When Elvis Presley described I’m So Lonesome I Could Cry as the saddest song he had ever heard, he didn’t know the half of it. His famous utterance was made on January 14th, 1973, at his Aloha from Hawaii Via Satellite concert, and preceded his acclaimed cover of the classic Hank Williams song. That same year, American sociologist and social psychologist Robert S Weiss released his seminal paper, Loneliness: The Experience of Emotional and Social Isolation. In it, he outlined two distinct forms of loneliness – emotional, and social – and how they impact the health and wellbeing of someone living with either condition in distinct, measurable and harmful ways. Emotional loneliness can be summarised as the absence of a close confidante or attachment.It is often linked to the loss or lack of a life partner, a best friend, or a deep emotional bond. Those experiencing it can become hyper-vigilant, overly sensitive and less empathetic, with a proneness to misinterpretation – all of which can inhibit efforts to re-engage with people and develop new meaningful close relationships, resulting in a vicious cycle. Simply telling someone experiencing emotional loneliness to join a club, and them following that instruction, for example, will not necessarily address the issue unless the person establishes a meaningful and trustful bond with someone in the club, or someone who links them to it. Social loneliness, on the other hand, refers to the dearth of a broader social network and can result in absence of social integration or embeddedness.It is regularly linked to a lack of friends, a community, or a sense of belonging to a group. Those experiencing or suffering from social loneliness may feel a sense of marginalisation and exclusion, boredom and a lack of concentration, among other symptoms. Social loneliness highlights the benefits associated with finding and maintaining connections to a person’s tribe. Both versions can co-exist, but one is usually dominant. Of the two, emotional loneliness is the more pernicious. It is, of course, essential to differentiate between experiencing loneliness in the short term – a common if undesirable state of being – and long-term loneliness, which is a significant risk factor for chronic ill-health. Research suggests the negative health impact of chronic loneliness is comparable to smoking 10-15 cigarettes a day and exceeds that of hypertension and obesity. My own tribe of psychiatrists – they don’t necessarily see loneliness as an important mental health issue. But people from other backgrounds, eg the social side, don’t want to see loneliness pathologised either— Brian Lawlor, professor of old-age psychiatryWeiss’s paradigm still informs much of our understanding of loneliness today, which has been recently recognised as a major public health issue, with the UK (2018) and Japan (2021) going as far as establishing dedicated ministers for loneliness. In Ireland, in 2019, the government added responsibility for loneliness to the brief of the minister of state for mental health and older people. Meanwhile, the World Health Organization (WHO) established a Commission on Social Connection in 2023 designed to treat loneliness as a global health priority. [ Does a Pacino-De Niro bromance ad contain the seeds of a cure for male loneliness?Opens in new window ]Prof Brian Lawlor gave a talk recently on loneliness at Trinity College Dublin’s Unit 18 on Macken Street as part of its Trinity in the Community initiative. In it, he referenced Weiss’s framework, highlighting the potential of loneliness to cause harm – and the potential of connection to heal. Lawlor started his presentation with a quote from the late American author Kurt Vonnegut, taken from an address he gave in 1974 to a group of college graduates. In it, the author asked: “What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."Vonnegut, reckons Lawlor, “was visionary in calling loneliness a disease”, and he makes the argument for the condition to be considered under mainstream psychiatry. This would not be as a mental health disorder classified in the diagnostic bibles – the ICD (International Classification of Disease) or the DSM (Diagnostic and Statistical Manual of Mental Disorders) – but as a co-morbidity due to its association with and tendency to exacerbate and worsen the prognosis of many psychiatric conditions.“Loneliness was considered a social issue, as most of the early literature came from sociology and social psychology rather than mental health psychiatry, and there’s still a bias in psychiatry because of that,” he opines. “If you go back to the contributions of the early psychoanalysts, they talk about the importance and impact of loneliness. But I think modern-day psychiatry has turned its back on loneliness.[ ‘I love my job, but the loneliness is hard’: Reality of life as a travel influencerOpens in new window ]“My own tribe of psychiatrists – they don’t necessarily see loneliness as an important mental health issue. But people from other backgrounds, eg, the social side, don’t want to see loneliness pathologised either. But there’s no denying it as a public health issue. When you have moderate to severe loneliness that is persistent, it really impacts people’s health. Prevention is key across the life course.”Loneliness, research demonstrates, is linked with an increased risk of hypertension, stroke, heart disease, diabetes, sleep disturbance, suicide, depression, dementia, psychosis, and even death. Loneliness affects individuals across all age groups but peaks at ages 30, 55-60, and again at 80, research suggests. A retired professor of old-age psychiatry and founding director of the Global Brain Health Institute at Trinity, Lawlor has a longstanding clinical and research interest in brain health, dementia prevention and loneliness as a consequence of and risk factor in dementia. His own “lightbulb moment” regarding the impact of loneliness occurred when he returned to take up a role in St James’s Hospital in the early 1990s following almost a decade working in the US. “We were looking at community-dwelling older people (in and around the St James’s hospital footprint in Dublin’s Liberties area) and using a computerised questionnaire system called AGECAT (that assesses mental health status in older adults). One of the questions was about loneliness, and we started measuring this from a research perspective,” he recalls. “I began to see from some of the loneliness data how it was a risk factor for depression ... and that this was an unexplored area.”Around the same time, a patient was referred to him for “treatment-resistant depression”, having failed multiple attempts at using medications, he explains. “Talking to her, it became clear that she was lonely, emotionally lonely. She had recently lost her husband. They did everything together. Her life was turned upside down when he died. “I asked her: ‘Do you feel lonely?’ She just stopped, looked at me a while and said, ‘You know what, I think you’re right’. It was only when we started talking about her loneliness and exploring how she could address that emotional loneliness that she started to process her grief and move on. Her treatment involved reconnecting her with her family, her friends, her community. There was no medical prescription required. And her depression lifted.”When I retired, I did have to make an effort to maintain purpose in my life in other ways, but I’m very connected and involved in a lot of local groups and activities— Betty Ashe, community activistBeing widowed and being a woman are two identified risk factors for loneliness, as are mental illness, having a physical disability, being a care-giver, living alone, bereavement, having a poor social network, and coming from a low socioeconomic status. Many of life’s key transitions bring heightened risk. Loneliness affects individuals across all age groups but peaks at ages 30, 55-60, and again at 80, research suggests. Approximately one in four people report feeling lonely at least occasionally, and between 5 per cent and 10 per cent experience loneliness at a level that significantly impairs their quality of life, mental health and daily functioning. [ Young people report higher levels of loneliness than their elders doOpens in new window ]There is notable debate in the academic world over the consistency of how loneliness is measured in the literature, with experts applying caveats to some high-profile findings, including the 2022 report from the European Commission’s Joint Research Centre (JRC) that suggested Ireland had the highest prevalence of loneliness of all European countries. Dr Joanna McHugh Power, associate professor in psychology at Maynooth University, and colleagues, in a position paper on PublicPolicy.ie, warn of the JRC’s use of a single-item measure for loneliness which raises legitimate questions over the validity of the findings and their comparability across countries. There is a profound difference between being lonely and living contentedly alone. To bring the point to life, Betty Ashe (85) interjected from the floor when Lawlor highlighted this during his talk. She stressed that she considered living alone a relief and her reward for a long, fulfilling and often challenging life as a wife and mother.Speaking to her afterwards, Ashe, a life-long community activist in Dublin’s inner city, explained: “I was married to a narcissist for 60 years. He died five years ago, so being on my own is a relief after that. The kids are all grown up and I can do what I want, not that I let him ruin my life – I’ve lived a very full life, and achieved my potential.“But when I retired, I did have to make an effort to maintain purpose in my life in other ways, but I’m very connected and involved in a lot of local groups and activities.”Ireland has the highest prevalence of loneliness of all European countries, according to European Commission research. Photo: Getty Images Ashe is a founding member of St Andrew’s Resource Centre on Pearse Street, and a member of the board of the Dublin Inner City Partnership and the council of the Dublin Docklands Development Authority. Reared in the flats on Pearse Street, she explained that the mass demolition of derelict buildings and forced relocation of families following the 1963 collapse of a tenement building on Fenian Street (which resulted in the deaths of two young girls, Linda Byrne and Marion Vardy) ripped up not only the local built environment, but the social fabric of the community too. “The combined population of the Westland Row and City Quay parishes before the demolitions and relocations was approximately 22,000 families. When it was all done and dusted there was about 6,000 people left, most of them older people. It was mainly women who stepped up to rebuild that inner city community,” she explains. [ Solitude is a rare chance to think. Loneliness is when the inner dialogue is unbearableOpens in new window ] Lawlor concluded his session on loneliness by highlighting how the design of our built and social environments can help address many of the social determinants of health that contribute to loneliness. These include access to fundamentals such as housing stability, financial security, and education and employment opportunities, but also connecting communities through social engagement, intergenerational interaction, and in so called third spaces (those outside where we live and work, including libraries, parks, sports clubs, community centres and commercial spaces). “I can see there is a lot to learn from this community,” he told the assembled crowd. Ashe is living proof. “I moved from volunteering to working in community development thanks to the help of a young woman who came out to means test me when I put in an application for social welfare. I had to receive just one payment to be eligible for the newly established Fás employment schemes,” she explains, noting the year was Dublin’s designation as European City of Culture in 1991. “Up to then I was listed as a dependent on my husband’s welfare payment, and I told her I was afraid he would lose that money, and maybe I shouldn’t apply.“She said, ‘That’s not a reason. This will allow you get your own money, your own job, and your own life’.” That young woman, she said, “changed my life – and since then all I wanted was to give that same opportunity to other women and other people”.