I'm so lonesome I could cry

watercolor illustration of a woman sitting alone in a forest clearing among bare trees

After only the opening chords and one or two bars of that haunting melody, you'd probably recognize the old song by Hank Williams — the one with the lyrics that express a feeling almost all of us have experienced:

Hear that lonesome whippoorwill
He sounds too blue to fly.
The midnight train is whining low
I'm so lonesome I could cry.

Although the song captures a common feeling, we now know it is not just a feeling, but a condition that has a very real effect on the body, and as it turns out is also a public health problem — so much so that as the new year turned in Great Britain, the issues of loneliness and social isolation were added to a ministerial portfolio. A survey study there showed that hundreds of thousands of people had not spoken to a friend or relative in a month — that's a lot of silence in your life.

Humans are social creatures. Among ourselves we form all kinds of complex alliances, affiliations, attachments, loves, and hates. If those connections break down, an individual risks health impacts throughout the body.

The health risks of loneliness

A brief list from recent research includes:

increased risk of cardiovascular disease
decreased cognitive and executive function (there is initial evidence of increased amyloid burden in the brains of the lonely)
as high as a 26% increase in the risk of premature death from all causes
decrease in the quality of sleep
increased chronic inflammation and decreased inflammatory control (linked to the risk of cognitive impairment and dementia)
decreased immune function leading to vulnerability to many types of disease
increased depressive symptoms
increased fearfulness of social situations (sometimes resulting in paranoia)
increased severity of strokes (with shortened survival)
and, as you would expect, an overall decrease in the subjective sense of well-being.

As early as 1988, an important overview of multiple studies documented that social isolation was a major risk factor for mortality, illness, and injury, and in fact was as significant a risk factor as smoking, obesity, or high blood pressure. The effects and prevalence of social isolation have been confirmed in good studies many times now, as well as in the work of advocacy groups such as the AARP. In a 2010 survey study, the AARP found that in the US, 35% of adults over the age of 45 were lonely, and isolation was getting worse — 56% of the lonely had fewer friends at the time of the survey than five years before. A study in 2012 found a higher percentage of lonely people: 40%. The AARP survey found (as have other studies) that loneliness was connected to poor health.

But it is only recently that mapping out the underlying neurobiology and neuroendocrinology has become possible, using new technologies.

The effects of loneliness on the brain

Here are a few ways in which loneliness shows up in the brain:

areas of the brain having to do with the perception of pain are activated
gray matter density decreases in an area of the brain related to social perception
areas of the brain having to do with "mentalization" (imagining other people's minds) are decreased in activity
the brain (in the all-important amygdala, for example) shows increased activity, with decreased recovery in response to negative stimuli — as Lily Tomlin on Sesame Street said about anger, this is "bad weather in the brain."

The endocrinology is also important

The HPA axis — the feedback system across the hypothalamus, pituitary, and adrenal glands — is impacted and results mainly through the dysregulation of stress hormones, and this is associated downstream with many negative health outcomes; oxytocin (the "social hormone") function is apparently decreased; brain derived neurotrophic factor (BDNF), one of the most abundant background facilitators of neuronal plasticity and nerve health, is decreased; and allopregnanolone, an important health-positive neurosteroid in the brain, is also decreased.

If that song, and all the health impacts of loneliness (from the cardio to the neuro to the hormonal), strike close to home, what can a person do?

Understand that people are a medicine

Sigmund Freud, in a chapter on anxiety in his Introductory Lectures on Psychoanalysis, relates a lovely story about a young boy who was afraid of the dark, except when his aunt talked to him. The boy said, "When someone speaks, it gets lighter."

So, people are anxiety relievers. And people are antidepressants, as well as blood pressure reducers (mostly). People, in general, are good for you. So, find ways to be around and be with people; let people accompany you on your travels through life.

Ways to do this are more common than you might think.

People from a distance: go to a library reading room to read the papers and take in the crowd.
People closer up: volunteer at a hospital, or a local food bank, or another organization that needs help.
People with engagement: join a congregation of worship; take up a hobby that you can share with others, such as a sport, or a game club (chess, mah-jongg, cards, Scrabble).
People with even more engagement: renew old friendships that may have withered on the vine; you will be surprised what a difference just having tea or coffee with an old friend regularly will make. The AARP found that having even one supportive relationship decreased perceived loneliness (and by implication, the health impact) from 76% for those with none to 36%.
If you feel introspective (Mark Twain said, "The worst loneliness is to not be comfortable with yourself"), seek out a therapist with whom you can think about your situation.

People are complicated. People can be difficult. But it is only within the complex and gratifying and sometimes challenging ecology of human relationships that we can truly thrive. See you at the coffee shop.

Christopher Bullock, MD, MFA (1947–2018), was a psychiatrist, psychoanalyst, and writer. He loved Gary Snyder's poetry; "all the junk that goes with being human" was a quote that inspired his life, his work, and his illness.