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Review of "Loneliness"

By John T. Cacioppo
W. W. Norton, 2008
Review by Roy Sugarman, Ph.D. on Apr 20th 2010

The authors are not alone in considering the value of belonging, or relatedness, given that Louis Cozolino and others have already added to the literature on the subject. As the world tries to deal with living longer but less healthily, one of the situations which we are urged to avoid is the loneliness which may accompany old age, and which may accompany a whole host of illnesses, as Cozolino and others suggest.

At the coffee shop along the high street in my road is a daily visitor, a resident really, Gianni by name.  At age 76, and unaware of the day and date, he engages with just anyone passing by, or certainly sitting to drink coffee.  He asserts that he has no idea how he came to be lonely at his age.  His antidote, driven by a need to consort with others, is to sit at the pavement café every day.  At five pm, as the shutters roll down, he passes through the pedestrian crossing to his apartment, only to emerge and repeat his day the next day, like Groundhog Day.  He says if he didn’t, he would just shrivel up.

Humans are desperate it seems, to form individual and group liaisons with multiple others.  Certainly it seems we evolved language and social systems to do this that, as we lost our protective jaws and claws and probably our four legged locomotion, and became vulnerable as loners. When we are ill or depressed, or damaged in some way, we tend to withdraw socially and lick our wounds.

Social systems, even in fairly ancient looking societies such as the Kung in the Kalahari Desert of southern Africa appear to be fairly typical of such agrarian societies.  Their hunting and living is cooperative, and it appears the capacity of the females to share themselves in dallying with others is also promoted, allowing for gossip and other entertainments. Breast feeding is on demand until five years old or more, children are carried in a sling for about 1500 miles a year, and the 11 000 year old Kung carry on pretty much as always they did before.  Being stingy is a serious offence, giving is everything: this does not create an Eden, as the Kung murder rate amongst themselves is higher than the USA per capita. Nevertheless, their tight knit and altruistic society underpins what we all value.

The authors explore in depth the interplay of three essential factors in the ‘sting’ of loneliness or social exclusion.  Most of us have been chosen last in the playground or classroom or at a dance, or some other place, some of us not I guess, but the sting of social exclusion is understood by all.  While it may no longer mean certain death, as it does in the African savannah, it certainly can drive people to despair, or even suicide. Our level of vulnerability to social disconnection is mentioned by many motivational scientists, speaking of the drive that is increased by a sense of social connectedness, not just mastery, when we contemplate change (see the excellent lectures on TED.com from Dan Pink and others).

Loneliness begins to disrupt our ability to self regulate our emotions and also our social cognitions.  It’s a two way street, with social separateness and dislocated emotions and cognition in turn leading to further social disconnectedness and further self fulfilling actions. This higher sensitivity to events and feelings, at the same time less accurate, creates a vortex which is difficult to escape. This also leads to other behaviors, as the authors describe, where loneliness leads us to seek and enjoy unhealthy food, even if we rate the food poorly in terms of taste and satisfaction: this leads us to understand why the stereotyped TV character, recently dumped by a lover or disappointed by a parent, is destined to appear onscreen with a tub of double chocolate something or the other, and eat it all.

As Baumeister found with cookie experiments, so it is clear too that lonelier adults eat fattier foods, and if loneliness is measured by a scale, for each standard deviation off the mean, lonely people consume about 2.5% more calories from fat.  The upper layers of our brain, the neocortex, are not thus immune to the influences from the ‘troops’ below, and when they get lonely, behavior and cognition changes.

Research connected to loneliness is spurred on by the changes in our society. We have demonstrably fewer close persons to discuss important issues with, despite social networking sites that allow us to connect widely but superficially with others. Average households are smaller, and increasingly run by a single parent. In 2000, 27million people lived alone in the USA, 36% of them under the age of 65, estimated this year to rise to 29 million, an increase in more than 30% since 1980….and of course we are getting fatter, for reasons the authors make clear.  One is reminded of what Hobbes suggested life might have been life without the social contract that guided our culture and laws: solitary, poor, nasty, brutish and short….I wonder if that will still emerge as the dominant life for many?

The authors go on to investigate the cultural and medical facets of loneliness, both in groups and in the self, but ask why loneliness promotes so much wear and tear on the system, so as to occasion illness. Social isolation has been shown to be on a par with other risk factors, such as hypertension, obesity, sedentary behavior, and smoking as risk factor for illness and early death.  One would imagine this is a behavioral issue, but the effect sizes are too large. Social class, as in the famous Whitehall British Service study, confers many risks, as does connectedness itself, and even obesity clusters in social classes.  Less education, less money, not only at the bottom end of the ladder, with imbalances in effort and reward, and low levels of control in one’s working life act as independent predictors of cardiovascular events, even when all other variables are controlled for.

Loneliness and health, say the authors, have five causal pathways. Health behaviors (executive control is compromised by loneliness), exposure to stress and life events (again, perceived control is an issue), so then perceived stress and coping are influenced as well, physiological responses to stress such as the allostatic load of loneliness is higher, and rest and recuperation are also impacted by loneliness.

Drawing on genetic evidence, part two of the book plays on the words ‘selfish genes’, as put forward by Dawkins, the authors then set out to show how there is more than just social influence at play here, more than just a skewing of our self image by comparison to those around us. This discussion involves the intrasubjective nature of our emotional social development, and the way we respond to subtle cues and outright rejections.

Reference is then made to Harlow’s studies on monkeys and tactile nurturing, and to the Romanian orphans’ autistic responses, Lorentz, Bowlby and the usual gang of suspects in the attachment and nurturing fields, as well as more modern examples moving away from Descarte’s errors, namely Damasio, and the work of McClintock on the merging of the menstrual cycles of her subjects.  Reference is also made to the physiology of oxytocin and related issues such as sucking on cigarettes, and the internal massage provided by food sliding down our digestive tracks.

The book tends to thus meander along, providing a very detailed look at all the usual aspects of loneliness and connectedness, finally providing an EASE approach to social connectedness (extend yourself, develop an action plan, selecting more promising relationships, and adopt an expect-the-best philosophy.

This is a really easy to read primer on social connectedness and its value, explaining a lot about human nature, a peep under the hood of something most lay people would just take for granted, blending biology and social cognitive theory with experiments in human nature, and anthropology. Csikszentmihalyi is mentioned more than once, and has written a comment on the book, fitting in with his Flow ideology, and the value of reaching out to others.  Of course, we all know by now, certainly post- Bowlby that we all need others, not just early in life, but late as well and in between, as Cozolino has written about, to keep us healthy in body and of course mind. Part of human motivation is to seek relatedness, and avoid the crash of self esteem that social ostracism will bring, with its impact on our executive function and social cognitive accuracy.

I do think that a second edition of this book could have a better structure, nicely accessible as it may be in its present form, but difficult to edit out the ‘take away message’ into a more succinct and functional format then it now presents. For instance, the effects on the motivating capacity of the organism, as Cozolino has done in his latest works (see The Neuroscience of Human Relationships and The Healthy Aging Brain)

Recommended though, highly so, a most interesting read indeed. Buy it, and share its insights with friends.


© 2010  Roy Sugarman


Roy Sugarman, PhD, Human Performance Institute, Sydney, Australia