Open Book

Islands in the Sea

At times, therapy can reinforce isolation

Magazine Issue
March/April 2009
Islands in the Sea

The Lonely American: Drifting Apart in the Twenty-First Century
Jacqueline Olds and Richard S. Schwartz
Beacon Press. 224 pp. ISBN-13:978-0-8070-0034-2

Loneliness: Human Nature and the Need for Social Connection
John T. Cacioppo and William Patrick
W. W. Norton. 269 pp. ISBN 978-0-393-06170-3

Sometimes it seems that the very idea of shame has been banished from our door. The underwear ads on bus stops are more lurid than the pornography of my childhood, while revelations of celebrity rehab, rather than a secret to be hidden at all costs, are a staple of cable TV. Until recently, about the only thing people appeared to be ashamed of was being exposed as making too little money (though with our current economic meltdown, that, too, seems passe). According to therapists Jacqueline Olds and Richard Schwartz, however, one shameful secret patients are still likely to conceal is that that they’re lonely.

Depressed? It’s become popular parlance. People use the term even when they’re just sad, forlorn, or having a bad spell. But lonely? Not me! It’s like admitting—to use that most stigmatizing term from high school—that you’re a “loser.”

Still, the evidence is piling up that loneliness is an increasing problem. According to the 2000 census, 25 percent of U.S. households consist of only one person. Contrast this with population statistics from 1940, when people living alone accounted for roughly 7 percent of the population. Duke University researchers report that, between 1985 and 2004, the number of people with whom the average person discussed personal and important matters dropped from three to two. Most stunningly, say Olds and Schwartz, a husband-and-wife team of psychiatrists who teach at Harvard Medical School, “the number of people who said there was no one with whom they discussed important matters, tripled. . . . Individuals without a single confidant now made up nearly a quarter of those surveyed.”

In The Lonely American, Olds and Schwartz tick off the cultural reasons for this epidemic of loneliness, which probably won’t surprise anybody: America has always been a land of rugged individualism, celebrating a cult of personal autonomy for close to two centuries. (Think Henry David Thoreau’s Walden, Ralph Waldo Emerson’s “Self-Reliance,” Walt Whitman’s “Song of Myself,” Jack Kerouac’s On the Road, and any number of frontier heroes and heroines from way back.) Cultural icons like the solitary cowboy (think John Wayne in The Searchers or Alan Ladd in Shane), action heroes like Rambo and Lara Croft, and legions of haunted detectives staring into the darkness late at night fill our imaginations. North Americans as a people move often, break connections, and extol individual freedom as if mobility and autonomy were God’s gift to the planet.

The result is that Americans spin through their isolated days like whirling dervishes. Instead of meeting other human beings, many of us succumb to electronic distractions. We gaze into our BlackBerries while walking. We endlessly check off items on to-do lists, caught up in what the writer Barbara Ehrenreich calls “the cult of busyness.” Underneath all this display of frantic activity lies the painfulness of social isolation and loneliness. For that, we hope that psychotherapists, like good sheriffs, ride to the rescue.

Therapy: Bad for Patients and Therapists?

All well and good! That’s what therapy is for, isn’t it? Therapists are trained to address the dynamics of emotional distress, the feelings and symptoms that keep people disconnected and in pain. But there’s the hitch. According to Olds and Schwartz, what usually goes on between the therapist and patient may not be the best way to help patients emerge from social isolation. Instead, therapy may teach lessons that are exactly the opposite of what patients need to know about how to build relationships with other people.

As the authors put it, “Patients get to talk mostly about themselves” without having to worry about the therapist’s state of mind (at least in theory). They insist that “the job of the therapist is to be curious about the patient [and] provide patients with reliable attention and understanding, keeping the focus on the patient’s problems and life and words. There is no expectation of equal time.” That can feel just dandy during the therapy hour: it can make us feel freer to express ourselves without fear or shame. While we may be conversational duds at a party, we may see ourselves as magically articulate, even fascinating, in front of this perfect confidant, who not only listens thoughtfully, but often hangs on our every word. The therapist becomes the model companion, who understands our every difficulty and empathizes with our secret pains. Who wants ordinary human beings after this therapeutically catered love-in?

While this may be wondrous for our self esteem, Olds and Schwartz say it’s a bad model for navigating the real world. Although therapists aren’t supposed to chatter about their own troubles, other humans typically demand equal time. The consequence may be that all other relationships “look like they fall short.” Patients may circle back to therapists as their only relationship that’s “good enough,” yet “good enough” isn’t fully satisfying.

In fact, according to Olds and Schwartz, this asymmetry in the consulting room may not be the best thing for therapists either. The temptation is that therapists will come to view themselves as selfless “healers,” heroically struggling on their patients’ behalf. Meanwhile, therapists’ own real-world “relationships can sometimes pale besides the intensity of time spent with patients who ask that [they] fight valiantly alongside them to transform their lives.” Of course, in theory, therapists “subscribe to the idea of tying patients to a rich social network.” Nevertheless, Olds and Schwartz suspect that many therapists “may be reluctant to encourage and reinforce real-life relationships when both their livelihoods and self-esteem might suffer.”

This is an intriguing, cautionary critique, for which Olds and Schwartz, who a dozen years ago wrote a book on overcoming loneliness, offer no real evidence, yet they’re inviting therapists to examine their therapeutic consciences. Is there a downside to being too devoted a therapist? We’re all subject to self-deception and cognitive dissonance, therapists included. Olds and Schwartz ask therapists to untangle their motivations and clinical procedures, as if looking through a one-way mirror at their own practices. They should ask themselves: am I helping this patient reintegrate into a larger, human community? or am I satisfied with the coziness of our relationship? Can I be doing something else? Does economic self-interest blind me to what’s best for my patients?

Loneliness vs. Depression

We all know that “lack of community” is a problem; by now, it’s become a sociological clichŽ. Of course, that doesn’t mean it isn’t a real issue, but some problems are the topic of so much commentary that little new can be said about them. So what do you say when you write a book about loneliness? Get out and join the human race? If you can’t do it alone, find some professional help? All true—and potentially, a big yawn.

That’s psychologist John T. Cacioppo’s dilemma, one that he handles surprisingly well. The key is to avoid banalities and delve into research. And that’s what he and his coauthor, William Patrick (the professional writer of the duo) manage to do.

Cacioppo, who’s been studying loneliness and human (and animal) connection for 30 years, has a simple definition for loneliness: “social pain.” But he insists that depression is different: “depression makes you apathetic,” but loneliness makes you want to affiliate. Loneliness is a signal, a warning sign: it “triggers feelings of threat and dread.” He even has a shorthand formula
to differentiate the conditions: “Loneliness reflects how you feel about your relationships. Depression reflects how you feel, period.”

Now before you start jumping up and shouting that things aren’t that simple, Cacioppo acknowledges that depression and loneliness can converge, producing a “diminished sense of personal control, which leads to passive coping.” Citing Martin Seligman’s research on “learned helplessness,” he argues that “this induced passivity prevents lonely people from effectively acting.” But he isn’t particularly interested in the internal dynamic states of depression or loneliness: as a social psychologist, he’s primed to see people acting—or not acting—in the world at large. Though lonely people may eventually become depressed, he believes they typically start off simply and desperately wanting to join in with their fellow creatures.

Unfortunately, research shows that lonely people are more socially inept than others. Studies in which subjects are divided and made to feel socially disconnected demonstrate these results: isolated people score lower on cognitive tests than those who have sturdy networks of connections. The immune systems of lonely people are less robust. Lonely people get sicker. They eat less well and consume fattier foods. Pass the donuts, please! It’s no joke.

Bicycling toward the Inner Adult

Cacioppo uses the image of bicycling to illustrate what he thinks human connection should ideally look like. When he cycles to school every day, he “glides through a sea of humanity,” noticing the intricate weaving of other bikers, as well as all the other human traffic moving smoothly in and out of tight but ample bike lanes, bobbing and weaving almost effortlessly. It’s his preferred image for social regulation: people humming along as if they were all “in sync,” almost like a well-run, human beehive.

Cacioppo is one of the new breed of evolutionary psychologists. Instead of seeing human beings as “selfish,” fighting to pass on their genes to the next generation, he sees cooperation as the key to survival. (Even armies have to cooperate.) From an evolutionary viewpoint, loneliness functions as a warning sign, which tells us something has gone wrong: it’s what physical pain is to the human body.

Cacioppo’s emphasis on the importance of social regulation, and Olds and Schwartz’s call to break through the potentially narcissistic intensity of the therapeutic encounter, are signs that a new respect for what might be called social maturity is emerging in psychology. In the ’50s, being “well-adjusted” was considered stodgy by many: conformity meant repression. The rebellious ’60s embraced expressive therapies, like primal scream and Gestalt therapy, focusing on liberating the Inner Child. But in the wake of the excesses of earlier therapeutic trends and fashions, today we seem to be entering a more realistic and hopeful era.

As we grow increasingly aware of our collective interdependence, a new emphasis is emerging on being socially adept, balanced, and squarely adult. One sign is how voters chose the new U.S. president. Barack Obama appealed to many, not just because of his rhetoric or policies, but because he exhibited qualities of social judgment and emotional maturity—and the problems we face seem to require a real grown-up. So bring on the Inner Adult. And not just in our leaders: in all of us!

Richard Handler

Richard Handler is a radio producer with the Canadian Broadcasting Corporation in Toronto, Canada.