Jeremy Nobel M.D., MPH is a primary-care physician, public health practitioner, and award-winning poet with faculty appointments at the Harvard T.H. Chan School of Public Health and the Harvard Medical School. He is the founder and president of the Foundation for Art & Healing, whose signature initiative, Project UnLonely, addresses the personal and public health challenges of loneliness and social isolation.
Below, Jeremy shares five key insights from his new book, Project UnLonely: Healing Our Crisis of Disconnection. Listen to the audio version—read by Jeremy himself—in the Next Big Idea App.
1. Loneliness can’t be cured because loneliness is not a disease.
We are all lonely from time to time, and occasional lonely feelings serve an important purpose in our lives. Loneliness is a natural alarm signal, like thirst or cold. Thirst warns us we need hydration and loneliness warns us we need to connect more deeply to others and to ourselves.
Loneliness is harmful only when it becomes so deep and enduring that it alters how our minds and bodies work, how we make sense of the world, and how we behave. That’s why it’s so important to better understand loneliness, so we can respond promptly and effectively to this flashing warning light on our personal dashboards.
When you feel a twinge of loneliness, it’s helpful to know that there are three different kinds of loneliness that may be calling to you. Psychological loneliness is the kind most people refer to when they say they are lonely. It’s that desire for a connection with a confidante, someone you can trust your secrets with. You can have a lot of friends and still feel lonely if you don’t feel safe opening yourself emotionally to any of them.
A second type of loneliness is societal loneliness, that sense of being a fish out of water, of feeling different, but also of being judged by others because of some aspect of who you are. It can also stem from being bullied or excluded—by co-workers, neighbors or by society at large. This loneliness can overlap with the third kind, existential loneliness, which can also be called spiritual loneliness. It’s the loneliness of having uncertain purpose and wondering if our lives have any meaning or consequence.
Each kind of lonely feeling is a call to fill a need, no different from the unpleasant bodily signals that indicate your need for warmth or water. Lonely people often interpret their loneliness very differently, not as a helpful warning, but as evidence they are inadequate and have failed. Some feel so ashamed of their loneliness that they may conclude the safest thing to do is stop even trying to connect with others.
I think of this when I hear loneliness referred to as an epidemic, as though it were a disease that needs to be eradicated. Pathologizing loneliness will make many lonely people conclude they have an illness without a cure, when loneliness is perhaps the most human of feelings. Loneliness can serve us as a catalyst for connection, but only if we accept its potentially helpful role in our lives, learn to interpret its signals and practice at navigating its emotional impact.
Importantly, it’s not just up to us as individuals to push back against loneliness. If we seek a less lonely world, there is a role for municipalities, health systems, employers, schools, faith-based groups, and yes, even our friends and neighbors to make it easier for each of us to feel more connected.
2. Extended loneliness, if ignored, can set off a disastrous spiral.
Feelings of loneliness likely evolved as a danger signal, perhaps to make our hunter-gatherer ancestors feel uneasy when straying from the safety of their group. Loneliness signals that we are vulnerable, which naturally triggers some levels of anxiety, our biological response to threat. If you remain lonely and in this anxious threat state for extended periods of time, it can dramatically change your brain. Some people enter a spiral in which they isolate to protect themselves, which makes them even lonelier and feeling more vulnerable.
Loneliness of this depth can distort what is called social cognition, the ability to correctly interpret the behavior of others. Very lonely people may become so suspicious of other people that they deny their need for social connection and also avoid seeking help. Some become standoffish, socially inappropriate, impulsive or irrational, behaviors that isolate them further. Many of the socially awkward loners who perpetrate mass shootings have become lost in this spiral.
There are five realms of human experience that put us at heightened risk of entering a loneliness spiral. I call them the five territories of loneliness. They are: Trauma, Illness, Aging, Difference and Modernity.
“There are five realms of human experience that put us at heightened risk of entering a loneliness spiral.”
Trauma, broadly speaking, is an injury or setback that takes an emotional toll on you. It could be a war-zone experience, domestic violence, a car crash, a divorce, or the premature death of a parent, sibling or friend. Illness and aging, both of which often include a sense of loss or social disorientation, are similar in the feelings of isolation and vulnerability they inspire. Difference is the loneliness territory traversed by anyone who doesn’t fit in or feels different from their peers, whether because of race, gender identity, a disability or simply not being considered attractive. Modernity is the fifth territory. It overlaps all four with its power to make some feel alienated, overwhelmed and all but “lost at sea.”
The people who are in one or more of these territories are subject to experiences that can damage their sense of trust and make them want to isolate themselves. Consider the loneliness of being transgender in certain states where the legislatures have made them targets of public hate. Or the loneliness of having a sudden illness that no longer enables you to participate in activities you once took for granted. If you find yourself in one of these territories, recognize that connecting with others is more important than you may have thought. And if you know someone who’s going through one of these often-lonely territories, reach out to them as though they are at risk of a loneliness spiral, even if they may not know it.
3. Other people’s loneliness can be hazardous to everyone’s health.
Many medical studies have documented how loneliness has terrible effects on lonely people’s well-being. A variety of mental and physical illnesses, from depression, addiction and suicidality to heart disease, dementia and diabetes have been associated with elevated levels of loneliness. Researchers say that loneliness is increasing and that it along with it comes health-damaging consequences as great as smoking 15 cigarettes a day, leading to a 30 percent increased risk of dying early.
Where is all this loneliness coming from? Mother Theresa once called loneliness “the leprosy of the West.” She sensed how modern secular societies that extol the benefits of individualism, freedom of choice, and progress also generate social anxieties and loneliness. The internet is a fountain of social comparison, conspiracy theories, hateful propaganda, and many other anti-social forms of communication that can cut people off from friends and family, leaving them desperately lonely. Media companies enrich their shareholders by promoting divisive content because negativity drives up click numbers and screen-time engagement. Social media, with its uniquely addictive appeal among young people, is a particularly damaging aspect of modernity. A correlation has been drawn between the ubiquity of cellphones and a decade-long rise in suicidality among young women, with a 2021 CDC report saying that three in five girls felt persistently sad and hopeless, a dramatic rise since 2011.
We can try to take steps to protect ourselves personally, but no one is immune from the damaging effects of other people’s loneliness. Consider the dangers that alienated angry people lost in loneliness spirals can cause to their families, within their workplaces, and to the public. Sometimes it’s serious enough to make others anxious, depressed, and unwell emotionally, as well as less productive and collaborative. Sometimes it can include more serious and even lethal risks.
In 2022, in the aftermath of yet another mass shooting, a 36-year-old father of two named Aaron Stark appeared on CNN to describe how, when he was a teenager, he had contemplated doing the same. Then a school friend reached out to him and suggested Aaron come to his house for a much-needed shower, to share a meal, and watch a movie. That evening, at his friend’s house, he abandoned his mass shooting plans. He told CNN, “I felt like I was just a ball of destruction waiting to explode. And I had someone who looked through all that and saw me as a person in pain, and just a kid crying out for help. And it literally saved my life and changed my whole world.”
We have a social responsibility to reach out to lonely people like young Aaron if they are in our lives. It is also in our self-interest. Other people’s loneliness is a danger to everyone, and it will never change if we remain ignorant about loneliness and the power of our own supportive attentiveness, engagement, and kindness to resolve it.
4. Creative expression can help you feel less lonely.
Making art changes our brains in powerful ways, reducing outflows of the stress hormone cortisol and boosting levels of the “feel good” neurotransmitters dopamine, serotonin, endorphins and oxytocin. That alone can be a catalyst for connection, but art can do more than reduce stress and improve mood. Recent studies of brain scans by Dutch neuroscientist Janneke van Leeuwen show that blood flow in the brain while interpreting works of visual art utilizes the same brain regions that influence our social interactions. It suggests that an important biological function of art may be to help us make sense of our social world, increasing our ability to connect authentically with others.
I have a six-word response whenever I’m asked for a brief prescription for reducing loneliness: “Be curious. Make something. Have conversations.”
First, get curious about your lonely feelings and meditate for a few moments about where they are coming from. Then harness your imagination to do something creative. Write, paint, dance, sculpt, crochet, cook, make ceramics, play music, make a quilt, or work in the garden. The experience of creating opens a cognitive and emotional flow between your conscious and unconscious mind, putting you in touch with thoughts and feelings otherwise difficult to access. You also get to experience the delight and inspiration of creative choices: select this word or that word, use this color or another, draw a thin line or a thick one, add more salt or less garlic, all while making a tangible artifact that reflects something unique and authentic, emerging from your creative self.
Then you can share what you’ve made with someone else, have a conversation about it and how it made you feel. When you invite someone to connect with something you’ve had the generosity to share, they often recognize within it something reflective of what they themselves have experienced. It’s like an electric circuit of human-to-human wiring is connected and both of you feel less lonely.
“The mere act of engaging with imagination and creative choices will stimulate their social brain activity.”
For anyone experiencing loneliness, creative expression can provide a safe and attractive pathway to authentic connection. It doesn’t require someone to change their social habits or examine why they’ve become lonely. If you know someone you suspect is suffering from loneliness, invite them to make something creative with you, or help you in the garden or even make a meal together. The mere act of engaging with imagination and creative choices will stimulate their social brain activity. It will make them feel more connected and more at ease in sharing themselves.
I’ll go out on a limb and suggest that in an age of weakening social norms and constraints, creative expression may well be an essential psychological survival skill. To engage creatively, to make your own meaning through aesthetic choices, and then share it with others is one important way we can all rise to modernity’s many challenges. And here’s the bonus: it’s also fun!
5. Detoxifying loneliness requires a two-pronged public health approach.
Any effective public health response to loneliness will require a dual focus, first on relieving the pain of those suffering the most, and then on addressing the powerful forces in our society that are isolating us and driving us apart. As we ramp up efforts to educate the public and boost support for those caught in loneliness spirals, we must also come up with new policies, regulatory measures and marketplace incentives to control the loneliness-producing effects of social media, the gig economy and the many other ways businesses currently profit from isolation, mistrust, and division.
A public awareness campaign is needed to educate people about the profound and potentially toxic nature of day-to-day loneliness. The chief objective of such a campaign would be to help normalize the experience of loneliness and reduce the shame and stigma that prevents so many people from seeking help. The public also needs a better understanding of how loneliness can begin to spiral after a negative life event such as a romantic break-up, a lost job, death of a loved one, or a serious illness diagnosis. Employers, colleges, and universities could make a substantial impact through education on these issues, similar to the way they address other workplace and campus health issues such as stress, smoking, and being overweight.
Our major healthcare organizations, including health systems, health insurers and government health agencies, must take the lead in raising awareness, particularly among very lonely people who are most at risk of entering the loneliness spiral. Clinicians and care managers should screen their patients for loneliness and then follow through with those patients who might benefit most from a supportive conversation and some specific guidance on connecting activities to consider.
Research has shown that patients are more likely to try daily exercise or healthy eating when these measures are part of a physician’s recommendation. It’s long past time that lonely people enjoy the same benefit from what’s been termed “social prescribing”—when doctors suggest patients use community resources to assist with their healing. Doctors with lonely patients might prescribe taking an art or pottery class, going on a nature hike, volunteering with a community group, whatever activity might seem most appealing to the patient.
To achieve a full public health solution, however, it will be critical to categorize, measure, and mitigate the loneliness impacts of massive social trends such as rising inequality, declines in religious affiliation, and dramatic increases in numbers of people living alone. All these trends generate huge “upstream effects” on loneliness that are impossible to deny but difficult to calculate. If we fail to counter them through social and regulatory policies, we risk seeing even our best efforts at public education and supportive outreach to address loneliness fall further and further behind.
To listen to the audio version read by author Jeremy Nobel, download the Next Big Idea App today:
