Friendship — Part 3

Chapter 3: Friendship

There are a number of key strategies that will help with loneliness. Most are self-evident but, nonetheless, I have described them here. Spend time each day with those you love. Focus on each other. Forget about multitasking and give another person the gift of your full attention, making eye contact and genuinely listening. And it might sound counterintuitive at first, but embrace solitude because the first step towards building stronger connections with others is to build a stronger connection with yourself. Meditation, prayer, art, music and time spent outdoors can all be sources of solitary comfort and joy. Help and be helped. Checking on a neighbour, seeking advice, even just offering a smile to a stranger six feet away all can make us happier and help with loneliness.

Unfortunately, some of the interventions imposed for prevention against the coronavirus such as ‘self-isolation’ and ‘social distancing’ have exaggerated loneliness for many. The long-term consequences and implications of these global public health approaches can only be imagined and we should be putting public health strategies in place to mitigate the likely inevitable consequences.

Chapter 3: Friendship

In April 2018, the UK government appointed Tracey Crouch as the world’s first minister for loneliness, a role created by Prime Minister Theresa May earlier that year. ‘For far too many people, loneliness is the sad reality of modern life,’ May said when announcing the new position. The appointment was created in response to a commissioned report that found that more than 9 million people in Britain – around 14 per cent of the population – often or always feel lonely. Loneliness is estimated to cost UK employers up to £3.5 billion annually. From my own research, a quarter of Irish adults feel lonely some of the time and 5 per cent often feel lonely. However, living alone doubles the likelihood of experiencing loneliness. Men who live alone are lonelier than women who live alone. Loneliness increases with age and lonely people are also more likely to suffer from depression. Contrary to our expectations, I found no difference in the likelihood of being lonely for people living in rural Ireland compared with city dwelling.

Probably one of the most striking cultural experiences of loneliness is Japan. Here, lonely deaths among older people have a name, kodokushi. This refers to someone dying alone and remaining undiscovered for a long period of time. The first instance that became national news in Japan was in 2000, when the corpse of a 69-year-old man was discovered three years after his death. Monthly rent and utilities had been withdrawn automatically from his bank account and only after savings were depleted was his skeleton discovered at his home. The body had been consumed by maggots and beetles. In 2008, there were more than 2,200 reported lonely deaths in Tokyo. Similar numbers were reported in 2011. One private removals company in Osaka reported that 20 per cent of the their jobs involved removing the belongings of people who had died lonely deaths. Approximately 4.5 per cent of funerals in 2006 involved instances of kodokushi.

Chapter 3: Friendship

Kodokushi mostly affects men who are 50 or older. Several reasons for the rise in this phenomenon have been proposed. Social isolation is increasing as older Japanese people are living alone more and more, rather than in multi-generational housing. They lack contact with family and neighbours, and are thus more likely to die alone and remain undiscovered. Japan has the highest proportion of long-lived people in the world. One hopes that this terrible epidemic of loneliness and in particular kodokushi is not replicated in other countries where there is also a growing older demographic. Social isolation is commonly coupled with economic hardship. Many incidents of kodokushi involve people who were receiving welfare or had few financial resources. The Japanese trait of uncomplaining endurance, or gaman, discourages people in need from seeking help. Victims of kodokushi have been described as ‘slipping through the cracks’ between governmental and familial support. Future policy should focus on these high-risk indicators.

Loneliness is not the preserve of old age – it spans all ages. In a recent US survey of over 20,000 people aged 18 upwards, loneliness was reported in all age groups. Social support and meaningful daily interactions had the strongest link with less loneliness, as had good family connections, good physical and mental health, friendships and being in a couple. Social anxiety was most strongly associated with loneliness, followed by social media overuse and daily use of text-based social media.

Chapter 3: Friendship

As you might expect, modern-day change in family structures is strongly implicated in loneliness. Household size is shrinking and there are now more single-person households in Europe than any other household type, which coincides with greater awareness of loneliness as an issue for all ages. How much effort we invest into relationships affects the level of support we receive from them and the long-term benefits. This is the case for all age groups and the benefits persist throughout our lifespan. Close relationships include both family members and friends. But is there a difference in the benefits to health and well-being from each? Should I invest more in friends or in family? When we speak of family members we mostly include siblings, children, parents and spouses. Harmonious family relationships have a long history of endowing positive effects on people, whether the relationships are with spouses or other immediate family. Friendships enrich health and well-being. William Chopik, a psychologist at Michigan State University, conducted two large-scale analyses to understand the relative contributions of friends and family to good health and happiness across the lifespan, including in later life. The first study examined over 271,000 people born between 1900 and 1999, and aged from 15 to 99 years, from 97 different countries. Participants were asked how important family and friends were in their lives. They were also asked to rate their own health and happiness. In relation to well-being, participants were asked, ‘All things considered, how satisfied are you with your life as a whole these days?’ The study was then repeated in a US cohort of adults aged 50 and older, average age 67 years, for whom long-term follow-up data on chronic health conditions, such as high blood pressure, diabetes, cancer, lung disease, heart attacks, angina, heart failure, emotional, nervous, or psychiatric problems, arthritis or rheumatism and stroke, were available to determine whether relationship quality had an enduring impact on long-term health into older ages. Questions about the quality of relationships included, ‘How much do they [close friends/family] really understand the way you feel about things?’ and ‘How much do they let you down when you are counting on them?’ For both studies, spousal support, child support, and friendship support were all associated with subjective well-being and happiness. This was the case at all ages and persisted through to latter years. However, if relationships were strained, chronic disease was more likely. In fact, strain from family and friendships was a principal predictor of likelihood to develop chronic illnesses over time. The findings align well with other research on the overall and lasting benefits of close relationships and the importance of relationship quality rather than relationship numbers. So, when friends and family are the source of strain, people experience more chronic illnesses; when friends and family are the source of support, people are healthier.