, if they feel like they can't be by themselves for that long, is to actually build that space, but also find ways of being by themselves and recharging as opposed to a source of distress for them.

Dr Sandro: This final one's from Andrei, I feel like I've been relying on technology more for social connections, especially with lockdown. But I'm worried that this is affecting my abilities to interact socially in real life. Should I be worried?

Dr Michelle: I think that's a very valid worry at this stage, and I think a lot of us would share that same concern. What is really important is when we do have these opportunities to actually see someone face to face is to take them. And that might alleviate the worry. And it's important that we keep a range of tools under our belt to actually maintain our friendships and relationships. So having those tools actually is very realistic, especially during Covid and to use them when they need to, but where there are times where we are able to see people, even if we’re able to stay Covid safe and in a mask, to do that.

Dr Sandro: Yeah, I think that’s really good advice.

Dr Sandro: Thanks for listening to the In Good Health podcast. To find out more about the work that we do, head over to our website, VicHealth.vic.gov.au. Oh, and make sure you check us out on social media under @VicHealth.