Thanksgiving Loneliness

We heard his booming voice long before we saw him - an opinionated, older man talking with the receptionist as he checked out after having dental work. "He says he wants to pull my tooth, but I told him, it doesn't hurt so let's leave it alone." As he continued, he mentioned living by himself, and went on to talk about having had a heart attack the year before, describing his symptoms, his recovery and then how he wasn't really sure he had had a heart attack at all, since he felt the same. He had tried medications to lower his cholesterol but they made him ache all over so he stopped them.  To our embarrassment, for some time, he continued to share intimate parts of his life and medical history.

Another man in the waiting room said to no one in particular, "Geez man, TMI, we don't really want to know your life story!" Others shifted uncomfortably in their seats, some nodded their heads, some looked away. Eventually, the man, having shared his life story with the receptionist, entered the waiting room, gathered up his coat and left the dental office. "What a relief!", said another man in the waiting room.

In my thoughts, an unfiltered response - "What a piece of work!, followed immediately by a realization, "This is a lonely man looking for connection". 

In America, there is evidence that the structure of social relationships and individual connectedness has changed. From 1985 to 2004, the American General Social Survey documented a tripling of respondents who report there is no one with whom they can discuss important matters.  In the same survey, the number of close confidants a person reported fell from 3 in 1985 to 0 in 2004.  Instead, individuals in the survey relied on "kin" - spouses and parents, while, at the same time, reporting having fewer contacts through voluntary associations and neighborhoods.(1.) 

Individuals who lack social connectedness or report feelings of loneliness tend to have higher morbidity and mortality rates, increased infection and depression rates, and higher rates of cognitive decline. (2)  In a meta-analysis of more than 300,000 participants, greater social connection is associated with a 50% reduced risk of early death. (3.) A second meta-analysis that includes over 3.4 million participants examined deficits in social connection (risks included social isolation, loneliness, and living alone), found that each risk has a significant and equivalent risk for mortality (4.), exceeding the risks associated with obesity.(5.) 

Research on social determinants of health has taught us that health outcomes are more strongly impacted by an individual's health behaviors and social and environmental circumstances than his genetic code, or health care services received.  As a social determinant of health, social isolation and loneliness can directly affect a person's sense of self, perception of life purpose, and ability to be resilient.

I have a friend who, for the last 25 years, has opened her home for Thanksgiving dinner to anyone who wanted or needed a place to spend time with others. I guess I never really got why she extended herself in this way. But now I think I do. In the spirit of Thanksgiving, let's remember that life in America can be a very lonely place, and that if we all make the effort to connect with others, we can make a difference.  

1. McPherson, M. (2006). Social Isolationin America; Change in Core Discussion Networks over Two Decades. American Sociological Review, Vol. 71 (June;33-375)
2. Cornwell, E. Y., et al. (2009). Social Disconnectedness, Perceived Isolation and Health among older adults. J Health Soc Behav. March; 50(1); 31 - 48.
3. Holt-Lunstad, J., Smith, T.B., & Layton, J.B . (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Medicine , 7(7 ), e1000316. doi:10.1371/journal.pmed.1000316.
4. Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T., & Stephenson, D . (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science , 10(2 ), 227–237. doi:10.1177/1745691614568352
5. Flegal, K.M. , Kit, B.K. , Orpana, H. , & Graubard, B.I . (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: A systematic review and meta-analysis. JAMA , 309(1), 71–82. doi:10.1001/jama.2012.113905.