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!