Now it is loneliness who comes at night

Loneliness

Now it is Loneliness who comes at night
Instead of Sleep, to sit beside my bed.
Like a tired child I lie and wait her tread,
I watch her softly blowing out the light.
Motionless sitting, neither left or right
She turns, and weary, weary droops her head.
She, too, is old; she, too, has fought the fight.
So, with the laurel she is garlanded.

Through the sad dark the slowly ebbing tide
Breaks on a barren shore, unsatisfied.
A strange wind flows… then silence.  I am fain
To turn to Loneliness, to take her hand,
Cling to her, waiting, till the barren land
Fills with the dreadful monotone of rain

-Katherine Mansfield

Alone in pain

A recent piece in The Conversation – The deadly truth about loneliness, triggered some thinking and research. The author Michelle Lim, a Clinical Psychologist, drew an analogy between loneliness and pain:

“From an evolutionary point of view, our reliance on social groups has ensured our survival as a species. Hence loneliness can be seen as a signal to connect with others. This makes it little different to hunger, thirst or physical pain, which signal the need to eat, drink or seek medical attention.” (emphasis added)

In drawing the analogy between pain, hunger, and thirst, there are echoes of the great Pat Wall’s thinking about these subjective experiences as “need states”, as well as some links to recent thinking (with acknowledged roots in Pat’s ideas) about pain as an “imperative” from Colin Klein. In language that readers of noijam would be familiar with, loneliness also fits easily within the notion of a “protective output”.

There are also links between loneliness and pain that evoke thoughts of DIMs and SIMs. As one of the seven categories of DIMs and SIMs, People in your life is often populated by, well, people – people that can either increase a sense of danger, or enhance a sense of safety for an individual. However it’s quite conceivable that the (perception of) absence of people and quality relationships in an individual’s life can be a very powerful DIM. There is evidence in the literature that suggests loneliness is a risk factor for the development of a concurrent pain, depression and fatigue ‘symptom cluster’ with a possible immunological basis, and recent evidence that suggests that chronic and transitory loneliness are associated with higher daily pain ratings in people diagnosed with fibromyalgia.

What to do?   

The poets may be ahead of the science here. The theme of loneliness infuses hundreds of verses from the great poets, and poetry (as a creative pursuit!) has helped many to understand and express their feelings of loneliness. One of the more famous poems on loneliness was penned by William Wordsworth:

I Wandered Lonely as a Cloud

I wandered lonely as a cloud
That floats on high o’er vales and hills,
When all at once I saw a crowd,
A host, of golden daffodils;
Beside the lake, beneath the trees,
Fluttering and dancing in the breeze.

 

Continuous as the stars that shine
And twinkle on the milky way,
They stretched in never-ending line
Along the margin of a bay:
Ten thousand saw I at a glance,
Tossing their heads in sprightly dance.

 

The waves beside them danced; but they
Out-did the sparkling waves in glee:
A poet could not but be gay,
In such a jocund company:
I gazed—and gazed—but little thought
What wealth the show to me had brought:

 

For oft, when on my couch I lie
In vacant or in pensive mood,
They flash upon that inward eye
Which is the bliss of solitude;
And then my heart with pleasure fills,
And dances with the daffodils.

 

The author Kurt Vonnegut also had an idea, in Palm Sunday: An Autobiographical Collage he wrote

“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.”

If loneliness is a DIM (of course it is), then Vonnegut’s “most daring thing” suggests a powerful role for Society* in the ‘treatment’ of both loneliness and pain. But there are strategies that can be developed in the clinic too – just identifying loneliness as a DIM could be a start, and clinicians can help patients find greater quality in relationships, or recognise the need to do so and refer on, depending on their particular expertise.

One final thought – how many patients have found a ‘solution’ to their loneliness in a clinician? What moral and ethical issues might this raise?

 

-Tim Cocks

 

*This of course is the “S” in the BPS model. Despite the increasing proliferation of the strawman argument that the BPS model calls for a rejection of consideration of the “bio” (how anyone came to this conclusion when there is a Big Bloody “B” at the Beginning of the name is anyone’s guess) the links between loneliness and pain/health surely reinforce the validity of treating a whole human being, whatever label one wants to give to this approach!

 

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17 Responses to “Now it is loneliness who comes at night”

  1. Blanaid@fiorilass

    Hi Tim,
    Thanks for a really interesting post. On the subject of loneliness I was reading recently about homesickness being a form of “mini grief”. I wondered if homesickness isn’t just a form of extreme loneliness, not just for people but also for place. As anyone knows who has left their home, mild homesickness is a normal response affecting most of us but intense homesickness can be deeply harrowing for those who experience it. Affecting both children and adults alike it can have an exacerbating effect on anxiety, depression and social isolation. For as well as affecting pre existing mood disorders it is known to add new problems to old with insomnia, memory problems, gastrointestinal and immune deficiencies all reported.

    While voluntary migration may bring its own level of homesickness, imagine the levels in those who are forcibly displaced. With the UNHCR’s World at War report stating, that wars, conflict and persecution have forced more people than at any other time since records began, to flee their homes and seek refuge and safety elsewhere. They estimate that a staggering 59.5 million refugees (half of them children) compared to 51.2 million a year earlier have been forcibly displaced at the end of 2014. Incredibly, this means that one in every 122 humans in this world of ours is internally displaced, seeking asylum or a refugee. If the link between loneliness and pain is easily understood, imagine being forced to flee your homeland with little hope of return and how that would affect your pain experience.

    Regards Blanaid

    Reply
    • timcocks0noi

      Hi Blanaid
      Thank you for your thoughtful and insightful comments. Researching this topic it quickly became apparent that loneliness stems not from being alone, but from the quality of relationships one perceives one has. For many people and cultures around the world, a relationship with the land – with ‘country’ in the terminology of Australia’s indigenous people, is as important as relationships with others. It makes a great deal of sense to me that people dislocated from their country could feel an immense loneliness.
      Thanks again
      Tim

      Reply
  2. Ian Stevens

    Relevant and seldom discussed . You might be interested in this popular UK story Tim
    http://www.independent.co.uk/news/uk/home-news/police-share-tea-with-elderly-couple-who-rang-999-because-they-are-lonely-a6731711.html

    I think your last question about the ethics of care and loneliness needs wider airing . There are many, many people who present to the GP and subsequently are referred or who regularly go to manual therapists privately when the main issue is isolation/boredom loneliness . I would imagine many people are kept going and helped by touch ,reassurance and contact with therapists . If those that do this understand that this is what they are doing than I see noting wrong with it (and I think its very common ) . However dressing this up in complex physical or neuro explanations misses the point and there are some people I have been unable to manage well and who are completely dependent on multiple health providers to stave off many of their needs. In an increasingly elderly population with friends and family scattered to the four winds it is inevitable that isolation will present ‘medically’ and therapists will have to think more about these issues . Whether they will or educationalists will prepare new therapists to think and interact with the issues that present is another matter ?

    Reply
    • Blanaid@fiorilass

      Hi Ian, Full marks to the police who dealt with these elderly people with great compassion. Its staggering to believe that a million older people in the UK havent spoken to another person for a month with 5 million claiming the TV is their main source of companionship (Age UK estimates). The knock on effect on health and wellbeing must be enormous.

      Reply
    • timcocks0noi

      Thanks Ian
      A heart warming story – a “brew and a chat” can be potent SIMs! This section from the story struck me:
      “Mrs Thompson [95 years old], whose first name has not been disclosed, is in poor health and currently cares for her husband, who is going blind…the couple were having difficulty caring for each other and were in need of company.” Certainly sounds like it could get desperately lonely.

      Ian, I really like your thoughts on those individuals presenting to manual therapists where the main issue is isolation/loneliness/boredom. Turning these people away would surely only exacerbate the problem – but then so would medicalising the problem – as you say, ‘dressing it up’ in tissue/biomedical/neuro explanations that then require ongoing tissue/biomedical/neuro “treatments”. I remember seeing these patients as a student working in public hospital out-patient settings and wondering why they wouldn’t get better. I can also recall tutors saying things like “coming here is probably the only social outing the get all week” – but there was no framework to offer anything more than the usual physical modalities – US, mobilisations, IFT for 20mins and home exercises (AROM, IRQ and SLR were standard for all the ‘OA knees’). Looking back, perhaps a brew and a chat (about DIMs and SIMs!!) in the hospital cafeteria might have been superior therapy.
      Thanks again,
      Tim

      Reply
  3. davidboltononoi

    Hi Tim,
    A very thought provoking article. I have, on this site shared the fact that I have suffered chronic pain and many other systemic issues since a very young age. One big issue, probably the main issue in my childhood was loneliness. Loneliness created by not being loved, nurtured, respected and protected from my parents and the world in general. In essence my childhood was denied to me, stolen from me. I believe that my condition evolved out of my environment and that loneliness, in what ever shape or form was a powerful driver, a powerful and overwhelming Dim.
    A Dim, in my opinion that is totally underrated. When someone has experienced loneliness it leaves a void and, depending on the extent permanent damage. One experiences, for want of a better term “Chroinc loneliness”. A part of the soul has been destroyed.
    I don’t really care why someone seeks my help because if they have reached out to me I will greet them with open arms. What matters is my awareness of their unique Dim/Sim weighing up of their World. Following clinical reasoning I will then “custom fit ” appropriate action.
    DB
    London 🎄

    Reply
    • timcocks0noi

      Hi David
      Thank you for your deeply honest and confronting thoughts. Confronting, because as a parent to young children hearing how you were treated as a child strikes a deep emotional chord. Is it presumptuous to suggest that perhaps your clinical approach – one of “open arms”, genuine warmth, love and a big hug when needed has been shaped by your childhood experiences?
      Thanks again
      TC

      Reply
      • libgore

        Tim, your children won’t suffer that fate ! But my experience in the aged care world is pertinent here. Many of my clients insist on their hug at the end of treatment, I know it’s the most important thing I can give . As therapists there is no need to fear empathy and engaging with our clients emotional pain.

        Reply
  4. davidbutler0noi

    Reading these poignant posts, I am acutely aware that I don’t think I have ever asked people if they had had periods of loneliness and if they thought loneliness was in any way related to their pains and other problems.

    I am guilty of missing this emotion in a clinical sense.

    David

    Reply
    • timcocks0noi

      Thanks for your thoughts Dave
      It does make me think that as we help individuals in trouble identify DIMs and SIMs we need to be aware of not only what is there in the categories- but also what is lacking, what is absent – the “voids” as David has called them above!

      (PS. Go the Antipodes!)

      Reply
  5. Blanaid@fiorilass

    You sometimes hear people say that someone is “dying of the loneliness”. It reminds me of a story about a group of islands off the west coast of Kerry in Ireland, called the Blaskets. Impossibly beautiful but perched in the wild Atlantic; they are the westernmost tip of Europe. A friend in school’s father came from there. He spoke our native language like a poetry I had never heard. The islands were impossible to reach in the winter because of heavy seas. In the 1950’s a young boy became extremely ill and needed evacuation but was unable to be reached and he subsequently died. The government issued a forcible evacuation order from the island and people were moved to the mainland where houses and a small patch of land awaited them. The weather was so bad when the islanders were evacuated they were only able to take two chairs and a single box between them. Though only separated by a narrow stretch of water, the loss of their island culture was enormous. It was said the men continued to walk in single file along the roads, as if still on their cliff paths. Many who were older did not settle at all. Looking out every day on their homeland was a daily reminder of their loss. The youngest survivor said they just curled up and died. Which makes you wonder …can you actually die of loneliness?

    Reply
    • timcocks0noi

      Speaking of poetry “impossibly beautiful” – what a wonderfully evocative phrase!

      Gregory Bateson spoke of seeing only a “short arc of the circuit” – a kind of shortsightedness that failed to take into account the full repercussions of our actions in the environment and within cultures. A kind of linear thinking when a more dynamic, circular or emergent thinking was required – this is a classic example of trying to “help” people but only seeing a short arc.
      Sadly, I suspect that the answer to your question may well be yes.
      Tim

      Reply
  6. betsancorkhill

    All the ladies who come to my knitting group were profoundly lonely before joining. When you are lonely you focus on all those negative issues.

    I think John Caccioppo’s work on loneliness is interesting. He’s found that you need the right type of social engagement – it needs to address the emotional and social aspects of loneliness. This is where programmes such as Care in the Community fall down because when a person lives alone a carer rushing in and out doesn’t fulfil their emotional needs.

    One of the things we’ve observed through our knitting group is that it is important to have the opportunity to ‘just be’ with other people – where you don’t have to speak or make conversation if you don’t want to. It’s also important to learn to enjoy ‘just being’ with yourself.

    Getting involved in a creative pastime can enable you to learn to enjoy moments of solitude as opposed to feeling lonely. We talk about this in the group as a way of managing loneliness. I think ‘learning to enjoy solitude’ should be a skill we teach in schools.

    Reply

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